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Gasner N, Provias J, Lu JQ, Fong C. Metachronous Brain Tumors: Supratentorial Ependymoma Following Polymorphous Low-grade Neuroepithelial Tumor of the Young. Can J Neurol Sci 2024:1-6. [PMID: 38644627 DOI: 10.1017/cjn.2024.61] [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: 04/23/2024]
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2
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Fareez F, Yahya S, Fong C, Moodley J, Provias J, Popovic S, Cenic A, Lu JQ. Spinal calcifying pseudoneoplasm of the neuraxis (CAPNON) associated with facet joint pathologies: CAPNON diagnostic and pathogenic insights. Hum Pathol 2024; 145:16-25. [PMID: 38336278 DOI: 10.1016/j.humpath.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like fibro-osseous lesion that can develop anywhere in the neuraxis. Approximately a half of reported CAPNONs developed in the spinal region, mostly close to the facet joint (FJ). The diagnosis of spinal CAPNONs is challenging given the existence of mimics and associated pathologies including calcific degeneration of the FJ ligaments (DFJL) and synovial cysts (SCs). The pathogenesis of CAPNON remains elusive, although there have been a few hypotheses including degenerative, reactive, proliferative and immune-mediated processes. Our present study examined clinical, radiological and pathological features of 12 spinal CAPNONs in comparison to 9 DFJL foci, and diagnostic and pathogenic relationship between CAPNONs and FJ pathologies. On imaging, CAPNONs were all tumor-like and typically bigger than DFJL foci. All CAPNONs showed pathologically diagnostic features including characteristic cores, consistently identifiable core-surrounding/peripheral palisading of macrophages and other cells including multinucleated giant cells, variable infiltration of CD8+ T-cells, and multifocal immunopositivity of neurofilament light chain (NF-L). These features were absent or limited in the DFJL foci with statistically significant differences from CAPNONs, except calcifications. Spinal CAPNONs co-existed with DFJL foci in all cases; some had transitional foci with overlapping focal CAPNON and DFJL-like features. These findings, along with our previously reported relationship between CAPNONs and SCs, suggest that spinal CAPNONs may occur in association with or in transition from calcifying/calcified degenerative lesions of FJ ligaments and/or SCs when a reactive proliferative process is complemented by other pathogenic changes such as immune-mediated pathology and NF-L deposition/expression.
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Affiliation(s)
- Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jinesa Moodley
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - John Provias
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Aleksa Cenic
- Department of Surgery/Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
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Kisiel M, Bass VM, Fong C, Graham AK, Yahya S, Eichorn FC, Lannon M, Kameda-Smith M, Reddy KKV, Lu JQ. Clinicopathologic characteristics of Nocardia brain abscesses: Necrotic and non-necrotic foci of various stages. J Neurol Sci 2024; 456:122850. [PMID: 38142539 DOI: 10.1016/j.jns.2023.122850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
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Affiliation(s)
- Marta Kisiel
- Department of Pathology and Molecular Medicine, Canada
| | | | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Canada.
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Beighley A, Rahimian J, Wong A, Torres F, Fong C, Rajamohan A, Vinci JP, Miller M, Lodin K, Girvigian MR, Bhattasali O. Impact of Concurrent Targeted Therapy and Immunotherapy on the Incidence of Radiation Necrosis Following Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e86. [PMID: 37786200 DOI: 10.1016/j.ijrobp.2023.06.839] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The management of metastatic disease has evolved with the advent of immunotherapy (IT) and targeted therapies (TT). Yet, there is limited understanding of the toxicity associated with combining these agents with stereotactic radiosurgery (SRS). We retrospectively evaluated the impact of concurrent systemic therapy (ST) on the risk of radiation necrosis (RN) following LINAC-based SRS for brain metastases (BM). MATERIALS/METHODS A retrospective study was conducted within an integrated health care system from March 2017 to December 2021 of 313 patients who underwent SRS or fractionated SRS in 3 or 5 treatments to a total of 1,644 intact BM. Post-operative cavity SRS and re-irradiated lesions were excluded. RN was diagnosed using perfusion MRI, contrast clearance MRI, or serial standard MRI and graded using CTCAE (v.5). Concurrent ST was defined as administration within 1 month preceding or following SRS. Overall survival (OS) and risk of RN were estimated by the Kaplan-Meier method. Logistics regression analyses were performed to compare risk of RN in patients who received concurrent systemic therapy to those who did not, adjusted for PTV volume and receipt of whole brain radiotherapy (WBRT). RESULTS Median follow-up was 12.2 months. Median age was 64 years (range: 24-92). Primary sites per patient included lung (48.9%), breast (18.2%), melanoma (11.5%), kidney (6.1%), and other (15.3%). Median total lesions treated was 3 (range: 1-44); 65.9% of patients underwent 1 course of SRS, 23.4% underwent 2 courses, 6.2% underwent 3 courses, 4.5% underwent >4 courses. Seventy-six (24.2%) patients received WBRT. Overall, 70.6% of lesions received concurrent ST including chemotherapy (CT) (32.5%), IT (26.8%), and TT (27.6%); 16.4% received a combination of ST. Median OS was 12.9 months (95% CI: 10.4-15.5). RN was observed in 50 (3.0%) lesions in 42 (13.4%) patients. The 1-year risk of RN was 4.0% per lesion and 15.4% per patient. Symptomatic RN (SRN) was observed in 31 (1.9%) lesions in 24 (7.7%) patients. The 1-year risk of SRN was 2.7% per lesion and 10.1% per patient. When compared to lesions treated without concurrent systemic therapy, there was no increased risk of RN observed in lesions treated with concurrent CT (adjusted OR = 0.86 (95% CI: 0.43-1.73) p = 0.68), concurrent IT (adjusted OR = 0.84 (95% CI: 0.41-1.71) p = 0.84), or concurrent TT (adjusted OR = 0.57 (95% CI: 0.25-1.30) p = 0.18). Treatments of SRN included dexamethasone (96.8%), bevacizumab (22.6%), and laser interstitial thermal therapy (6.5%). CONCLUSION Concurrent IT and TT appears well-tolerated in patients who undergo SRS for treatment of BM. No increased risk of RN was observed in lesions treated with concurrent IT or TT compared to lesions treated in the absence of concurrent ST. Further prospective and agent-specific evaluation is necessary to confirm these findings.
