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Shah C, Srinivasan D, Erus G, Kurella Tamura M, Habes M, Detre JA, Haley WE, Lerner AJ, Wright CB, Wright JT, Oparil S, Kritchevsky SB, Punzi HA, Rastogi A, Malhotra R, Still CH, Williamson JD, Bryan RN, Fan Y, Nasrallah IM. Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial. AJNR Am J Neuroradiol 2023; 44:582-588. [PMID: 37105682 PMCID: PMC10171386 DOI: 10.3174/ajnr.a7852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE The Systolic Blood Pressure Intervention (SPRINT) randomized trial demonstrated that intensive blood pressure management resulted in slower progression of cerebral white matter hyperintensities, compared with standard therapy. We assessed longitudinal changes in brain functional connectivity to determine whether intensive treatment results in less decline in functional connectivity and how changes in brain functional connectivity relate to changes in brain structure. MATERIALS AND METHODS Five hundred forty-eight participants completed longitudinal brain MR imaging, including resting-state fMRI, during a median follow-up of 3.84 years. Functional brain networks were identified using independent component analysis, and a mean connectivity score was calculated for each network. Longitudinal changes in mean connectivity score were compared between treatment groups using a 2-sample t test, followed by a voxelwise t test. In the full cohort, adjusted linear regression analysis was performed between changes in the mean connectivity score and changes in structural MR imaging metrics. RESULTS Four hundred six participants had longitudinal imaging that passed quality control. The auditory-salience-language network demonstrated a significantly larger decline in the mean connectivity score in the standard treatment group relative to the intensive treatment group (P = .014), with regions of significant difference between treatment groups in the cingulate and right temporal/insular regions. There was no treatment group difference in other networks. Longitudinal changes in mean connectivity score of the default mode network but not the auditory-salience-language network demonstrated a significant correlation with longitudinal changes in white matter hyperintensities (P = .013). CONCLUSIONS Intensive treatment was associated with preservation of functional connectivity of the auditory-salience-language network, while mean network connectivity in other networks was not significantly different between intensive and standard therapy. A longitudinal increase in the white matter hyperintensity burden is associated with a decline in mean connectivity of the default mode network.
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Affiliation(s)
- C Shah
- From the Department of Radiology (C.S.), Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - D Srinivasan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - G Erus
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Kurella Tamura
- Division of Nephrology (M.K.T.), Stanford University, and VA Palo Alto Geriatric Research and Education Clinical Center, Palo Alto, California
| | - M Habes
- Biggs Institute, University of Texas San Antonio (M.H.), San Antonio, Texas
| | - J A Detre
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - W E Haley
- Department of Nephrology and Hypertension (W.E.H.), Mayo Clinic, Jacksonville, Florida
| | | | - C B Wright
- National Institute of Neurological Disorders and Stroke (C.B.W.), National Institutes of Health, Bethesda, Maryland
| | - J T Wright
- Medicine (J.T.W.), Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - S Oparil
- Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham, Alabama
| | - S B Kritchevsky
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - H A Punzi
- Punzi Medical Center (H.A.P.), Carrollton, Texas
| | - A Rastogi
- Division of Nephrology (A.R.), Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - R Malhotra
- Division of Nephrology (R.M.), University of California San Diego, San Diego, California
| | - C H Still
- Frances Payne Bolton School of Nursing (C.H.S.), Case Western Reserve University, Cleveland, Ohio
| | - J D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine (S.B.K., J.D.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - R N Bryan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Y Fan
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - I M Nasrallah
- Department of Radiology (D.S., G.E., J.A.D., R.N.B., Y.F., I.M.N.), University of Pennsylvania, Philadelphia, Pennsylvania
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Berg N, Shah C, Guglin M, Ferguson H. Stroke and Survival Outcomes in Left Ventricular Device Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.773] [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: 04/05/2023] Open
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Asha W, Alhilli Z, Djohan R, Budd G, Fleming-Hall E, Yang K, Tendulkar R, Shah C. 97P Modern outcomes with re-irradiation, systemic therapy and surgery for radiotherapy-associated angiosarcoma of the breast. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101134] [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: 04/05/2023] Open
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Stierhof J, Kühn S, Winter M, Micke P, Steinbrügge R, Shah C, Hell N, Bissinger M, Hirsch M, Ballhausen R, Lang M, Gräfe C, Wipf S, Cumbee R, Betancourt-Martinez GL, Park S, Niskanen J, Chung M, Porter FS, Stöhlker T, Pfeifer T, Brown GV, Bernitt S, Hansmann P, Wilms J, Crespo López-Urrutia JR, Leutenegger MA. A new benchmark of soft X-ray transition energies of Ne , CO 2 , and SF 6 : paving a pathway towards ppm accuracy. Eur Phys J D At Mol Opt Phys 2022; 76:38. [PMID: 35273463 PMCID: PMC8888507 DOI: 10.1140/epjd/s10053-022-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
ABSTRACT A key requirement for the correct interpretation of high-resolution X-ray spectra is that transition energies are known with high accuracy and precision. We investigate the K-shell features of Ne , CO 2 , and SF 6 gases, by measuring their photo ion-yield spectra at the BESSY II synchrotron facility simultaneously with the 1s-np fluorescence emission of He-like ions produced in the Polar-X EBIT. Accurate ab initio calculations of transitions in these ions provide the basis of the calibration. While the CO 2 result agrees well with previous measurements, the SF 6 spectrum appears shifted by ∼ 0.5 eV, about twice the uncertainty of the earlier results. Our result for Ne shows a large departure from earlier results, but may suffer from larger systematic effects than our other measurements. The molecular spectra agree well with our results of time-dependent density functional theory. We find that the statistical uncertainty allows calibrations in the desired range of 1-10 meV, however, systematic contributions still limit the uncertainty to ∼ 40-100 meV, mainly due to the temporal stability of the monochromator energy scale. Combining our absolute calibration technique with a relative energy calibration technique such as photoelectron energy spectroscopy will be necessary to realize its full potential of achieving uncertainties as low as 1-10 meV.
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Affiliation(s)
- J. Stierhof
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - S. Kühn
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - M. Winter
- Institute of Theoretical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstr. 7/B2, 91058 Erlangen, Germany
- CNRS, Institut NEEL, Université Grenoble Alpes, CNRS, Institut NEEL, 25 rue des Martyrs BP 166, 38042 Grenoble Cedex 9, France
| | - P. Micke
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- CERN, 1211 Geneva 23, Switzerland
| | - R. Steinbrügge
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
| | - C. Shah
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - N. Hell
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - M. Bissinger
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - M. Hirsch
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - R. Ballhausen
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - M. Lang
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - C. Gräfe
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - S. Wipf
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
| | - R. Cumbee
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
- Department of Astronomy, University of Maryland, College Park, MD 20742 USA
| | - G. L. Betancourt-Martinez
- Institut de Recherche en Astrophysique et Planétologie, 9, avenue du Colonel Roche BP 44346, 31028 Toulouse Cedex 4, France
| | - S. Park
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, Ulsan, South Korea
| | - J. Niskanen
- Institute for Methods and Instrumentation in Synchrotron Radiation Research G-ISRR, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Strasse 15, 12489 Berlin, Germany
| | - M. Chung
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, Ulsan, South Korea
| | - F. S. Porter
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
| | - T. Stöhlker
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - T. Pfeifer
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - G. V. Brown
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - S. Bernitt
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - P. Hansmann
- Institute of Theoretical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstr. 7/B2, 91058 Erlangen, Germany
| | - J. Wilms
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | | | - M. A. Leutenegger
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
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Jenkins P, Shah C, Cavero Chavez V, Portillo Romero J, Cuervo-Pardo L. M001 ACUTE KIDNEY INJURY POST IVIG TREATMENT IN A PATIENT WITH HYPOGAMMAGLOBULINEMIA: SOMETIMES LESS IS MORE. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gharti BB, Shrestha PM, Shrestha A, Basnet RB, Shah C, Adhikari B. Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum. Kathmandu Univ Med J (KUMJ) 2021; 19:309-313. [PMID: 36254415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2 , mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2 ), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum.
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Affiliation(s)
- B B Gharti
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - P M Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - A Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - R B Basnet
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - C Shah
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - B Adhikari
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Liposits G, Eshoj H, Möller S, Winther S, Skuladottir H, Jesper R, Hofsli E, Poulsen L, Shah C, Berglund Å, Qvortrup C, Osterlund P, Glimelius B, Sorbye H, Pfeiffer P. SO-15 Quality of life and physical functioning in older patients with metastatic colorectal cancer receiving palliative chemotherapy: The randomized NORDIC9-study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [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] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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Stefanidis D, G U, Sánchez-Bursón J, Shah C, Bakhle D. POS0598 COMPARISON OF INJECTION SITE REACTIONS AND INJECTION SITE ERYTHEMA BETWEEN YLB113 AND ETANERCEPT REFERENCE PRODUCT FROM PHASE 3 ACTIVE COMPARATOR STUDY (STUDY NO. YLB113-002). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.829] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:YLB113 is an etanercept biosimilar approved in all indications of its etanercept Reference Product (RP). Therapeutic equivalence in terms of clinical efficacy, safety and immunogenicity was previously demonstrated in a pivotal multicenter, double-blind, randomized, parallel-group, active-control, comparative study (YLB113-002) in rheumatoid arthritis (RA) subjects.1,2 Similar incidence of treatment emergent adverse events (TEAEs) was seen in both treatment arms except for injection site reactions (ISRs) and injection site erythema (ISE), both of which were less frequent in subjects treated with YLB113.Objectives:This post-hoc analysis was performed to further evaluate the differences in the incidence of ISRs and ISE during the 24 week treatment when the subjects with RA were treated with 50 mg of YLB113 or RP given once a week as a SC injection along with methotrexate.Methods:Safety analysis set (263 in YLB113 arm and 254 in RP arm) was considered for this analysis.Local reactions at the site of injection were assessed at each of eight study visits.The number of subjects who experienced ISRs and ISE were statistically compared for YLB113 and RP. The risk difference and 95% confidence interval (CI) were computed between arms to understand the magnitude of difference in the incidence of events. The statistical significance of between group difference was tested using chi-square test.Results:The result of this analysis showed a statistically significant difference in the incidences of ISRs and ISE between subjects who received YLB113 and RP. The risk difference between YLB113 and RP arms for ISR was -9.98% (95% CI, WALD -14.81%, -5.15%) and, for ISE it was -7.94% (95% CI, WALD -11.96%, - 3.92%; Table 1). This could be possibly explained by the absence of latex in the syringe needle cap of YLB113.3Table 1.Differences in ISRs and ISEs between YLB113 and Reference Product (RP)EventYLB113N=263RPN=254YLB113 vs RPNo of subjects with events [n(%)]No of subjects with events[n(%)])Risk Diff (95%CI, WALD)P-value (Chi-Square)Injection-site reactions10 (3.8%)35 (13.8%)-9.98% (-14.81%, -5.15%)<0.0001Injection-site erythema5 (1.9%)25 (9.8%)-7.94% (-11.96%, -3.92%)0.0001Conclusion:YLB113 has shown statistically significant lower incidences of ISRs (P-value <0.0001) and ISEs (P value 0.0001) compared to RP. This property may translate to a better acceptability by patients.References:[1]EULAR Abstract AB0416 (2019). Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1670.[2]Yamanaka H, Kamatani N, Tanaka Y, et al. A Comparative Study to Assess the Efficacy, Safety, and Immunogenicity of YLB113 and the Etanercept Reference Product for the Treatment of Patients with Rheumatoid Arthritis. Rheumatol Ther. 2020;7(1):149-163.[3]Viatris Etanercept Summary of Product Characteritics May 2020.Disclosure of Interests:Dimitris Stefanidis Employee of: Viatris GmbHSr. Director, Global Medical Affairs Lead, Immunology Biosimilars, Unmesh G Employee of: Viatris, Juan Sánchez-Bursón: None declared, Chirag Shah Shareholder of: As an employee, Shareholder of Lupin LTD, Employee of: Employee of Lupin LTD, Dhananjay Bakhle Shareholder of: As part of Employee Stock Options Plan from Lupin LTD, Employee of: Employee of Lupin LTD
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Hisashi Y, Tanaka Y, Hibino T, Shah C, Bakhle D, Stefanidis D. POS0604 LONG TERM SAFETY AND TOLERABILITY WITH ETANERCEPT BIOSIMILAR (YLB113), RESULTS FROM A 2-YEAR OPEN LABEL EXTENSION STUDY (STUDY NO. YLB113-003). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1030] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Eligible subjects with moderate-to-severely active rheumatoid arthritis (RA) who completed a phase 3 double-blind comparative efficacy and safety study (Study No. YLB113-002; Yamanaka et al, 2019) of 50 mg etanercept biosimilar (YLB113) or etanercept reference product (RP) by subcutaneous administration with concomitant MTX treatment for 52 weeks, were enrolled in this open label extension (OLE) study (Study No. YLB113-003) to assess the long-term safety and tolerability of YLB113 through to 3 years.Objectives:This OLE study aimed to evaluate the long-term safety of YLB113 administration in subjects with RA who received RP or YLB113 in a phase 3 active comparator study. The main parameters assessed were safety and tolerability in terms of adverse events (AEs) and injection site reactions (ISRs), incidence of immunogenicity and efficacy as DAS28 improvement (disease activity score in 28 joints).Methods:Subjects received 50 mg of YLB113 subcutaneously once every 1 to 2 weeks. Safety was assessed by AEs after study drug administration, ISRs, physical examination findings, and immunogenicity. Efficacy (DAS28 score) was assessed at the time of transition to the OLE study (Week 0), and at weeks 12, 24, 48, 72, 96 and at the end of the study.Results:201 (Full analysis set [FAS]) subjects received the study drug and 184 subjects completed the study (91.5% completion rate). The average drug exposure in 94 subjects who continued to receive YLB113 and completed the study (94.0% completion rate) and 90 subjects who switched from RP to YLB113 and completed the study (89.1% completion rate) was 103 weeks providing the long-term drug exposure data of YLB113.The CTCAE Grade of TEAEs and ADRs observed were Grade 2 or less in severity (with no Grade ≥3). The overall incidence of ISRs was 10.0% (20/201 subjects) 77 events. All the ISRs reported were Grade 1 except for one Grade 2.An overview of the AEs experienced by the subjects is summarized in the Table 1.Table 1.Overview of Adverse events in OLE studyFASn (%)Number of eventsNumber of subjects201-Treatment emergent adverse events (TEAEs)188(93.5)975Adverse drug reactions (ADRs)82(40.8)221Serious adverse events (SAEs)21(10.4)27Serious adverse drug reactions (SADRs)7(3.5)7AEs leading to premature study discontinuation4(2.0)6ADRs leading to premature study discontinuation3(1.5)4SAEs leading to premature study discontinuation3(1.5)4SADRs leading to premature study discontinuation2(1.0)2n - number of subjects with at least 1 AE in the categoryThe mean DAS28 (mean ± S.D.) of 2.22 ± 0.95 at the study transition was 2.10 ± 0.91 at Week 72 and 2.06 ± 0.89 at the end of the study. It was confirmed that DAS28 slightly decreased with time after the study transition and continued until the end of the study. The average DAS28 value remained low even with long-term administration of YLB113, suggesting that the effects of the study drug was sustained (Figure 1).Figure 1.DAS28 over time with YLB113 N: Number of subjects. * The administration period at the study completion differs for each subject, because the study transition time differs for each subject.cts who tested positive for anti-drug antibodies (ADA) at least once in the OLE study were 1.0% (2/200 subjects). All ADA were transient and disappeared at study completion. Such transient ADA formation was reported in the phase 3 study as well. In the phase 3 study, ADA formation was more frequent in subjects who received RP at 24 weeks, but all subjects were negative in the OLE study after switching. Therefore, switching did not affect immunogenicity.Conclusion:The safety, efficacy and immunogenicity profile of YLB113 was maintained over the long-term through to 3 years. Switching from RP to YLB113 did not impact safety or immunogenicity.References:[1]Yamanaka H, Kamatani N, Tanaka Y, et al. A Comparative Study to Assess the Efficacy, Safety, and Immunogenicity of YLB113 and the Etanercept Reference Product for the Treatment of Patients with Rheumatoid Arthritis. Rheumatol Ther. 2020 Mar;7(1):149-163.Disclosure of Interests:Yamanaka Hisashi Speakers bureau: YL Biologics Ltd, Consultant of: YL Biologics Ltd, Yoshiya Tanaka Speakers bureau: Received speaking fees and/or honoraria from Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen., Grant/research support from: Received research grants from Abbvie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, Daiichi-Sankyo., Toshihiko Hibino: None declared, Chirag Shah Shareholder of: Lupin LTD, Employee of: Lupin LTD, Dhananjay Bakhle Shareholder of: As part of Employee Stock Options Plan of Lupin LTD, Employee of: Lupin LTD, Dimitris Stefanidis Employee of: Sr. Director, Global Medical Affairs Lead, Immunology Biosimilars for Viatris GmbH
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Batbayar K, Ye K, Waldman S, Marsh A, Shi M, Siddiqui T, Suzuki M, Desai A, Patel D, Patel J, Dobkin J, Sadoughi A, Shah C, Yakov P, Vijig J, Spivack S. P58.02 Bronchial Field Progenitor Basal Cells Show Methylome-Wide Characteristics Reflective of Lung Cancer Case-Control, Age, and Smoking Status. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cheng H, Zou Y, Shah C, Fan N, Bhagat T, Gucalp R, Kim M, Verma A, Piperdi B, Spivack S, Halmos B, Perez-Soler R. P01.05 Pilot Study of Inhaled Azacitidine in Patients With Advanced Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Nikiforov I, Shah C, Kanukuntla AK, Vanjarapu JMR, Singh P, Tadepalli S, Cheriyath P, Nookala V. Salt Consumption and Myocardial Infarction: Is Limited Salt Intake Beneficial? Cureus 2021; 13:e13072. [PMID: 33680614 PMCID: PMC7931262 DOI: 10.7759/cureus.13072] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Sodium is an essential mineral that plays a crucial role in the maintenance of normal cellular homeostasis, regulation of fluid and electrolytes, and blood pressure (BP). Due to the presence of sodium in a variety of regularly consumed food products, the deficiency of sodium is extremely unlikely. On the other hand, excess intake of dietary sodium is observed in many populations as it is generally used in most food products. Existing guidelines recommend lowering salt consumption for better cardiovascular health; these dietary sodium intake recommendations are not reassuring as the evolving studies show evidence that there is a higher risk of cardiovascular disease (CVD) with low sodium consumption. The aim of this study was to identify the association between salt consumption and myocardial infarction (MI). Methods: The National Health and Nutrition Examination Survey (NHANES) data between 2017- 2018 was analyzed to examine the association between sodium intake (use in daily meal preparation) and reported history of MI. Logistic regression was used to assess for significant differences between the groups and calculated odds ratios while adjusting for confounders. Results: A total of 4626 participants were included in the study, with a mean age of 66 ± 11 years in those with a history of MI (n = 212). Amongst these participants, those with salt consumption "Occasionally used" or "Very often used" were less likely to have suffered from MI than those who "Never used" salt in meal preparation. Multivariable logistic regression was performed to control for confounders. “Occasionally used” compared to “Never used” odds ratio was 0.5227 (95% confidence interval (CI); 0.3053-0.9009 p = 0.0184) and “Very often used” compared to “Never used” odds ratio was 0.5033 (95% CI; 0.2892-0.8799 p = 0.0152). Conclusion: After adjusting for confounders, the participants that used salt more liberally during meal preparation were less likely to have MI than those who minimally or never used salt in meal preparation.