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Affiliation(s)
- A Beighley
- Southern California Permanente Medical Group, Los Angeles, CA
| | - J Rahimian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - A Wong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - F Torres
- Southern California Permanente Medical Group, Los Angeles, CA
| | - C Fong
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - A Rajamohan
- Southern Kaiser Permanente Medical Group, Los Angeles, CA
| | - J P Vinci
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - M Miller
- Southern California Permanente Medical Group, Los Angeles, CA
| | - K Lodin
- Southern California Permanente Medical Group, Los Angeles, CA
| | - M R Girvigian
- Southern California Permanente Medical Group, Los Angeles, CA
| | - O Bhattasali
- Southern California Permanente Medical Group, Los Angeles, CA
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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Jin A, Fong C, Lu JQ. Intracranial Aneurysmosis with Multilobular Aneurysms and Brain Microaneurysms. Ann Neurol 2023; 93:637-639. [PMID: 36511420 DOI: 10.1002/ana.26571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Andrew Jin
- Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology, McMaster University, Hamilton, Ontario, Canada
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Hobbis L, Duncan J, Kinnaird F, Fong C, Li S, Gordon A, Chau I, Starling N, Rao S, Watkins D, Fribbens C, Cunningham D. CN45 The Gastrointestinal and Lymphoma Unit Advanced Nurse Practitioner role in clinical research at The Royal Marsden Hospital. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.370] [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: 11/01/2022] Open
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Lu JQ, Al Mohammadi WJB, Fong C, Yang K, Moodley J, Provias J, Popovic S, Chebib I, Cenic A. Spinal calcifying pseudoneoplasm of the neuraxis (CAPNON) and CAPNON-like lesions: CAPNON overlapping with calcified synovial cysts. Pathology 2022; 54:573-579. [DOI: 10.1016/j.pathol.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
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Vreugdenhil M, Fong C, Iqbal G, Roques T, Evans M, Palaniappan N, Yang H, O'Toole L, Sanghera P, Nutting C, Foran B, Sen M, Al Booz H, Fulton-Lieuw T, Dalby M, Dunn J, Hartley A, Mehanna H. Improvement in Dysphagia Outcomes Following Clinical Target Volume Reduction in the De-ESCALaTE Study. Clin Oncol (R Coll Radiol) 2021; 33:795-803. [PMID: 34340917 DOI: 10.1016/j.clon.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
AIMS The De-ESCALaTE study showed an overall survival advantage for the administration of synchronous cisplatin chemotherapy with radiotherapy in low-risk oropharyngeal cancer when compared with synchronous cetuximab. During the trial, a radiotherapy quality assurance protocol amendment permitted centres to swap from the original radiotherapy contouring protocol (incorporating the whole oropharynx into the high-dose clinical target volume (CTV); anatomical protocol) to a protocol that incorporated the gross tumour volume with a 10 mm margin into the CTV (volumetric protocol). The purpose of this study was to examine both toxicity and tumour control related to this protocol amendment. MATERIALS AND METHODS Overall survival and recurrence at 2 years were used to compare tumour control in the two contouring cohorts. For toxicity, the cohorts were compared by both the number of severe (grades 3-5) and all grades acute and late toxicities. In addition, quality of life and swallowing were compared using EORTC-C30 and MD Anderson Dysphagia Inventory, respectively. RESULTS Of 327 patients included in this study, 185 were contoured according to the anatomical protocol and 142 by the volumetric protocol. The two cohorts were well balanced, with the exception of significantly more patients in the anatomical cohort undergoing prophylactic feeding tube insertion (P < 0.001). With a minimum of 2 years of follow-up there was no significant difference in overall survival or recurrence between the two contouring protocols. Similarly, there was no significant difference in the rate of reported severe or all grades acute or late toxicity and no sustained significant difference in quality of life. However, there was a significant difference in favour of volumetric contouring in several domains of the MD Anderson Dysphagia Inventory questionnaire at 1 year, which persisted to 2 years in the dysphagia functional (P = 0.002), dysphagia physical (P = 0.009) and dysphagia overall function (P = 0.008) domains. CONCLUSION In the context of the unplanned post-hoc analysis of a randomised trial, measurable improvement in long-term dysphagia has been shown following a reduction in the CTV. Further reductions in the CTV should be subject to similar scrutiny within the confines of a prospective study.
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Affiliation(s)
- M Vreugdenhil
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - C Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - G Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Roques
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - M Evans
- Velindre University NHS Trust, Cardiff, UK
| | | | - H Yang
- Addenbrooke's Hospital, Cambridge, UK
| | - L O'Toole
- Castle Hill Hospital, Cottingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | | | - B Foran
- Weston Park Hospital, Sheffield, UK
| | - M Sen
- St James' Institute of Oncology, Leeds, UK
| | - H Al Booz
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - M Dalby
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
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Lau D, Fong C, Arouri F, Cortez L, Katifi H, Gonzalez-Exposito R, Razzaq M, Li S, Macklin-Doherty A, Fribbens C, Watkins D, Rao S, Chau I, Cunningham D, Starling N. 453P Routine DPYD mutation testing for patients receiving fluoropyrimidines for gastrointestinal (GI) cancers: Real world experience in a tertiary UK oncology centre. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Chang J, Vreugdenhil M, Fong C, Sanghera P, Hartley A. In Response to Lewis et al. Clin Oncol (R Coll Radiol) 2021; 33:e613. [PMID: 34215449 DOI: 10.1016/j.clon.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Affiliation(s)
- J Chang
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - M Vreugdenhil
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
| | - C Fong
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - P Sanghera
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - A Hartley
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
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Jiang NN, Sahlas DJ, Fong C, Wu W, Monteiro S, Larrazabal R. Radiographic horizontal gaze deviation in the setting of acute PICA territory ischemia: A potential mimic of large vessel occlusion. J Neurol Sci 2020; 420:117226. [PMID: 33316616 DOI: 10.1016/j.jns.2020.117226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Horizontal gaze deviation (HGD) is a predictor of acute large vessel occlusion (LVO) and helps to expedite the triage of patients to CTA and endovascular-capable sites. Patients with acute cerebellar ischemia, particularly involving the PICA territory, can also exhibit HGD. MATERIALS AND METHODS We reviewed 2260 CTA stroke assessment cases between January 2016 and May 2020. Forty-six patients with CTA-proven acute PICA occlusions were identified and compared with 114 patients with acute LVO (ICA, M1, and M1/2). Both clinical and radiographic HGD were examined. The degree of radiographic HGD was measured for each patient. Site of ischemia was confirmed on subsequent MRI. RESULTS Of the 46 patients with acute PICA occlusions, 20 (43.5%) patients had radiographic (+) HGD with either ipsilateral or contralateral gaze deviation, 6 of whom (13.0%) displayed clinical HGD. Of the 114 patients with LVO (control group), 72 (63.2%) patients had radiographic (+) HGD, all ipsilateral, 49 of whom (68.0%) displayed clinical HGD. The mean degree of HGD between PICA and LVO were 30.0° vs. 22.9°, respectively, p < 0.001; AUC = 0.68. CONCLUSION Patients with acute PICA occlusion can exhibit either ipsilateral or contralateral HGD and a higher degree of HGD than LVO occlusion on NECT. In hyperacute stroke, the presence of radiographic HGD > 30° in the absence of ischemic changes in the MCA territory should prompt clinicians to closely evaluate for features of early ischemic changes in the cerebellar hemispheres that suggest acute PICA occlusion.
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Affiliation(s)
- Nan N Jiang
- Department of Diagnostic Radiology, Hamilton General Hospital, McMaster University, United States of America
| | - Demetrios J Sahlas
- Department of Medicine (Neurology), Hamilton General Hospital, McMaster University, Canada
| | - Crystal Fong
- Department of Diagnostic Radiology, Hamilton General Hospital, McMaster University, United States of America
| | - Wei Wu
- Faculty of Medicine, McGill University, United States of America
| | - Sandra Monteiro
- Department of Biostatistics, Hamilton Health Sciences, McMaster University, United States of America
| | - Ramiro Larrazabal
- Department of Diagnostic Radiology, Hamilton General Hospital, McMaster University, United States of America.