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Affiliation(s)
- Ivan Nikiforov
- Internal Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA
| | - Charvi Shah
- Internal Medicine, Rutgers University, New Brunswick, USA
| | | | | | - Pratiksha Singh
- Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA.,Internal Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA
| | - Satish Tadepalli
- Internal Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Health, Ocean Medical Center, Brick, USA
| | - Vinod Nookala
- Internal Medicine, Community Medical Center, Toms River, USA
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MacDonald MJ, Widmann K, Beiersdorfer P, Hell N, Hoarty DJ, Magee EW, Shah C, Shepherd R, Brown GV. Absolute throughput calibration of multiple spherical crystals for the Orion High-REsolution X-ray spectrometer (OHREX). Rev Sci Instrum 2021; 92:023509. [PMID: 33648146 DOI: 10.1063/5.0043683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
We present absolute throughput analysis of several crystals for the Orion High-REsolution X-ray (OHREX) imaging crystal spectrometer using ray tracing and experimental measurements. The OHREX spectrometer is a high-resolution x-ray spectrometer designed to measure spectral line shapes at the Orion laser facility. The spectrometer is fielded with up to two spherical crystals simultaneously covering two independent spectral ranges. Each crystal has a nominal radius of curvature of R = 67.2 cm and is fielded at a nominal Bragg angle of 51.3°. To cover different bands of interest, several different crystals are available, including Ge (111), KAP, and several cuts of quartz, whose resolving power λ/Δλ exceeds 10 000. The calibrated response of the available crystals has previously been reported from measurements at the EBIT-I electron beam ion trap at Lawrence Livermore National Laboratory. Here, we model the absolute throughput of each crystal using ray tracing and verify the results using experimental data for the quartz (101¯1) crystal.
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Affiliation(s)
- M J MacDonald
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Widmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Beiersdorfer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Hell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D J Hoarty
- Directorate of Research and Applied Science, AWE plc, Reading RG7 4PR, United Kingdom
| | - E W Magee
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Shah
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Shepherd
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G V Brown
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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Leutenegger MA, Kühn S, Micke P, Steinbrügge R, Stierhof J, Shah C, Hell N, Bissinger M, Hirsch M, Ballhausen R, Lang M, Gräfe C, Wipf S, Cumbee R, Betancourt-Martinez GL, Park S, Yerokhin VA, Surzhykov A, Stolte WC, Niskanen J, Chung M, Porter FS, Stöhlker T, Pfeifer T, Wilms J, Brown GV, Crespo López-Urrutia JR, Bernitt S. High-Precision Determination of Oxygen K_{α} Transition Energy Excludes Incongruent Motion of Interstellar Oxygen. Phys Rev Lett 2020; 125:243001. [PMID: 33412031 DOI: 10.1103/physrevlett.125.243001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
We demonstrate a widely applicable technique to absolutely calibrate the energy scale of x-ray spectra with experimentally well-known and accurately calculable transitions of highly charged ions, allowing us to measure the K-shell Rydberg spectrum of molecular O_{2} with 8 meV uncertainty. We reveal a systematic ∼450 meV shift from previous literature values, and settle an extraordinary discrepancy between astrophysical and laboratory measurements of neutral atomic oxygen, the latter being calibrated against the aforementioned O_{2} literature values. Because of the widespread use of such, now deprecated, references, our method impacts on many branches of x-ray absorption spectroscopy. Moreover, it potentially reduces absolute uncertainties there to below the meV level.
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Affiliation(s)
- M A Leutenegger
- NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, Maryland 20771, USA
| | - S Kühn
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - P Micke
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Physikalisch-Technische Bundesanstalt, Bundesallee 100, 38116 Braunschweig, Germany
| | - R Steinbrügge
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - J Stierhof
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - C Shah
- NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, Maryland 20771, USA
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - N Hell
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | - M Bissinger
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erwin-Rommel-Strasse 1, 91058 Erlangen, Germany
| | - M Hirsch
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - R Ballhausen
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - M Lang
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - C Gräfe
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - S Wipf
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
| | - R Cumbee
- NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - G L Betancourt-Martinez
- Institut de Recherche en Astrophysique et Planétologie, 9, avenue du Colonel Roche BP 44346, 31028 Toulouse Cedex 4, France
| | - S Park
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, 44919 Ulsan, Republic of Korea
| | - V A Yerokhin
- Peter the Great St. Petersburg Polytechnic University, 195251 St. Petersburg, Russia
| | - A Surzhykov
- Physikalisch-Technische Bundesanstalt, Bundesallee 100, 38116 Braunschweig, Germany
- Institut für Mathematische Physik, Technische Universität Braunschweig, D-38106 Braunschweig, Germany
| | - W C Stolte
- Advanced Light Source, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Niskanen
- Institute for Methods and Instrumentation in Synchrotron Radiation Research G-ISRR, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Strasse 15, 12489 Berlin, Germany
- Department of Physics and Astronomy, University of Turku, FI-20014 Turun Yliopisto, Finland
| | - M Chung
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, 44919 Ulsan, Republic of Korea
| | - F S Porter
- NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, Maryland 20771, USA
| | - T Stöhlker
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - T Pfeifer
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - J Wilms
- Remeis-Sternwarte and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstrasse 7, 96049 Bamberg, Germany
| | - G V Brown
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, USA
| | | | - S Bernitt
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
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Chepke C, Marder S, Comella C, Singer C, Farahmand K, Shah C, Lundt L. Long-term treatment with valbenazine 40 mg once-daily in adults with Tardive dyskinesia. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bavadiya G, Roy A, Sarkar KK, Shekhda KM, Chatterjee A, Shah C, Chakrabarty A. PRIMARY PIGMENTED NODULAR ADRENOCORTICAL DISEASE (PPNAD) PRESENTING AS CUSHING SYNDROME IN A CHILD AND REVIEW OF LITERATURE. Acta Endocrinol (Buchar) 2020; 16:362-365. [PMID: 33363661 DOI: 10.4183/aeb.2020.362] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cushing syndrome in the paediatric age group is very difficult to diagnose due to atypical presenting features in children. Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing syndrome in children and it has characteristic gross and microscopic pathologic features. We report a case of PPNAD in a 16-year-old boy who was evaluated in our hospital with chief complaints of poor height velocity and rapid weight gain for 2-3 years before presentation. Proper evaluation showed ACTH-independent Cushing syndrome with normal imaging. Total bilateral adrenalectomy was performed followed by hormones replacement. 6 months after surgery, significant acceleration of height velocity was noticed. Patient also lost body weight and developed secondary sexual characteristics.