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13
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Graham AK, Fong C, Naqvi A, Lu JQ. Toxoplasmosis of the central nervous system: Manifestations vary with immune responses. J Neurol Sci 2020; 420:117223. [PMID: 33213861 DOI: 10.1016/j.jns.2020.117223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022]
Abstract
Toxoplasmosis is an opportunistic infection caused by Toxoplasma gondii (TG), which affects one third of the global human population and commonly involves the central nervous system (CNS)/brain despite the so-called CNS immune privilege. Symptomatic clinical disease of TG infection is much more commonly associated with immunodeficiency; clinicopathological manifestations of CNS toxoplasmosis are linked to individual immune responses including the CNS infiltration of T-cells that are thought to prevent the disease. In patients with autoimmune diseases, immune status is complicated mainly byimmunosuppressant and/or immunomodulatory treatment but typically accompanied by infiltration of T-cells that supposedly fight against toxoplasmosis. In this article, we review characteristics of CNS toxoplasmosis comparatively in immunocompromised patients, immunocompetent patients, and patients with coexisting autoimmune diseases, as well as CNS immune responses to toxoplasmosis with a representative case to demonstrate brain lesions at different stages. In addition to general understanding of CNS toxoplasmosis, our review reveals that clinical manifestations of CNS toxoplasmosis are commonly nonspecific, and incidental pathological findings of TG infection are relatively common in immunocompetent patients and patients with autoimmune diseases (compared to immunocompromised patients); CNS immune responses such as T-cell infiltrates vary in acute and chronic lesions of brain toxoplasmosis.
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Affiliation(s)
- Alice K Graham
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
| | - Crystal Fong
- Neuroradiology Division, Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Asghar Naqvi
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada; Neuropathology Section, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
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14
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Snyder HE, Ali S, Sue J, Unsal A, Fong C, Deng Z. Artery of Percheron infarction with persistent amnesia: a case report of bilateral paramedian thalamic syndrome. BMC Neurol 2020; 20:370. [PMID: 33032538 PMCID: PMC7545865 DOI: 10.1186/s12883-020-01949-0] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background The artery of Percheron is an uncommon anatomic variant which supplies the bilateral paramedian thalami and rostral midbrain. While infarction of its vascular territory can result in a wide range of symptoms, paramedian thalamic syndrome is classically described as a triad of symptoms including vertical gaze disturbances, fluctuating level of consciousness, and amnesia. There is minimal evidence to date to characterize the long-term cognitive consequences of infarction of the artery of Percheron utilizing neuropsychological assessment. Case presentation We describe a 40-year-old female patient initially presenting with dizziness, confusion and falls with unremarkable head CT scans. Subsequent MRI, more than 24 h after symptom onset, identified evidence of bilateral thalamic and rostral midbrain infarction. Neuropsychological testing was administered at 4 months post-stroke, with follow up testing at 1 year. The patient was found to have profound anterograde and retrograde amnesia, which did not change significantly over the first year of rehabilitation, and which was not easily identifiable in everyday encounters due to her relatively intact working memory and social skills. Conclusions As early diagnosis of infarction of the artery of Percheron is challenging, patients have frequently missed the time window for acute management of ischemic stroke. Moreover, this case study highlights the need for further research in deciphering the role of the paramedian thalamus in memory and cognition, as well as the importance of standardized neuropsychological testing for the artery of Percheron stroke patients to identify safety and rehabilitation concerns that may be overlooked.
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Affiliation(s)
- Hannah E Snyder
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sheliza Ali
- Regional Rehabilitation Centre, Hamilton Health Sciences, Hamilton, Canada.,Department of Psychology, University of Victoria, Victoria, Canada
| | - Joanna Sue
- Regional Rehabilitation Centre, Hamilton Health Sciences, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ayse Unsal
- Regional Rehabilitation Centre, Hamilton Health Sciences, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Canada
| | - Zhihui Deng
- Regional Rehabilitation Centre, Hamilton Health Sciences, Hamilton, Canada. .,Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, Canada.
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15
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Jiang NN, Wu W, Fong C, Sahlas DJ, Larrazabal R. Role of Radiological Eye Deviation in Imaging Occult Cases of Acute Large Vessel Occlusion. J Stroke Cerebrovasc Dis 2020; 29:104687. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
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16
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Jiang NN, Fong C, Sahlas DJ, Monteiro S, Larrazabal R. Response to “Potential Clinical and Radiographic Horizontal Gaze Deviation an Early Sign of Stroke”. J Stroke Cerebrovasc Dis 2019; 28:104393. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104393] [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: 10/25/2022] Open
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17
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Lu JQ, Fong C, Attar A. Levodopa-responsive parkinsonism in a patient with corticobasal degeneration and bilateral choroid plexus xanthogranulomas. J Clin Neurosci 2019; 71:286-289. [PMID: 31537463 DOI: 10.1016/j.jocn.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022]
Abstract
Corticobasal degeneration (CBD) has substantial overlap of clinical features with other neurodegenerative diseases including Parkinson's disease (PD). Its clinical diagnostic accuracy is the lowest among the common neurodegenerative diseases, and its antemortem diagnosis is more challenging when CBD is comorbid with another brain disease. We report an elderly male patient with multiple medical conditions and a family history of essential tremor. He presented with progressive tremor that was initially thought to be essential tremor and later diagnosed as PD despite head computerized tomography showing bilateral intraventricular masses and other minor changes. The clinical diagnosis of PD was supported by his responsiveness to low-dose levodopa. However, postmortem neuropathological examination revealed CBD and bilateral choroid plexus xanthogranulomas with mild ventricular enlargement and multifocal ependymal lining injury presumably due to mild hydrocephalus. CBD is typically levodopa-unresponsive, but hydrocephalus-associated parkinsonism is commonly levodopa-responsive. We raise awareness of the present comorbidity and atypical parkinsonism due to the choroid plexus xanthogranuloma-induced hydrocephalus for the clinical diagnosis and management of parkinsonism.
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Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Neuropathology, McMaster University, Hamilton, Ontario, Canada.
| | - Crystal Fong
- Department of Diagnostic Imaging, Neuroradiology, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Attar
- Department Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada
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Davidson M, Butler C, Butters O, Fong C, Turkes F, Cafferkey C, Kouvelakis K, Cunningham D, Watkins D, Rao S, Starling N, Chau I. Treatment of relapsed oesophagogastric adenocarcinoma after perioperative chemotherapy and surgery. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.200] [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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19
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Carver A, Hickman M, Warren S, Ward M, Thomas A, Sanghera P, Fong C, Hartley A. EP-1924 Are spatial dose metrics predictive of oral mucositis duration in oropharyngeal cancer? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32344-8] [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: 10/26/2022]
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20
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Sawlani V, Davies N, Patel M, Flintham R, Fong C, Heyes G, Cruickshank G, Steven N, Peet A, Hartley A, Benghiat H, Meade S, Sanghera P. Evaluation of Response to Stereotactic Radiosurgery in Brain Metastases Using Multiparametric Magnetic Resonance Imaging and a Review of the Literature. Clin Oncol (R Coll Radiol) 2018; 31:41-49. [PMID: 30274767 DOI: 10.1016/j.clon.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
AIMS Following stereotactic radiosurgery (SRS), brain metastases initially increase in size in up to a third of cases, suggesting treatment failure. Current imaging using structural magnetic resonance imaging (MRI) cannot differentiate between tumour recurrence and SRS-induced changes, creating difficulties with patient management. Combining multiparametric MRI techniques, which assess tissue physiological and metabolic information, has shown promise in answering this clinical question. MATERIALS AND METHODS Multiparametric MRI techniques, including spectroscopy, diffusion and perfusion imaging, were used for the differentiation of radiation-related changes and tumour recurrence after SRS for intracranial metastases in six cases. All patients presented with enlargement of the treated lesion, an increase in perilesional brain oedema and aggravation or appearance of neurological signs and symptoms from 7 to 29 weeks after primary treatment. RESULTS Multiparametric imaging helped to differentiate features of tumour progression (n = 4) from radiation-related changes (n = 2). A low apparent diffusion coefficient (ADC) <1000 × 10-6 mm2/s, high relative cerebral blood volume (rCBV) ratio > 2.1, high choline:creatine (Cho:Cr) ratio > 1.8 suggested tumour recurrence. A high ADC > 1000 × 10-6 mm2/s, low rCBV ratio < 2.1, Cho:Cr ratio < 1.8 suggested SRS-induced radiation changes. Multiparametric MRI diagnosis was confirmed by histology or radiological and clinical follow-up. CONCLUSION Multiparametric MRI was helpful in the early identification of radiation-related changes and tumour recurrence and may be useful for monitoring treatment changes in intracranial neoplasms after SRS treatment.