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Affiliation(s)
- G Bavadiya
- Vivekananda Institute of Medical Sciences - Urology, West Bengal, India
| | - A Roy
- Vivekananda Institute of Medical Sciences - Diabetes and Endocrinology, West Bengal, India
| | - K K Sarkar
- Vivekananda Institute of Medical Sciences - Urology, West Bengal, India
| | - K M Shekhda
- Southend University Hospital NHS Foundation Trust - Diabetes and Endocrinology, Prittlewell chase, Westcliff-on-Sea, United Kingdom of Great Britain and Northern Ireland
| | - A Chatterjee
- Vivekananda Institute of Medical Sciences - General Medicine, Kolkata, West Bengal, India
| | - C Shah
- Vivekananda Institute of Medical Sciences - Urology, West Bengal, India
| | - A Chakrabarty
- Vivekananda Institute of Medical Sciences - Urology, West Bengal, India
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Wylie TAF, Shah C, Connor R, Farmer AJ, Ismail K, Millar B, Morris A, Reynolds RM, Robertson E, Swindell R, Warren E, Holt RIG. Transforming mental well-being for people with diabetes: research recommendations from Diabetes UK's 2019 Diabetes and Mental Well-Being Workshop. Diabet Med 2019; 36:1532-1538. [PMID: 31177573 PMCID: PMC6899580 DOI: 10.1111/dme.14048] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2019] [Indexed: 12/23/2022]
Abstract
AIMS To identify key gaps in the research evidence base that could help to improve the mental well-being of people with diabetes, and to provide recommendations to researchers and research funders on how best to address them. METHODS A 2-day international research workshop was conducted, bringing together research experts in diabetes and in mental health, people living with diabetes and healthcare professionals. RESULTS The following key areas needing increased financial investment in research were identified: understanding the mechanisms underlying depression; understanding the multifactorial impact of social stigma; improving the language used by healthcare professionals; supporting people who find it difficult to engage with their diabetes; supporting significant others; supporting people with diabetes and eating disorders; improving models of care by learning from best practice; the potential benefits of screening and managing diabetes distress in routine diabetes care pathways; primary prevention of mental health issues at the time of diagnosis of diabetes; establishing the effectiveness of diabetes therapies on mood and other mental health issues; and understanding the impact of current diabetes technologies on mental health. Research recommendations as to how to address each of these priority areas were also developed. CONCLUSIONS This inaugural position statement outlines recommendations to address the urgent unmet need related to the mental well-being of people living with diabetes, and calls on the research community and funders to develop research programmes and strategies to reduce this need.
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Affiliation(s)
- T. A. F. Wylie
- Diabetes UKWells Lawrence House, 126 Back Church LaneLondonUK
| | - C. Shah
- Diabetes UKWells Lawrence House, 126 Back Church LaneLondonUK
| | | | - A. J. Farmer
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - K. Ismail
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeurosciencesKing's College LondonLondonUK
| | - B. Millar
- Diabetes UK Clinical Studies Group MemberUniversity of EdinburghEdinburghUK
| | - A. Morris
- Diabetes UKWells Lawrence House, 126 Back Church LaneLondonUK
| | - R. M. Reynolds
- Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - E. Robertson
- Diabetes UKWells Lawrence House, 126 Back Church LaneLondonUK
| | - R. Swindell
- Diabetes UK Clinical Studies Group MemberUniversity of EdinburghEdinburghUK
| | - E. Warren
- Diabetes UK Clinical Studies Group MemberUniversity of EdinburghEdinburghUK
| | - R. I. G. Holt
- Human Development and Health, Faculty of MedicineUniversity of SouthamptonUK
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Spivack S, Shi M, Patel D, Desai A, Dobkin J, Shah C, Hosgood D, Ye K, Qiu Y, Kurland I. P1.11-11 Initial Discovery of Exhaled Small Polar Energetics-Related Metabolites by GC-MS for Lung Cancer Risk Assessment. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parmar D, Krishnappa M, Arifahmed F, Mali N, Patel J, Shah M, Parmar K, Shah C, Faldu K. A Clinical Trial To Evaluate The Safety And Efficacy Of Saroglitazar Compared To Fenofibrate In Patients With Dyslipidemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Batohi B, Fang C, Michell MJ, Morel J, Shah C, Wijesuriya S, Peacock C, Rahim R, Wasan R, Goligher J, Satchithananda K. An audit of mammographic screen detected lesions of uncertain malignant potential (B3) diagnosed on initial image guided needle biopsy: how has our practice changed over 10 years? Clin Radiol 2019; 74:653.e19-653.e25. [PMID: 31078275 DOI: 10.1016/j.crad.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
AIM To review all cases of B3 lesion diagnosed at initial image-guided needle biopsy over two 5-year cohorts to identify upgrade rates to malignancy and the effect of changing guidance on the management of such lesions. MATERIALS AND METHODS Data was collected retrospectively. Mammographic features, biopsy type and management were recorded for each lesion. Upgrade rates for each B3 histological category were quantified. Statistical analysis was performed using SPSS. RESULTS There were 224 cases in 2005-2010 and 240 cases in 2010-2015. Mammographically 211 lesions were microcalcifications, 182 masses, 65 distortions and six asymmetric densities with no difference in the mammographic features in the two cohorts. Two hundred and eight 14 G core biopsies and 256 initial vacuum-assisted biopsies were performed. There was a statistically significant reduction in benign surgical biopsies and an increase in second-line vacuum biopsy/excision in the latter cohort, with no significant change in the upgrade rate. There was an overall 6% upgrade to invasive malignancy and 13% upgrade to ductal carcinoma in situ (DCIS). The upgrade rates for the following histological categories were atypical intraductal epithelial proliferation (AIDEP) 33.2% (21/63); classical (not pleomorphic) in situ lobular neoplasia (ISLN) 18.2% (6/33); flat epithelial hyperplasia (FEA) 21.7% (20/92); papilloma with atypia 53.8% (7/13), without atypia 12.1% (8/66); and radial scar/complex sclerosing lesion with atypia 16.7% (2/12), and without atypia 7.9% (6/76). CONCLUSION Upgrade rates remain high for some histological categories even with first-line use of vacuum biopsy. Management of borderline lesions should be considered carefully in a multidisciplinary meeting. In many cases, the need for diagnostic surgical excision has been replaced by image-guided vacuum sampling.
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Affiliation(s)
- B Batohi
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - C Fang
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - M J Michell
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Morel
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Shah
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - S Wijesuriya
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Peacock
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Rahim
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Wasan
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Goligher
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - K Satchithananda
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Li C, Chen J, Levi D, Shah C, Quintana J. UNEXPECTED IMMEDIATE DETERIORATION AFTER ANTICOAGULATION FOR PULMONARY EMBOLISM IN LUNG CANCER: A CASE REPORT. Chest 2019. [DOI: 10.1016/j.chest.2019.02.178] [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: 10/27/2022] Open
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Ward MC, Vicini F, Chadha M, Pierce L, Recht A, Hayman J, Thaker N, Khan A, Keisch M, Shah C. Abstract P5-15-02: Evaluating the cost of endocrine therapy vs. radiation therapy alone for low risk hormone positive early stage breast cancer in elderly patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-15-02] [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
Objective: Elderly patients with low-risk hormone-positive breast cancer are at risk of over treatment. Avoidance of radiation therapy (RT) in favor of endocrine therapy alone was first heralded as the optimal conservative strategy due to logistical simplicity, low acute sequelae and a reduction of contralateral cancers not seen with RT. However, long-term use of aromatase inhibitors (AI) is not without costs and morbidity, often leading to low compliance and notable late effects. We therefore performed a cost-effectiveness analysis to compare the outcomes and costs between AI for five years without RT versus hypofractionated RT alone without endocrine therapy.
Materials and Methods: Using data from available phase III trials and meta-analyses, we constructed a patient-level microsimulation Markov decision model to replicate the comparative outcomes between the strategies above from the societal perspective among 200,000 simulated patients. Five years of anastrozole was compared to a 15-fraction hypofractionated whole breast RT course without boost in a cohort of patients with low-risk disease as defined by CALGB 9343 entry criteria. Noncompliance with AI was modeled from recent population-based data. Relative effectiveness on ipsilateral breast tumor recurrence and contralateral breast cancers were based off the NSABP B-21 trial, adjusted to match the modern outcomes demonstrated in CALGB 9343 and PRIME II with further adjustment for AI over tamoxifen (ATAC, EBCTCG meta-analysis). Indirect costs of travel were accounted for, as were the costs of common and serious side-effects from RT (dermatitis, fibrosis, second malignancy, heart disease) and AI (arthralgia, hot flashes, osteopenia, fracture, thrombosis). A 1-year cycle time and lifetime horizon were used, with all costs adjusted to 2018 US dollars and extracted primarily from Medicare reimbursement data. The primary measure of efficacy was the quality-adjusted life-year (QALY) with age-adjusted utilities extracted from the literature. Half-cycle correction and a 3% discount rate were applied. Probabilistic sensitivity analysis was used to vary all parameters simultaneously.
Results: On average, RT was approximately $3,981 more expensive than endocrine therapy over the lifetime horizon. Under a number of assumptions, RT appeared similar in long-term effectiveness to AI therapy, with a difference of less than 0.03 quality-adjusted life years. Given the low value of the denominator in the incremental cost-effectiveness ratio (ICER), RT did not meet the formally defined $100,000/QALY threshold. On one-way sensitivity analysis, the ICER was particularly sensitive to the incidence and impact of salvage strategies for recurrence, treatment of contralateral breast cancers, cardiac events and fracture rates.