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Affiliation(s)
- V Sawlani
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - N Davies
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Patel
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Flintham
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Fong
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Heyes
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Cruickshank
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Steven
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Peet
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - A Hartley
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Benghiat
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Meade
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Sanghera
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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21
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Lu JQ, Menon S, Fong C, Lach B, Power C. Tumor-to-Lesion Metastasis: Case Report of Carcinoma Metastasis to Multiple Sclerosis Lesion. World Neurosurg 2018; 116:14-17. [PMID: 29772358 DOI: 10.1016/j.wneu.2018.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The term "tumor-to-lesion metastasis" is an extension of "tumor-to-tumor metastasis," which is a rare but well-documented phenomenon. Tumor metastasis to the meninges and/or central nervous system (CNS) is rare in patents with multiple sclerosis (MS), although MS lesions bear many similarities to the primary tumor microenvironment and metastatic niche. We present the first case of malignant tumor metastasis to MS lesions with immunophenotyping of inflammatory cells in the metastatic foci. CASE DESCRIPTION A 45-year-old male patient with a 6-year history of MS and newly diagnosed lung carcinoma developed carcinoma metastases in the meninges and CNS, as well as into mixed active/inactive MS lesions. The carcinoma-hosting MS lesions exhibited abundant macrophages/microglia with ongoing demyelination but rare T cells. In comparison, a 46-year-old female patient with a 21-month history of MS and newly diagnosed gastric carcinoma was found to have leptomeningeal carcinomatosis and separate active MS lesions containing not only frequent macrophages/microglia but also T cells. CONCLUSIONS The carcinoma-hosting MS lesions are unlike typical active lesions but recapitulate the CNS metastatic niche. Our observations suggest that metastasis-hosting MS lesions might require a distinct immune microenvironment to be permissive to the seeding and growth of metastatic tumors.
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Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology and Molecular Medicine (Neuropathology), McMaster University, Hamilton, Ontario, Canada.
| | - Suresh Menon
- Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada
| | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Boleslaw Lach
- Department of Pathology and Molecular Medicine (Neuropathology), McMaster University, Hamilton, Ontario, Canada
| | - Christopher Power
- Department of Medicine (Neurology), Multiple Sclerosis Centre, University of Alberta, Edmonton, Alberta, Canada
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22
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Fong C, Good J, Hickman M, Hartley A, Sanghera P. Systematic Outcome Documentation and Potential Impact of New International Delineation Guidelines for Head and Neck Contouring Peer Review. Clin Oncol (R Coll Radiol) 2018; 30:593. [PMID: 29709254 DOI: 10.1016/j.clon.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 03/23/2018] [Accepted: 04/16/2018] [Indexed: 11/24/2022]
Affiliation(s)
- C Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - J Good
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - M Hickman
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
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Hickman M, Kelly S, Fong C, Nightingale P, Sanghera P, Mehanna H, Hartley A. OC-0095: Use of a patient reported outcome as a potential radiobiological endpoint in oropharyngeal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30405-5] [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: 10/14/2022]
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Hartley A, Best J, Fong C, Benhiat H, Mehanna H, Glaholm J. EP-2283: Squamous cell carcinoma of the head and neck: a low α/β when treated with synchronous cisplatin? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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25
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Lalani N, Paszat L, Sutradhar R, Gu S, Fong C, Nofech-Mozes S, Hanna W, Tuck A, Youngson B, Miller N, Done SJ, Chang MC, Sengupta S, Elavathil L, Jani PA, Bonin M, Rakovitch E. Abstract P4-15-05: The presence of one or multiple foci of microinvasion is not associated with an increased risk of local recurrence in women with ductal carcinoma in situ treated with breast conserving therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-15-05] [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: Ductal Carcinoma in Situ (DCIS) is a non-invasive breast cancer often treated with breast-conserving surgery (BCS) with or without radiotherapy (RT). It is unclear if the presence of microinvasion (MI) (invasion ≤1mm) is associated with an increased risk of LR (DCIS or invasive) or invasive LR compared to women with pure DCIS. In addition, the impact of multiple foci (>2) of MI compared to pure DCIS is also unknown; therefore, it is unclear if some women with MI require more aggressive treatment. We evaluated the impact of the presence of MI and the number of foci of MI on the risks of any LR and invasive LR in a population of women with DCIS with and without MI treated with BCS.
Methods: The cohort includes all women diagnosed with pure DCIS or DCIS with MI in Ontario from 1994-2003 treated with BCS +/- RT. All cases had systematic pathology review to confirm the presence and number of foci of MI. Treatment and outcomes were ascertained through administrative databases and validated by chart review. Cox proportional hazards model was used to evaluate the impact of MI and the number of foci of MI (1 vs >2 foci) on the development of any LR and invasive LR compared to cases with pure DCIS. The 10-yr local recurrence-free survival (LRFS) and invasive LRFS rates were calculated using the Kaplan-Meier approach with differences compared using the log-rank test.
Results: The population cohort includes 2,988 women with DCIS treated by BCS (N=2,721 pure DCIS, N= 267 DCIS with MI). Median follow-up (12 years; p=.23) and median age at diagnosis (58 years; p=.17) were similar in both groups. RT was given in 58% of cases with MI and 51% of cases with pure DCIS (p=.03). Hormonal therapy was utilized in 7.1% of women with MI and 5.3% of women with pure DCIS (p=.22). LR developed in 59 (22.1%) cases with MI and 530 (19.6%) cases of pure DCIS. Women with MI were more likely to have high nuclear grade (p<.001), and larger tumor size (p<.001) compared to those without MI. On multivariable analyses adjusted for age, the presence of 1 focus of MI(HR=.92, 95% CI: .64-1.33) or ≥2 foci of MI (HR=1.26, 95% CI: .85-1.85) was not associated with an increased risk of any LR compared to cases with pure DCIS. Factors associated with any LR were age <50 years at diagnosis, RT, multifocality and high nuclear grade. The presence of 1 focus of MI (HR=.86, 95% CI: .52-1.40) or > 2 foci of MI (HR=1.45, 95% CI: .90-2.32) was also not associated with an increased risk of invasive LR compared to cases of pure DCIS. Among women treated with BCS alone, the 10 year LRFS rates were 80%, 75% and 73% for women with pure DCIS, 1 focus, >2 foci of MI (p=.10). The invasive LRFS rates were 89%, 91% and 85% (p=.26). Among women treated with BCS+RT, the 10 year LRFS rates were 87%, 88% and 80% (p=0.32) for women with pure DCIS, 1 focus or ≥2 foci of MI. The invasive LRFS rates were 93%, 90% and 86% (p=.44). There was no interaction between the presence of MI and RT.
Conclusions: Women with DCIS with one or multiple foci of microinvasion (<1mm) treated by breast conserving therapy do not have an increased risk of LR or invasive LR compared to women with pure DCIS.
Citation Format: Lalani N, Paszat L, Sutradhar R, Gu S, Fong C, Nofech-Mozes S, Hanna W, Tuck A, Youngson B, Miller N, Done SJ, Chang MC, Sengupta S, Elavathil L, Jani PA, Bonin M, Rakovitch E. The presence of one or multiple foci of microinvasion is not associated with an increased risk of local recurrence in women with ductal carcinoma in situ treated with breast conserving therapy [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 P4-15-05.
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Affiliation(s)
- N Lalani
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - L Paszat
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - R Sutradhar
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Gu
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - C Fong
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Nofech-Mozes
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - W Hanna
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - A Tuck
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - B Youngson
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - N Miller
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - SJ Done
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - MC Chang
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Sengupta
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - L Elavathil
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - PA Jani
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - M Bonin
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - E Rakovitch
- University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Health Sciences Centre, London, ON, Canada; University Health Network, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
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Lalani N, Paszat L, Nofech-Mozes S, Sutradhar R, Gu S, Hanna W, Fong C, Miller N, Youngson B, Done SJ, Tuck A, Chang MC, Sengupta S, Jani PA, Bonin M, Rakovitch E. Abstract P2-12-02: Is breast-conserving therapy effective in women with large ductal carcinoma in situ (DCIS) lesions? A population-based analysis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-12-02] [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: Most women diagnosed with DCIS will be treated by breast-conserving surgery (BCS) with or without radiotherapy (RT). Data on outcomes following breast-conserving therapy are predominantly based on women with small (<25mm) lesions. The paucity of data on outcomes of women with larger (>40mm) DCIS lesions leads to uncertainty of the appropriateness of breast-conserving therapy for women with larger lesions. Specifically, it is unclear if women with large tumors experience higher risks of local recurrence (LR) and invasive LR after BCS+/-RT that would preclude recommendations of breast-conserving therapy. We report the outcomes and evaluate the impact of large tumor size (>40mm) on recurrence risk in a population of women with pure DCIS treated by BCS alone or with RT.
Methods: The cohort includes all women diagnosed with DCIS in Ontario from 1994-2003 treated with BCS +/- RT; 82% had pathology review. Treatment and outcomes were ascertained through administrative databases and validated by chart review. Cox proportional hazards model was used to evaluate the impact of tumor size (≤10mm,11-25mm, 26-39mm, ≥40mm) on the development of any LR (DCIS or invasive) and invasive LR. The 10 and 15-year LR-free survival (LRFS) and invasive LRFS rates were calculated using the Kaplan-Meier method with differences compared using the log-rank test.
Results: The cohort includes 3262 women with DCIS treated by BCS (N=1635 had RT). Median age at diagnosis was 59 years (IQR 50-68 years). Median follow-up was 13 years (IQR 8-15 years). Distribution of tumor size: 707 (22%) ≤10mm, 524 (16%) 11-25mm, 107 (3%) 26-39mm, 84 (3%) ≥40mm, unable to determine in 1840 (56%). Women with lesions ≥ 40mm were more likely to be ≤50 years of age at diagnosis (p=.02), have high nuclear grade (p<.001), multifocality (p<.001), and positive margins (p<.001) compared to women with smaller lesions. On multivariable analyses adjusted for age and year of diagnosis, tumor size ≥40mm was significantly associated with an increased risk of LR compared to size ≤10mm (HR=2.5, 95%CI:1.64-3.81). Other factors associated with LR were age <50 years (p<.001), omission of RT (p<.001), high nuclear grade (p=.002), and multifocality (p=.0008). Tumor size ≥40mm was not significantly associated with an increased risk of invasive LR (HR=1.68, 95%CI:.94-3.04). Women with tumour size ≥40mm treated with BCS alone had lower 10 and 15 year LRFS (53% and 41%) and invasive LRFS rates (78% and 75%) compared to women with smaller lesions. However, women with larger lesions treated with RT had significantly higher LRFS and invasive LRFS rates
Outcomes by tumour size for women with DCIS treated with BCS with or without RT ≤10mm N=70711-25mm N=52426-39mm N=107≥40mm N=84p-valueBCS AloneLRFS (%) 10 yr85797053<0.001 15 yr81746741 Invasive LRFS (%) 10 yr928786780.03 15 yr89838375 BCS + RTLRFS (%) 10 yr928874850.01 15 yr86847079 Invasive LRFS (%) 10 yr959492910.27 15 yr90918789
. There was a significant interaction between tumor size ≥40mm and RT (p=.02).
Conclusions: Women with DCIS lesions ≥40mm treated by BCS alone experience significantly higher risks of LR and invasive LR compared to smaller lesions but this risk can be mitigated with the addition of RT.
Citation Format: Lalani N, Paszat L, Nofech-Mozes S, Sutradhar R, Gu S, Hanna W, Fong C, Miller N, Youngson B, Done SJ, Tuck A, Chang MC, Sengupta S, Jani PA, Bonin M, Rakovitch E. Is breast-conserving therapy effective in women with large ductal carcinoma in situ (DCIS) lesions? A population-based analysis [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 P2-12-02.
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Affiliation(s)
- N Lalani
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - L Paszat
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - S Nofech-Mozes
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - R Sutradhar
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - S Gu
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - W Hanna
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - C Fong
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - N Miller
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - B Youngson
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - SJ Done
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - A Tuck
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - MC Chang
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - S Sengupta
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - PA Jani
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - M Bonin
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
| | - E Rakovitch
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Clinical Evaluative Sciences, Toronto, ON, Canada; Univeristy Health Network, Toronto, ON, Canada; London Health Sciences Centre, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Queen's University, Kingston, ON, Canada; Thunder Bay Regional Health Sciences Centre & Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial. Osteoarthritis Cartilage 2017; 25:1969-1979. [PMID: 28011099 DOI: 10.1016/j.joca.2016.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim was to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Secondary aims evaluated the effects on cardiovascular health, function and quality of life. DESIGN Participants with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity, or to usual care. The primary outcome was knee pain (0-10). Secondary outcomes were of cardiovascular risk including physical activity, blood pressure, blood lipid and glucose levels, body mass index and waist circumference; WOMAC Index scores; physical function; and quality of life. RESULTS Forty-six participants (23 each group) were recruited. Sixteen participants (70%) adhered to the walking program. Intention to treat analysis showed no between-group difference in knee pain. The walking group had increased odds of achieving a healthy systolic blood pressure (OR = 5.7, 95% CI 1.2-26.9), and a faster walking speed (Mean Difference (MD) = 0.12 m/s, 95% CI 0.02-0.23). Per protocol analysis based on participant adherence showed the walking group had more daily steps (MD = 1345 steps, 95% CI 365-2325); more time walking (MD = 18 min/day, 95% CI 5-31); reduced waist circumference (MD = -5.3 cm, 95% CI -10.5 to -0.03); and increased knee stiffness (MD = 0.9 units, 95% CI 0.07-1.8). CONCLUSIONS Patients with severe knee OA prescribed a 12-week walking program of 70 min/week may have had cardiovascular benefits without decreasing knee pain. Australian New Zealand Clinical Trials Registry ACTRN12615000015549.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Monash and Deakin University, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Monash University, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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Fong C, Sanghera P, Good J, Nightingale P, Hartley A. Implementing Head and Neck Contouring Peer Review without Pathway Delay: The On-demand Approach. Clin Oncol (R Coll Radiol) 2017; 29:841-847. [DOI: 10.1016/j.clon.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 09/06/2017] [Indexed: 11/24/2022]