Conclusions: Modeling with the available evidence suggests it is likely that quality-of-life after RT-alone is nearly identical to an AI-alone strategy but associated with a small increase in cost. These results suggest select patients at risk of noncompliance can safely be treated with RT-alone rather than AI alone. Given the relative pros and cons of each strategy, RT-alone should be considered for select elderly low-risk breast patients.
Citation Format: Ward MC, Vicini F, Chadha M, Pierce L, Recht A, Hayman J, Thaker N, Khan A, Keisch M, Shah C. Evaluating the cost of endocrine therapy vs. radiation therapy alone for low risk hormone positive early stage breast cancer in elderly patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-02.
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Affiliation(s)
- MC Ward
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - F Vicini
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - M Chadha
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - L Pierce
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - A Recht
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - J Hayman
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - N Thaker
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - A Khan
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - M Keisch
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
| | - C Shah
- Levine Cancer Institute, Charlotte, NC; 21st Century Oncology, Farmington Hills, MI; Mt Sinai Hospital, New York, NY; University of Michigan, Ann Arbor, MI; Beth Israel Deaconess Medical Center, Boston, MA; Arizona Oncology, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; Cancer HealthCare Associates, Miami, FL; Cleveland Clinic, Cleveland, OH
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Harness J, Shah C, Brooks E, Via C, Vicini F. Abstract P2-11-13: Meta-analysis of local recurrence of invasive breast cancer after electron intraoperative radiotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-13] [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: Electron intraoperative radiotherapy (IORT) can be used during breast conservation surgery to treat early-stage invasive breast cancer. While IORT may be an attractive alternative to traditional post-operative radiotherapy for many patients, its effectiveness in preventing local recurrence is still being evaluated. Using data from current clinical and observational studies, we aimed to assess the impact of single-fraction electron IORT on local recurrence rates.
Methods: Studies on single-fraction electron IORT during breast conservation surgery were identified through a search of PubMed and Google Scholar, as well as secondary referencing. Local recurrence rate was the main outcome of interest. Protocols from each publication were assessed for potential sources of heterogeneity. A meta-analysis of proportions, using binomial distribution to model the within-study variability and a random effects model, was conducted to estimate a pooled local recurrence rate. In order to estimate a 5-year recurrence rate, we applied a single-sample Poisson-normal model to model the probability of events occurring during a fixed period of time (60 months).
Results: A total of 13 independent publications were identified for abstraction. The analysis demonstrated a pooled monthly local recurrence rate of 0.02% per person-month (95% CI: 0.00 – 0.06%) for the studies with < 5 years of follow-up, 0.03% per person-month (0.02 – 0.06%) for studies with ≥ 5 years of follow-up, and 0.02% per person-month (0.01 – 0.04%) overall. Based on this model, the predicted 5-year recurrence rate is 2.7%, with a 95% confidence interval of 1.9% - 3.7%.
Conclusions: According to the published literature, the rate of breast cancer local recurrence after electron IORT was 0.02% per person-month; with an adjusted 5-year recurrence rate of 2.7%. These findings support the recent guidelines from the American Society for Radiation Oncology (ASTRO) supporting the use of electron IORT in low-risk patients.
Citation Format: Harness J, Shah C, Brooks E, Via C, Vicini F. Meta-analysis of local recurrence of invasive breast cancer after electron intraoperative radiotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-13.
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Affiliation(s)
- J Harness
- St. Joseph Hospital- Center for Cancer Prevention and Treatment, Orange, CA; Cleveland Clinic, Cleveland, OH; Decision Driver Analytics / Translational Technologies International, Asheville, NC; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - C Shah
- St. Joseph Hospital- Center for Cancer Prevention and Treatment, Orange, CA; Cleveland Clinic, Cleveland, OH; Decision Driver Analytics / Translational Technologies International, Asheville, NC; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - E Brooks
- St. Joseph Hospital- Center for Cancer Prevention and Treatment, Orange, CA; Cleveland Clinic, Cleveland, OH; Decision Driver Analytics / Translational Technologies International, Asheville, NC; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - C Via
- St. Joseph Hospital- Center for Cancer Prevention and Treatment, Orange, CA; Cleveland Clinic, Cleveland, OH; Decision Driver Analytics / Translational Technologies International, Asheville, NC; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - F Vicini
- St. Joseph Hospital- Center for Cancer Prevention and Treatment, Orange, CA; Cleveland Clinic, Cleveland, OH; Decision Driver Analytics / Translational Technologies International, Asheville, NC; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
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Kaufman D, Shah C, Vicini F. Abstract P3-14-09: Low rates of chronic breast cancer related lymphedema (BCRL) in a cohort of high-Risk patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-14-09] [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: We report outcomes using prospective BIS surveillance in a high-risk cohort of patients who all underwent axillary lymph node dissection (ALND).
Methods: From 8/2010 through 12/2016, 206 consecutive patients were evaluated with BIS as part of a prospective surveillance program. 30 underwent ALND and constitute the study population. The program included pre-operative BIS measurement as well as post-operative assessments at regular intervals. Patients with L-Dex readings increasing by more than 10 from baseline were considered to have subclinical BCRL and treated with an over-the-counter (OTC) compression sleeve for 4 weeks. For the purpose of this analysis, additional high-risk features were defined as receipt of axillary radiation, a high body mass index (BMI) or the use of taxane based chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy (CDP).
Results: Median follow-up was 36 months (range: 4.8-122.1 months). The median number of nodes removed was 18 (range: 5-32) and the median number of positive nodes was two. The median age for the cohort was 57.5 years old with 70% of patients undergoing mastectomy and the remainder breast conserving therapy. With respect to additional high-risk features, 77% also received taxane-based chemotherapy, 62% axillary irradiation, and 48% had an elevated BMI. Overall, 86% of patients had at least one additional high-risk feature, 70% at least two, and 23% had all three additional high-risk features. Seven patients (23%) had an elevated L-Dex score at some point during follow-up and underwent intervention with an OTC sleeve for 4 weeks. To date, no patients have required CDP at any time.
Conclusions: Prospective surveillance with BIS in a high-risk cohort of patients all undergoing ALND (plus additional high-risk features) led to no patients requiring CDP. These excellent findings are consistent with growing data supporting the use of BIS in prospective BCRL surveillance programs.
Citation Format: Kaufman D, Shah C, Vicini F. Low rates of chronic breast cancer related lymphedema (BCRL) in a cohort of high-Risk patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-09.
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Affiliation(s)
- D Kaufman
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
| | - C Shah
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
| | - F Vicini
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
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Whitworth P, Cooper A, Shah C, Vicini F. Abstract P3-14-08: The impact of a structured surveillance protocol using bioimpedance spectroscopy (BIS) on preventing breast cancer related lymphedema (BCRL) in high-Risk patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-14-08] [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: We evaluated the impact of structured surveillance using bioimpedance spectroscopy (BIS) to prevent clinical BCRL in a group of high-risk (axillary lymph node dissection) patients.
Methods: From April 2010 through November 2016, 93 patients who were treated with axillary lymph node dissection (ALND) were prospectively monitored with BIS using L-Dex (Impedimed). Patients received a pre-operative baseline L-Dex measurement followed by post-operative assessments at regular intervals. An elevated L-Dex score was defined as an increase of ≥10 points above baseline (considered subclinical BCRL). Intervention consisted of applying an over the counter (OTC) sleeve for 4 weeks followed by re-evaluation. The need for complete decongestive physiotherapy (CDP) represented a surrogate for the development of clinically significant, chronic BCRL.
Results: Median follow-up was 24 months (range: 0.3-206.4 months). The median number of nodes removed was 19 (range: 5-41) and the median number of positive nodes was 3. Median age was 53 years old. Eighty five percent of patients underwent mastectomy and the remainder breast conserving therapy. 55% of patients received taxane based chemotherapy, 24% received some form of axillary RT (15% high tangents and 9% comprehensive regional nodal RT) and 74% had an elevated body mass index (BMI, > 25). Overall, 75% of these patients had at least one additional high-risk feature, 48% had at least two, and 6% had 3 (either taxane chemotherapy, axillary RT or elevated BMI). Thirty-three patients (35.4%) developed an elevated L-Dex score at some point during follow up. Overall, 10 patients (11%) required CDP at any point after treatment.
Conclusions: The results of this analysis support previously published data on the efficacy of prospective BCRL surveillance and early intervention using BIS. Of the 93 high-risk patients prospectively followed and managed in this structured BCRL protocol, 11% required CDP. These results compare favorably to all contemporary studies reporting BCRL rates in high-risk patients.
Citation Format: Whitworth P, Cooper A, Shah C, Vicini F. The impact of a structured surveillance protocol using bioimpedance spectroscopy (BIS) on preventing breast cancer related lymphedema (BCRL) in high-Risk patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-08.