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Lalani N, Paszat L, Sutradhar R, Gu S, Fong C, S. nofech-Mozes, Hanna W, Tuck A, Youngson B, Miller N, Done S, Chang M, Sengupta S, Elavathil L, Jani P, Bonin M, Rakovitch E. Impact of Microinvasion as a Predictor of Local Recurrence in Ductal Carcinoma In Situ Treated With Breast Conserving Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sood S, Fong C, Kalyanam K, Kveton O, Busigin A, Ruthven D. A New Pressure Swing Adsorption (PSA) Process for Recovery of Tritium from the Iter Solid Ceramic Breeder Helium Purge Gas. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst92-a29761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S.K. Sood
- Ontario Hydro700 University Ave., Toronto, Ontario M5G 1X6 (416) 592-5501
| | - C. Fong
- Ontario Hydro700 University Ave., Toronto, Ontario M5G 1X6 (416) 592-5501
| | - K.M. Kalyanam
- Ontario Hydro700 University Ave., Toronto, Ontario M5G 1X6 (416) 592-5501
| | - O.K. Kveton
- Canadian Fusion Fuels Technology Project, 2700 Lakeshore Road West, Mississauga, Ontario L5J 1K3 (416) 855-4718
| | - A. Busigin
- NITEK Corporation 939 Griffith Street, London, Ontario N6K 3S2 (519) 657-4914
| | - D.M. Ruthven
- University of New Brunswick Fredericton, New Brunswick E3B 5A3 (506) 453-4520
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31
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Fong C, Chow A, Chan C. INTEGRATIVE AND HOLISTIC END-OF-LIFE CARE: INSIGHTS FROM A COMMUNITY-WIDE SURVEY IN CHINESE SOCIETY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C. Fong
- Department of Social Work, The University of Hong Kong, Hong Kong, Hong Kong
| | - A. Chow
- Department of Social Work, The University of Hong Kong, Hong Kong, Hong Kong
| | - C. Chan
- Department of Social Work, The University of Hong Kong, Hong Kong, Hong Kong
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Fong C, Boon I, Boon C, Benghiat H, Hickman M, Nightingale P, Hartley A, Sanghera P. Hypofractionated Accelerated Chemoradiation for Oropharyngeal Cancer and the 2016 Royal College of Radiologists’ Fractionation Guidelines. Clin Oncol (R Coll Radiol) 2017; 29:e138. [DOI: 10.1016/j.clon.2017.02.003] [Citation(s) in RCA: 2] [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] [Received: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Boon I, Boon C, Nightingale P, Cashmore J, Sangha G, Hickman M, Benghiat H, Fong C, Sanghera P, Hartley A. PO-079: Hypofractionated versus prolonged chemo-IMRT schedules in oropharyngeal carcinoma. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30213-x] [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: 11/29/2022]
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Hickman M, Meade S, Fong C, Sanghera P, Good J, Hartley A. A prospective comparison of common toxicity criteria adverse events Version 3 and 4 in assessing oral mucositis for oral and oropharyngeal carcinoma. Tech Innov Patient Support Radiat Oncol 2017; 1:18-21. [PMID: 32095539 PMCID: PMC7033787 DOI: 10.1016/j.tipsro.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND PURPOSE Oral mucositis is an expected complication of radiotherapy in the management of carcinoma of the head and neck. The Common Terminology Criteria for Adverse Events (CTCAE) Version 3 (V3) and related systems based on mucosal appearance have been used in clinical trials historically. More recently, Version 4 (V4) which is based on patient symptoms has been employed. This study compares the use of V3 and V4 in the grading of mucositis in patients undergoing radiotherapy with or without concurrent systemic therapy for carcinoma of the oral cavity and oropharynx. METHODS Oral mucositis was graded prospectively in patients receiving radiotherapy with or without concurrent systemic therapy using both V3 and V4. Grading was recorded during and after completion of therapy. RESULTS Between November 2014 and November 2015, 555 measurements were taken from 73 patients. Mucositis scores were equal in both versions in 327 (59%) measurements. Significant differences between V3 and V4 were seen in patients receiving cetuximab-based concurrent therapy (p < 0.001) and beyond 8 weeks from the start of radiotherapy (p = 0.004). CONCLUSION Differences in grading of mucositis scored by V3 and V4 are frequent. Relationships between biologically effective dose and rates of grade 3 mucositis have historically been based on mucosal appearances. It is not known whether the same relationships apply when mucositis is graded based on symptomatic grading systems. Both V3 and V4 should be used in clinical trials to improve understanding of mucositis and its relationship to quality of life and late mucosal toxicity.
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Affiliation(s)
| | | | | | | | | | - A. Hartley
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Rakovitch E, Nofech-Mozes S, Hanna W, Gu S, Fong C, Tuck A, Sengupta S, Elavathil L, Jani P, Done S, Miller N, Youngson B, Bonin M, Chang M, Paszat L. Abstract P3-17-01: Long-term rates of breast preservation after breast-conserving therapy for ductal carcinoma in situ. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-17-01] [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: Despite evidence that radiotherapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) halves the risk of recurrence, the benefit of RT in the management of DCIS continues to be a matter of controversy. One argument against the use of RT after BCS is that patients who develop ipsilateral local recurrence (LR) can be salvaged with further breast-conserving surgery such that the omission of RT will lead to high rates of breast preservation while minimizing exposure to RT. Breast preservation is an important determinant of quality of life for women with early stage breast cancer and DCIS. Yet the management of LR and the impact of RT on the resultant long-term risks of bilateral breast preservation in a population of women with DCIS are unclear. We assessed the treatment of LR, the impact of RT on the use of salvage mastectomy and the long-term risks of bilateral breast preservation achieved in a population of women with DCIS treated with BCS alone or BCS+RT.
Methods: A population-based analysis of women diagnosed with DCIS from 1994-2003 treated with BCS alone or BCS+RT with pathology review. Treatment and outcomes, including the development of LR and contralateral breast events, were determined by administrative databases with validation by review of operative or pathology reports. Median follow-up was 10.2 years for cases treated by BCS alone, 11.6 years for those treated by BCS+RT. We used a propensity-adjusted Cox proportional hazards model to evaluate factors associated with the use of salvage mastectomy for LR and to evaluate factors associated with any mastectomy. We assessed the risk of long-term breast preservation by calculating the KM 10-year risk of ipsilateral mastectomy and any mastectomy.
Results: The population cohort includes 3303 women with pure DCIS;1649 (50%) were treated by BCS alone, 1654 (50%) received BCS+RT. Women treated with RT had more high risk features of DCIS than those treated by BCS alone. LR developed in 343 (21%) women treated by BCS alone and in 257 (15.5%) women treated by BCS+RT (p<0.01). Most women who developed LR received salvage mastectomy, irrespective of age at diagnosis and histology. Salvage mastectomy was used in 57.4% (197/343) of cases that recurred after BCS alone and in 67.6% (173/257) that recurred after BCS+RT. The likelihood of receiving salvage mastectomy for LR was similar in patients initially treated by BCS+RT vs. those initially treated BCS alone. Most (90%) of mastectomies were performed for a LR. Overall, individuals initially treated by BCS+RT had a 29% lower probability of having a mastectomy at 10 years compared to those treated by BCS alone (HR=0.71, 95%CI: 0.60,0.84,p<0.0001). The 10 year mastectomy-free survival rates are 82.7% for women initially treated by BCS alone and 87.3% for those treated by BCS+RT (p=0.0096).
Conclusion: Women who received RT after BCS for DCIS experience a greater likelihood of long-term bilateral breast preservation. This is attributable to the lower risks of LR and that most local recurrences after breast-conserving therapy are treated by salvage mastectomy. Long-term breast preservation should be considered in discussions weighing the benefits and risks of RT after conservative surgery for DCIS.