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Affiliation(s)
- P Whitworth
- Nashville Breast Center, Nashville, TN; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
| | - A Cooper
- Nashville Breast Center, Nashville, TN; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
| | - C Shah
- Nashville Breast Center, Nashville, TN; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
| | - F Vicini
- Nashville Breast Center, Nashville, TN; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals, Farmington Hills, MI
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Kaufman D, Shah C, Vicini F. Abstract P6-12-03: Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer related lymphedema. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-03] [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: With improved breast cancer outcomes, an increasing focus on sequelae of treatment as part of survivorship has emerged. Breast cancer related lymphedema (BCRL) represents one such sequelae. Increasing data and recent NCCN guidelines support the use of prospective BCRL surveillance to allow for early detection and intervention as a method to reduce chronic, irreversible BCRL. Therefore, this study was performed to evaluate the impact early detection and treatment of BCRL in breast cancer patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS).
Methods: From 8/2010 through 12/2016, 206 patients were evaluated with BIS as part of a prospective surveillance program.The protocol included pre-operative assessment with BIS as well as post-operative assessments with BIS at regular intervals. Patients with L-Dex readings increasing by more than 10 from baseline were considered to have subclinical BCRL and treated with a compression sleeve for 4 weeks. For the purpose of this analysis, high-risk was defined as receipt of ALND, regional nodal irradiation, or taxane chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy.
Results: A total of 206 patients were analyzed, with a mean age of 61 years old and a median follow up of 25.9 months. Overall, 17% of patients had least one high-risk feature, 8% had two factors, and 7% had all three factors. A total of 21 patients (9.8%) were diagnosed with subclinical BCRL. Increased rates of subclinical BCRL were seen in patients undergoing ALND (23% vs. 7%, p=0.01) with ALND and receipt of RNI associated with development of subclinical BCRL. At last follow-up, no patients had persistent, chronic BCRL following early, conservative intervention measures.
Conclusions: The results of this study support prospective surveillance and early treatment utilizing BIS. Intervention triggered by subclinical BCRL detection with an elevated L-Dex score was associated with a very low rate of chronic BCRL.
Citation Format: Kaufman D, Shah C, Vicini F. Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer related lymphedema [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-03.
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Affiliation(s)
- D Kaufman
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - C Shah
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
| | - F Vicini
- Breast Cancer Specialists, Bethpage, NY; Cleveland Clinic, Cleveland, OH; Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI
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Su C, Bhargava A, Shah C, Halmos B, Gucalp R, Packer S, Ohri N, Haramati L, Perez-Soler R, Cheng H. P2.13-008 Lung Cancer Screening Improves Mortality: Examining Screening Patterns in an Urban Underserved Community. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1355] [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: 10/18/2022]
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Jani Y, Shah C, Hough J. ISQUA17-3144MEDICINES RECONCILIATION IN PRIMARY CARE FOLLOWING HOSPITALISATION. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cummin T, Araf S, Du M, Barrans S, Bentley M, Clipson A, Wang M, Ahmed S, Rahim T, Shah C, Hamid D, Dhondt J, Maishman T, Vaughan-Spickers N, Pocock C, Forbes A, O'Callaghan A, Westhead D, Griffiths G, Fitzgibbon J, Tooze R, Care M, Burton C, Davies A, Johnson P. PROGNOSTIC SIGNIFICANCE AND CORRELATION TO GENE EXPRESSION PROFILE OF EZH2
MUTATIONS IN DIFFUSE LARGE B-CELL LYMPHOMA (DLBL) IN 2 LARGE PROSPECTIVE STUDIES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T.E. Cummin
- Cancer Sciences; University of Southampton; Southampton UK
| | - S. Araf
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - M. Du
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - M.A. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Ahmed
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - T. Rahim
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - C. Shah
- Bioinformatics group,IMCB; University of Leeds; Leeds UK
| | - D. Hamid
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Dhondt
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T. Maishman
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - N. Vaughan-Spickers
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - C. Pocock
- Haematology Department; East Kent Hospitals University NHS Foundation Trust; Canterbury UK
| | - A. Forbes
- Haematology Department; Royal Cornwall Hospital; Truro UK
| | - A. O'Callaghan
- Haematology Department; Queen Alexandra Hospital, PO6 3LY; Portsmouth UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - R.M. Tooze
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - C.H. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - A.J. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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Rivkin SE, Moon J, Iriarte D, Sloan H, Wiseman C, Klee M, Ference K, Drescher C, Veljovich D, Bondurant A, Peters W, Jiang P, Goodman G, Park M, Fer M, Shah C, Johnston E, Kaplan H, Wahl T, Ellis E. Abstract AP30: PHASE IB/II WITH EXPANSION OF PATIENTS AT THE MTD STUDY OF OLAPARIB PLUS WEEKLY (METRONOMIC) CARBOPLATIN AND PACLITAXEL IN RELAPSED OVARIAN CANCER PATIENTS. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-ap30] [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: We established the olaparib tablet maximum tolerated dose (MTD) at 150 mg bid, dose limiting toxicities (DLT's) and response to therapy or carboplatin, paclitaxel and olaparib tablet given simultaneously, reported at ASCO 2014. This abstract will include data from both the phase 1b and the phase 2 expansion.
METHODS: A total of 54 subjects were evaluated in this trial, 14 in phase 1b and 40 in phase 2. Eligibility required measurable disease, adequate organ function and ECOG performance status of ~ 2. Subjects had to have failed first line platinum containing chemotherapy. BRCA testing was conducted as available. Subjects received the metronomic therapy of paclitaxel 60mg/m2 IV and carboplatin AUC 2 IV weekly, 3 weeks out of 4, and olaparib tablets at 150 mg bid administered orally for 3 consecutive days (D1-D3) every week for each cycle. Subjects were assessed for toxicity and response according to the protocol. Subjects that reached a confirmed complete remission were transitioned to olaparib tablets only, 300 mg bid until disease progression.
RESULTS: Median age was 58 and median number of prior regimens was 4. There have been no deaths due to the study regimen. One patient had grade 4 neutropenia and an allergic reaction to carboplatin. The common grade 3/4 toxicities were caused by the chemotherapy (neutropenia. anemia and thrombocytopenia). Two patients had mild GI toxicities. One patient had a skin rash. There was no evidence of cardiac, hepatic, or pulmonary toxicities in any of these patients. 25% of subjects had a complete remission (CR), 31% had PR, 23% had SD and 21% had
PD. Of the 13 CRs, 4 were BRCA negative. PFS median for BRCA positive subjects is 12.6 months vs 4.8 months for BRCA negative subjects. OS median for BRCA positive subjects is 24 months vs 16 months for BRCA negative subjects. All of the CR's are alive.
CONCLUSION: Olaparib tablet can be safely administered simultaneously with a weekly regimen of carboplatin and paclitaxel in heavily pretreated ovarian cancer patients. Olaparib appears to be highly effective in BRCA positive subjects. This is the first successful combination of olaparib tablets with carboplatin and paclitaxel that has been well tolerated.
Citation Format: Rivkin SE, Moon J, Iriarte D, Sloan H, Wiseman C, Klee M, Ference K, Drescher C, Veljovich D, Bondurant A, Peters W, Jiang P, Goodman G, Park M, Fer M, Shah C, Johnston E, Kaplan H, Wahl T, Ellis E. PHASE IB/II WITH EXPANSION OF PATIENTS AT THE MTD STUDY OF OLAPARIB PLUS WEEKLY (METRONOMIC) CARBOPLATIN AND PACLITAXEL IN RELAPSED OVARIAN CANCER PATIENTS [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr AP30.
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Affiliation(s)
- SE Rivkin
- 1Swedish Cancer Institute. Seattle. WA,
- 2Rivkin Center for Ovarian Cancer, Seattle. WA,
| | - J Moon
- 3Fred Hutchinson Cancer Research Center, Seattle, WA,
| | - D Iriarte
- 1Swedish Cancer Institute. Seattle. WA,
| | - H Sloan
- 2Rivkin Center for Ovarian Cancer, Seattle. WA,
| | - C Wiseman
- 1Swedish Cancer Institute. Seattle. WA,
| | - M Klee
- 1Swedish Cancer Institute. Seattle. WA,
| | - K Ference
- 1Swedish Cancer Institute. Seattle. WA,
| | - C Drescher
- 4Pacific Gynecology Specialists. Seattle, WA,
| | - D Veljovich
- 4Pacific Gynecology Specialists. Seattle, WA,
| | - A Bondurant
- 4Pacific Gynecology Specialists. Seattle, WA,
| | - W Peters
- 4Pacific Gynecology Specialists. Seattle, WA,
| | | | - G Goodman
- 1Swedish Cancer Institute. Seattle. WA,
| | - M Park
- 1Swedish Cancer Institute. Seattle. WA,
| | - M Fer
- 1Swedish Cancer Institute. Seattle. WA,
| | - C Shah
- 4Pacific Gynecology Specialists. Seattle, WA,
| | - E Johnston
- 5Providence Regional Cancer Partnership Everett Clinic. Everett, WA, USA
| | - H Kaplan
- 1Swedish Cancer Institute. Seattle. WA,
| | - T Wahl
- 1Swedish Cancer Institute. Seattle. WA,
| | - E Ellis
- 1Swedish Cancer Institute. Seattle. WA,
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Ridner S, Shah C, Dietrich M, Vicini F. Abstract OT3-07-01: A randomized trial evaluating bioimpedance spectroscopy vs. tape measurement in the prevention of lymphedema following breast cancer treatment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot3-07-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: Breast cancer related lymphedema (BCRL) represents a common treatment associated complication following surgery, radiation and/or chemotherapy. Increasing data has demonstrated the ability of new diagnostic modalities to detect BCRL in the subclinical phase of the process allowing for early intervention.
Trial Design: This 2-group stratified randomized clinical trial evaluates the effectiveness of bioimpedance spectroscopy (BIS) for early detection and prevention of BCRL compared to tape measurement (TM). Baseline assessments are made pre-operatively. Two-months post-op, patients are censored out if they have developed any of the exclusion conditions, did not have a mastectomy, axillary dissection, >6 sentinel nodes removed, radiation therapy, or taxane. Remaining patients are randomized within site to either BIS or TM; monitored at 3 to 6-month intervals up to 36-months post-op for a change over baseline specified to trigger a compression sleeve & gauntlet intervention. Cohort trigger thresholds are change of ≥10 L-Dex units or 5 to <10% volume. If the intervention is triggered, measurements by the other method are taken before initiating the 4-week intervention. Post intervention, patients are monitored only with TM. Volume change of ≥10% results in study removal and physician referral. At the 2 study endpoints (36 month visit or volume change of ≥10%) measurements are taken with each method.
Eligibility Criteria: Inclusion criteria: ≥ 18 with histologically confirmed stage I-III breast cancer (BC) or DCIS with planned surgery. Exclusion criteria include history of BC therapy or lymphedema.
Specific Aims: The primary hypothesis is that subclinical detection of BCRL with BIS and early intervention will reduce the rate of lymphedema progression (as measured by referral to complex decongestive physiotherapy) compared to TM. Secondary outcomes include BCRL risk factors, quality of life, and time to treatment.
Statistical Methods: Sample size and powering were based on the hypothesis that BIS would reduce progression rate by 20%. A rate of 50% progression in the TM group was used as the standard. 1100 patients will be enrolled to result in randomized groups of 100 (Total N=200) Statistics include relative risks with respective bootstrapped 95% C.I. and Cochran-Mantel-Haenszel tests.
Present Accrual and Target Accrual: Overall, the study target or expected enrollment as of the end of March 31, 2016 was 690 participants, 534 were actually enrolled (actual accrual 77% of target). Accrual at the study sites ranged from 15 to 104% of target.
Contact Information: Sheila Ridner: 615-322-0831, Sheila.ridner@vanderbilt.edu
Support: ImpediMed Limited, ImpediMed, Inc. and medi USA.
Citation Format: Ridner S, Shah C, Dietrich M, Vicini F. A randomized trial evaluating bioimpedance spectroscopy vs. tape measurement in the prevention of lymphedema following breast cancer treatment [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- S Ridner
- Vanderbilt University; Cleveland Clinic; Michigan Healthcare Professionals/21st Century Oncology
| | - C Shah
- Vanderbilt University; Cleveland Clinic; Michigan Healthcare Professionals/21st Century Oncology
| | - M Dietrich
- Vanderbilt University; Cleveland Clinic; Michigan Healthcare Professionals/21st Century Oncology
| | - F Vicini
- Vanderbilt University; Cleveland Clinic; Michigan Healthcare Professionals/21st Century Oncology
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Shah C, Zhang W, Xiao Y, Yao L, Zhao Y, Gao X, Liu L, Liu J, Li S, Tao B, Yan Z, Fu Y, Gong Q, Lui S. Common pattern of gray-matter abnormalities in drug-naive and medicated first-episode schizophrenia: a multimodal meta-analysis. Psychol Med 2017; 47:401-413. [PMID: 27776571 DOI: 10.1017/s0033291716002683] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Studies of schizophrenia at drug-naive state and on antipsychotic medication have reported a number of regions of gray-matter (GM) abnormalities but the reports have been inconsistent. The aim of this study was to conduct multimodal meta-analysis to compare the cross-sectional voxel-based morphometry studies of brain GM in antipsychotic-naive first-episode schizophrenia (AN-FES) and those with antipsychotic treatment within 1 year (AT-FES) to determine the similarities and differences in these groups. We conducted two separate meta-analyses containing 24 studies with a sample size of 801 patients and 957 healthy controls. A multimodal meta-analysis method was used to compare the findings between AN-FES and AT-FES. Meta-regression analyses were done to determine the influence of different variables including age, duration of illness, and positive and negative symptom scores. Finally, jack-knife analyses were done to test the robustness of the results. AN-FES and AT-FES showed common patterns of GM abnormalities in frontal (gyrus rectus), superior temporal, left hippocampal and insular cortex. GM in the left supramarginal gyrus and left middle temporal gyrus were found to be increased in AN-FES but decreased in AT-FES, whereas left median cingulate/paracingulate gyri and right hippocampus GM was decreased in AN-FES but increased in AT-FES. Findings suggest that both AN-FES and AT-FES share frontal, temporal and insular regions as common anatomical regions to be affected indicating these to be the primary regions of GM abnormalities in both groups.
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Affiliation(s)
- C Shah
- Radiology Department,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China
| | - W Zhang
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - Y Xiao
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - L Yao
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - Y Zhao
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - X Gao
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - L Liu
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - J Liu
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - S Li
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - B Tao
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - Z Yan
- Radiology Department,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China
| | - Y Fu
- Radiology Department,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China
| | - Q Gong
- Department of Radiology,Huaxi MR Research Center (HMRRC), the Center for Medical Imaging, West China Hospital of Sichuan University,Chengdu,Sichuan,China
| | - S Lui
- Radiology Department,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,China
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Shah C, Mokashe N, Mishra V. Preparation, characterization and in vitro antioxidative potential of synbiotic fermented dairy products. J Food Sci Technol 2016; 53:1984-92. [PMID: 27413225 PMCID: PMC4926925 DOI: 10.1007/s13197-016-2190-3] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Revised: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 12/25/2022]
Abstract
The present study, evaluates the antioxidative potential of two synbiotic dairy products viz. synbiotic lassi with honey and whey based synbiotic drink with inulin and orange juice, along with their physicochemical and microbiological activity during storage period. Antioxidative potential of raw ingredients and probiotic cultures used to prepare synbiotic products was also evaluated. Synbiotic lassi with honey was prepared using Streptococcus thermophilus MTCC 5460 (MD2) and Lactobacillus helveticus MTCC 5463 (V3) as probiotics and honey as prebiotic. For preparation of whey based synbiotic drink, Lactobacillus helveticus MTCC 5463 and inulin were used as probiotic and prebiotic, respectively and orange juice was also incorporated. Titratable acidity and pH of both synbiotic products followed a similar pattern of increase or decrease during storage. Furthermore, no major changes were observed in viability of probiotic cultures under storage conditions adapted. The hydroxyl radical scavenging activity of synbiotic lassi with honey was found to significantly decrease from 107.76 to 79.41 % at the end of storage whereas, the activity of whey based synbiotic drink was 100.32 % which declined sharply to 79.21 % on 7th day but further increased to 102.59 % on 14th day. The DPPH (α, α-Diphenyl-β-Picrylhydrazyl) radical scavenging activity of freshly prepared synbiotic lassi with honey was 28.43 % which decreased to 23.03 % on 7th day while for whey based synbiotic drink decreased from 26.85 % (0 day) to 17.12 % (7th day) and continued to decline. Moreover, probiotic strains used for synbiotic preparation also demonstrated good antioxidative activity.
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Affiliation(s)
- C. Shah
- />Dairy Microbiology Department, Anand Agricultural University, Anand, Gujarat India
| | - N. Mokashe
- />Department of Basic and Applied Sciences, National Institute of Food Technology Entrepreneurship and Management (NIFTEM), HSIIDC Industrial Estate, Kundli, Sonepat, Haryana India
| | - V. Mishra
- />Department of Basic and Applied Sciences, National Institute of Food Technology Entrepreneurship and Management (NIFTEM), HSIIDC Industrial Estate, Kundli, Sonepat, Haryana India
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Shukla A, Shah C, Hardik P, Gupte P. A probable case of histoplasmosis presenting as portal hypertension and bone lesion in a case of common variable immunodeficiency syndrome. J Postgrad Med 2015; 61:49-50. [PMID: 25511221 PMCID: PMC4944370 DOI: 10.4103/0022-3859.147054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- A Shukla
- Department of Gastroenterology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Abstract
We present a simple and versatile polarimeter for x rays in the energy range of 10-30 keV. It uses Compton scattering in low-Z materials such as beryllium or boron carbide. The azimuthal distribution of the scattered x rays is sampled by an array of 12 silicon PIN diodes operated at room temperature. We evaluated the polarimetry performance using Monte-Carlo simulations and show experimental results.