Citation Format: Rakovitch E, Nofech-Mozes S, Hanna W, Gu S, Fong C, Tuck A, Sengupta S, Elavathil L, Jani P, Done S, Miller N, Youngson B, Bonin M, Chang M, Paszat L. Long-term rates of breast preservation after breast-conserving therapy for ductal carcinoma in situ [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 P3-17-01.
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Affiliation(s)
- E Rakovitch
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Nofech-Mozes
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - W Hanna
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Gu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - C Fong
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - A Tuck
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Sengupta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - L Elavathil
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - P Jani
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - S Done
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - N Miller
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - B Youngson
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - M Bonin
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - M Chang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - L Paszat
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; University Health Network, Toronto, ON, Canada; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada; Henderson General Hospital, Hamilton, ON, Canada; Sudbury Regional Hospital, Sudbury, ON, Canada; London Health Sciences Centre, London, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada
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Hartley A, Fong C, Sanghera P, Wong W, McConkey C, Rahman J, Nutting C, Al-Booz H, Robinson M, Junor E, Rizwanullah M, Dunn J, Mehanna H. Radiation Therapy Variation in the Randomized Phase 3 Positron Emission Tomography Neck Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.285] [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: 10/20/2022]
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Cavalcanti PG, Shirani S, Scharcanski J, Fong C, Meng J, Castelli J, Koff D. Lung nodule segmentation in chest computed tomography using a novel background estimation method. Quant Imaging Med Surg 2016; 6:16-24. [PMID: 26981451 DOI: 10.3978/j.issn.2223-4292.2016.02.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lung cancer results in the highest number of cancer deaths worldwide. The segmentation of lung nodules is an important task in computer systems to help physicians differentiate malignant lesions from benign lesions. However, it has already been observed that this may be a difficult task, especially when nodules are connected to an anatomical structure. METHODS This paper proposes a method to estimate the background of the nodule area and how this estimation is used to facilitate the segmentation task. RESULTS Our experiments indicate more than 99% of accuracy with less than 1% of false positive rate (FPR). CONCLUSIONS The proposed methods achieved better results than a state-of-the-art approach, indicating potential to be used in medical image processing systems.
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Affiliation(s)
- Pablo G Cavalcanti
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shahram Shirani
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jacob Scharcanski
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Crystal Fong
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jane Meng
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jane Castelli
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Koff
- 1 Department of Informatics, Federal University of Technology-Paraná, Via do Conhecimento Km 1, Pato Branco, PR, Brazil ; 2 Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada ; 3 Institute of Informatics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil ; 4 Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada ; 5 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Hernandez-Mejia M, Prendiville B, Fong C, Burke M, Nguyen L, Schiehser D, Turk E, Delis D, Filoteo J. A-27The Impact of Reduced Retrieval Demands on Verbal Memory in Parkinson's Disease Patients at Various Levels of Global Cognitive Functioning. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial. Osteoarthritis Cartilage 2015; 23:1285-93. [PMID: 25882926 DOI: 10.1016/j.joca.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/10/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). DESIGN Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS Twenty-four participants (13 women) aged 53-83 years, and average body mass index (BMI) of 34 kg/m(2) (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R(2) = 0.31, cubic R(2) = 0.69) and reduced stiffness (linear R(2) = 0.20, cubic R(2) = 0.52), with increased benefits at moderate to higher doses. CONCLUSIONS There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.
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Affiliation(s)
- J A Wallis
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia.
| | - K E Webster
- School of Allied Health, La Trobe University, Australia
| | - P Levinger
- Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Australia
| | - P J Singh
- Department of Orthopaedics, Eastern Health, Australia
| | - C Fong
- Department of Rheumatology, Eastern Health, Australia
| | - N F Taylor
- School of Allied Health, La Trobe University, Australia; Department of Physiotherapy, Eastern Health, Australia
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Vogel BH, Bradley SE, Adams DJ, D'Aco K, Erbe RW, Fong C, Iglesias A, Kronn D, Levy P, Morrissey M, Orsini J, Parton P, Pellegrino J, Saavedra-Matiz CA, Shur N, Wasserstein M, Raymond GV, Caggana M. Newborn screening for X-linked adrenoleukodystrophy in New York State: diagnostic protocol, surveillance protocol and treatment guidelines. Mol Genet Metab 2015; 114:599-603. [PMID: 25724074 DOI: 10.1016/j.ymgme.2015.02.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [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] [Received: 12/09/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe a diagnostic protocol, surveillance and treatment guidelines, genetic counseling considerations and long-term follow-up data elements developed in preparation for X-linked adrenoleukodystrophy (X-ALD) newborn screening in New York State. METHODS A group including the director from each regional NYS inherited metabolic disorder center, personnel from the NYS Newborn Screening Program, and others prepared a follow-up plan for X-ALD NBS. Over the months preceding the start of screening, a series of conference calls took place to develop and refine a complete newborn screening system from initial positive screen results to long-term follow-up. RESULTS A diagnostic protocol was developed to determine for each newborn with a positive screen whether the final diagnosis is X-ALD, carrier of X-ALD, Zellweger spectrum disorder, acyl CoA oxidase deficiency or D-bifunctional protein deficiency. For asymptomatic males with X-ALD, surveillance protocols were developed for use at the time of diagnosis, during childhood and during adulthood. Considerations for timing of treatment of adrenal and cerebral disease were developed. CONCLUSION Because New York was the first newborn screening laboratory to include X-ALD on its panel, and symptoms may not develop for years, long-term follow-up is needed to evaluate the presented guidelines.
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Affiliation(s)
- B H Vogel
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
| | - S E Bradley
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - D J Adams
- Jacobs Equity Management Personalized Genomic Medicine Program, Goryeb Pediatrics Genetics and Metabolism, Morristown, NJ, USA
| | - K D'Aco
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - R W Erbe
- Division of Genetics, Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - C Fong
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - A Iglesias
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - D Kronn
- New York Medical College, Valhalla, NY, USA
| | - P Levy
- Center for Inherited Medical Disorders, Children's Hospital at Montefiore, Bronx, NY, USA
| | - M Morrissey
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - J Orsini
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - P Parton
- Division of Genetics, Stony Brook Long Island Children's Hospital, Stony Brook, NY, USA
| | - J Pellegrino
- Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - C A Saavedra-Matiz
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - N Shur
- Albany Medical Center, Albany, NY, USA
| | - M Wasserstein
- Division of Medical Genetics, Division of Genomic Sciences, Mount Sinai Medical Center, New York, NY, USA
| | - G V Raymond
- Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - M Caggana
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Johnson D, Haimowitz Z, Fong C, Hill D, Surrey M, Danzer H, Barritt J. Successful Laboratory Transition to a New Single-Stage Time-Lapse Medium (G-TL™) for All Embryo Culture. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.045] [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: 11/17/2022]
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Masurekar A, Fong C, Hussein A, Revesz T, Hoogerbrugge PM, Love S, Ciria C, Parker C, Krishnan S, Saha V. The optimal use of PEG-asparaginase in relapsed ALL--lessons from the ALLR3 Clinical Trial. Blood Cancer J 2014; 4:e203. [PMID: 24769644 PMCID: PMC4003420 DOI: 10.1038/bcj.2014.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- A Masurekar
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
| | - C Fong
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
| | - A Hussein
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
| | - T Revesz
- Department of Haematology-Oncology, SA Pathology at Women's and Children's Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - P M Hoogerbrugge
- Childrens Hospital, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Dutch 17 Childhood Oncology Group, The Hague, The Netherlands
| | - S Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - C Ciria
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - C Parker
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
| | - S Krishnan
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
- Department of Paediatric Oncology, Tata Translational Cancer Research Centre, Kolkata, India
| | - V Saha
- Children's Cancer Group, Manchester Academic Health Sciences Centre, Institute of Cancer, University of Manchester, Manchester, UK
- Department of Paediatric Oncology, Tata Translational Cancer Research Centre, Kolkata, India
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Abstract
Zinc levels are known to be elevated in certain cancer tissues. In this study, zinc content in metastatic and primary nasopharyngeal carcinoma (NPC) cells were quantitated by X-ray microanalysis at the ultrastructural level. Zinc levels of cancer cells derived from the cervical lymph node of a patient with metastatic carcinoma and that from the nasopharynx biopsy of another NPC patient with no clinical evidence of secondary spread, were analyzed. X-ray microanalysis revealed significantly higher cellular zinc levels in metastatic NPC cells. Zinc is a known anti-apoptotic agent and tumor response to radiotherapy is linked with apoptosis or programmed cell death. Raised zinc levels observed here could provide the biological basis for the observation of a higher percentage of distant metastasis in cervical node positive NPC patients treated by radiotherapy (the mainstay of treatment for NPC) as compared to those without regional nodal disease.