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Affiliation(s)
- S Weber
- Physics Institute, Heidelberg University, 69120 Heidelberg, Germany
| | - C Beilmann
- Physics Institute, Heidelberg University, 69120 Heidelberg, Germany
| | - C Shah
- Physics Institute, Heidelberg University, 69120 Heidelberg, Germany
| | - S Tashenov
- Physics Institute, Heidelberg University, 69120 Heidelberg, Germany
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Shah C. Intensive dose of rosuvastatin (40 mg/day), initiated early and continued for 12 weeks, in very high-risk or high-risk indian patients. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.970] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kouyos RD, Rauch A, Boni J, Yerly S, Shah C, Aubert V, Klimkait T, Kovari H, Calmy A, Cavassini M, Battegay M, Vernazza PL, Bernasconi E, Ledergerber B, Gunthard HF, Aubert V, Barth J, Battegay M, Bernasconi E, Boni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Egger M, Elzi L, Fehr J, Fellay J, Francioli P, Furrer H, Fux CA, Gorgievski M, Gunthard H, Haerry D, Hasse B, Hirsch HH, Hirschel B, Hosli I, Kahlert C, Kaiser L, Keiser O, Kind C, Klimkait T, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, Muller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schmid P, Schultze D, Schoni-Affolter F, Schupbach J, Speck R, Taffe P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Clustering of HCV coinfections on HIV phylogeny indicates domestic and sexual transmission of HCV. Int J Epidemiol 2014; 43:887-96. [DOI: 10.1093/ije/dyt276] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Shah C, Vicini F, Beitsch P, Laidley A, Anglin B, Ridner SH, Lyden M. The use of bioimpedance spectroscopy to monitor therapeutic intervention in patients treated for breast cancer related lymphedema. Lymphology 2013; 46:184-192. [PMID: 25141461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We performed a multi-institutional analysis to evaluate the ability of bioimpedance spectroscopy (BIS) to capture the impact of lymphedema treatment compared with observation alone in the management of breast cancer related lymphedema (BCRL). We utilized a retrospective review of 50 patients with breast cancer who were evaluated with BIS at baseline and following loco-regional treatment. An analysis was performed comparing changes in L-Dex scores for those patients undergoing treatment for BCRL (n=13) versus those not undergoing intervention (n=37). A second (subset) analysis was also performed on all patients with elevated L-Dex scores compared to baseline prior to undergoing loco-regional treatment (n=32). When comparing the cohort treated for BCRL to those not treated, L-Dex scores were significantly reduced (-4.3 v. 0.1, p=0.005) in the period following intervention (for treated patients). For the subset of patients with elevated L-Dex scores postoperation, the change in L-Dex score following BCRL treatment was significantly reduced (-5.8 v. 0.1, p=0.001) compared with the group observed that had elevated postsurgical L-Dex scores. In this analysis, BIS was able to detect early onset lymphedema and subsequently significant changes (reductions) in L-Dex scores directly related to intervention for BCRL compared with observation alone.
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Shah C, Knickerbocker A, Veljovich D, BonDurant A, Drescher C, Paley P. Outcomes after robotic radical hysterectomy as compared to open radical hysterectomy at a single high-volume institution after the institution of a robotic surgery program. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.004] [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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Khwaja S, Shah C, Badiyan S, Wilkinson J, Vicini F, Beitsch P, Keisch M, Arthur D, Lyden M. Long-term Cosmesis and Toxicity Profile Following Accelerated Partial Breast Irradiation (APBI): Final Analysis of the American Society of Breast Surgeons Breast Brachytherapy Registry Trial. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wallace M, Wilkinson J, Shah C, Amin M, Jawad M, Fowler A, Mitchell C, Chen P, Grills I. Clinical Outcomes Following Accelerated Partial Breast Irradiation Stratified by Estrogen Receptor Status. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.625] [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: 12/01/2022]
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Jawad M, Wilkinson J, Shah C, Wobb J, Stone B, Fowler A, Mitchell C, Wallace M, Chen P, Grills I. Impact of Lymphovascular Space Invasion, Extensive Intraductal Component, and Multifocality on Outcomes Following Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chen P, Shah C, Wilkinson J, Wallace M, Ye H, Fowler A, Dekhne N, Benitez P, Brabbins D, Grills I. Clinical Efficacy of 2- Versus 5-day Accelerated Partial Breast Irradiation Delivered via Balloon-based Brachytherapy: Results of a Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jawad M, Wilkinson J, Shah C, Gustafson G, Fowler A, Mitchell C, Wobb J, Brabbins D, Chen P, Grills I. Seven-year Clinical Outcomes Following Accelerated Partial Breast Irradiation Stratified by ASTRO Consensus Groupings. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vogel T, Shah C, Dunsmoor-Su R, Knickerbocker A, McLean K, Garcia R, Goff B. A contemporary analysis of clear cell carcinoma of the endometrium. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lassalle P, De Freitas Caires N, Portier L, Palud A, Parmentier E, Pastre J, Shah C, Scherpereel A, Mathieu D, Delehedde M. Endothelial cell specific molecule 1 is today a relevant marker of respiratory failure in sepsis and polytrauma patients. Crit Care 2012. [PMCID: PMC3504911 DOI: 10.1186/cc11797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martinez A, Shah C, Mohammed N, Demanes J, Martinez-Monge R, Ye H, Galalae R. OC-24 TEN-YEAR OUTCOMES FOR PATIENTS WITH GLEASON 8-10 TREATED WITH HIGH DOSE RATE BRACHYTHERAPY BOOST. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wilkinson J, Shah C, Keisch M, Beitsch P, Arthur D, Lyden M, Vicini F. OC-92 IMPACT OF MARGIN STATUS AFTER APBI: AN ANALYSIS OF THE AMERICAN SOCIETY OF BREAST SURGEONS MAMMOSITEEE REGISTRY TRIAL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72059-5] [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: 10/28/2022]
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Shah C, Wilkinson JB, Wallace M, Vicini F. P3-13-02: The Impact of Lymph Node Status on Clinical Outcomes Following Accelerated Partial Breast Irradiation. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-13-02] [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: Limited data exists on outcomes following accelerated partial breast irradiation in node-positive breast cancer patients. The purpose of this analysis was to compare clinical outcomes following accelerated partial breast irradiation (APBI) between node-negative and node-positive early stage breast cancer patients and to identify if nodal positivity leads to increased rates of local or axillary failure. Materials and Methods: 510 patients with early stage breast cancer received accelerated partial breast irradiation (APBI) as part of their breast conservation therapy between April 1993 and November, 2010. Of these, 39 were lymph node positive with 10 patients having N1mi disease (median size of mets= 0.82 mm) and 29 patients having N1 disease (61.5% had one node positive [median size of mets= 2.5 mm], 30.8% had 2 nodes positive [median size of mets= 8.0 mm], and 7.7% had 3 nodes positive [median size of mets= 20 mm]). Patient, clinical, and pathologic factors were analyzed and compared for the node-negative and node-positive cohorts including age, tumor size, receptor status, margin status, adjuvant hormonal therapy, adjuvant chemotherapy, and length of follow-up. Clinical outcomes were analyzed including local recurrence (LR), regional recurrence (RR), axillary recurrence (AR), regional-nodal recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS).
Results: Node-positive patients were younger (p=0.04), had larger tumors (p<0.001), and were more likely to receive chemotherapy (p<0.001). Median follow up was 5.3 years for node-negative patients and 5.9 years for node-positive patients (p=0.06). At 5 years, no differences were seen in the 5-year actuarial rates of LR (2.2% v. 2.6%, p=0.86), AR (0% v. 0%, p=0.69), DFS (90.0% v. 88.0%, p=0.79), CSS (98.0% v. 90.0%, p=0.06), or OS (91.0 v. 84.0%, p=0.65) while higher rates of RR (0% v. 6.1%, p<0.001) and DM (2.2% v. 8.9%, p=0.005) were noted in node-positive patients. A total of 10 LRs occurred in the node-negative patients and 1 LR in the node-positive patients at a median of 2.6 and 1.5 years respectively. Both RR that developed in node-positive patients were within the supraclavicular fossa at a median of 2.8 years. Univariate analysis of LR was performed and age (p=0.31), tumor size (p=0.48), ER status (p=0.13), PR status (p=0.34), T-stage (p=0.48), chemotherapy (p=0.41), APBI technique (p=0.80), and nodal status (p=0.86) were not associated with LR while there was a trend for the association of LR with close/positive margins (p=0.07), and failure to receive adjuvant hormonal therapy (p=0.06). No variables were associated with any type of AR.
Discussion: No difference was seen in the rates of local recurrence or axillary failure between node-negative and node-positive following APBI with 5-years of follow-up. Increased rates of regional failure were noted with APBI in node-positive patients due to supraclavicular failures; however, traditional whole breast irradiation techniques would not have covered these failures.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-02.
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Affiliation(s)
- C Shah
- 1William Beaumont Hospital, Royal Oak, MI
| | | | - M Wallace
- 1William Beaumont Hospital, Royal Oak, MI
| | - F Vicini
- 1William Beaumont Hospital, Royal Oak, MI
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