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Affiliation(s)
- B Bay
- NATL UNIV SINGAPORE,DEPT OTORHINOLARYNGOL,SINGAPORE 119260,SINGAPORE. SINGAPORE GEN HOSP,DEPT PATHOL,SINGAPORE 169608,SINGAPORE
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Abstract
Motivation: The Prokaryotic-genome Analysis Tool (PGAT) is a web-based database application for comparing gene content and sequence across multiple microbial genomes facilitating the discovery of genetic differences that may explain observed phenotypes. PGAT supports database queries to identify genes that are present or absent in user-selected genomes, comparison of sequence polymorphisms in sets of orthologous genes, multigenome display of regions surrounding a query gene, comparison of the distribution of genes in metabolic pathways and manual community annotation. Availability and Implementation:The PGAT website may be accessed at http://nwrce.org/pgat. Contact:mbrittna@uw.edu
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Affiliation(s)
- M J Brittnacher
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA.
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C Digby G, Fong C, R Methot M, Simpson CS, Redfearn D. Acquired QT Interval Prolongation & Methadone: The Risk of Pharmacological Interaction. ACTA ACUST UNITED AC 2011. [DOI: 10.4172/2155-9880.1000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Caldwell JC, Fong C, Muhyaldeen SA. Should sevoflurane be used in the electrophysiology assessment of accessory pathways? Europace 2010; 12:1332-5. [DOI: 10.1093/europace/euq076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pang J, Yu H, Pearson K, Lynch P, Fong C. Comparison of the MMSE and RUDAS cognitive screening tools in an elderly inpatient population in everyday clinical use. Intern Med J 2010; 39:411-4. [PMID: 19580621 DOI: 10.1111/j.1445-5994.2009.01918.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We compared test score and performance times of Folstein's Mini Mental State Examination (MMSE) and the Rowland Universal Dementia Assessment Scale (RUDAS). Forty-six patients were recruited. The mean score was 20.6 for the MMSE and 20.5 for the RUDAS. Linear regression analysis revealed an r value of 0.83 (P < 0.05). The mean performance time was 9.4 min for both the MMSE and the RUDAS. Patient satisfaction was similar for both tests. Surveyed clinicians preferred the MMSE because of greater familiarity. We concluded that the RUDAS correlates well with the MMSE and is no more time-consuming to perform. It has good clinical utility as a cognitive screening tool.
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Affiliation(s)
- J Pang
- Aged Care, Eastern Health, Monash University, Melbourne, Victoria, Australia.
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Abstract
The most recent Confidential Enquiry into Maternal Deaths expressed concern that mortality in women from non-English-speaking ethnic groups was twice that of native-born women. There are very few published data on the obstetric performance of Kosovo Albanian refugees who have relocated to the United Kingdom and the aim of this study was to compare the obstetric performances of Kosovo Albanian women currently residing in the United Kingdom with their British-born Caucasian counterparts. Sixty-one index and 61 control cases were analysed; 63% of the Kosovo Albanian women spoke little or no English and 50% were on income support. Of the study group, 9.8% had caesarean sections, 8.2% had instrumental vaginal deliveries and 82% achieved normal deliveries. The Kosovo Albanian women were statistically younger and had shorter duration of labour compared to controls (P < 0.05, unpaired t-test). Epidural use was significantly lower in Kosovan women (P < 0.05, chi2 test). The rates of induction of labour (IOL), caesarean section, instrumental deliveries, premature delivery and low birth weight < 2.5 kg were not statistically different (P > 0.05 in all cases, chi2 test) between the two groups. This is the first study to examine the obstetric outcomes of Kosovo Albanian women who have resettled in a western European country. Most Kosovo Albanian refugees living in the United Kingdom are not socio-economic migrants but displaced due to civil unrest and many had reasonable socio-economic status prior to resettlement. The similarity in obstetric and fetal outcomes between the study and control groups could be attributed to the 'healthy immigrant effect', where immigrant groups appear to have better outcomes due to family support and relatively lower intake of alcohol and nicotine. It also suggests that obstetricians may be heeding the recommendations from recent Confidential Enquiry into Maternal Deaths, which highlight the need for increased vigilance in women from ethnic minorities.
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Affiliation(s)
- W Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK.
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Goergen SK, Fong C, Dalziel K, Fennessy G. Can an evidence-based guideline reduce unnecessary imaging of road trauma patients with cervical spine injury in the emergency department? ACTA ACUST UNITED AC 2007; 50:563-9. [PMID: 17107528 DOI: 10.1111/j.1440-1673.2006.01655.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine if an unvalidated imaging guideline can reduce the use of imaging in patients with cervical spine trauma. A non-randomized clinical trial using historical controls was conducted in the emergency department from October 2001 to September 2002. Following an education programme, which introduced the imaging guideline to clinicians, the use of guideline and imaging were measured. The guideline was also converted to decision-support software for use in the emergency department. Three hundred and fifty-three patients satisfied inclusion criteria during the study period and these were compared with 403 historical control subjects. No significant difference was found between the two groups for age, sex or fracture prevalence. A significant increase was observed during the study period in the proportion of patients who were managed without the use of any cervical spine imaging (21.25 vs 31.2%; P=0.03; 95% confidence interval, 3-13). There were no delayed diagnoses of cervical spine injury among those not imaged. It is feasible to disseminate and implement an evidence-based imaging guideline for patients with cervical spine trauma. The use of a computerized decision-support system can facilitate this and is associated with a safe reduction in the proportion of patients imaged.
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Affiliation(s)
- S K Goergen
- Department of Diagnostic Imaging, Monash Medical Centre, Melbourne, Victoria, Australia.
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Abstract
In the quest to rationally design novel mesophase systems the challenge remains to deconvolute the relationship between structure, composition, and function. In the current study, novel glycerol-derived surfactants with high negative interfacial areas and a preference for inverse phase behavior have been targeted and synthesized. This has been achieved by application of the rule-of-thumb afforded by the critical packing parameter (CPP), namely, that inverse phase behavior is favored by wedge-shaped molecules with relatively small head group versus chain volume. Highly splayed hydrophobes with exaggerated cross section such as oleyl (cis-octadec-9-enyl) hexahydrofarnesyl (3,7,11-trimethyl-dodecyl) and phytanyl (3,7,11,15-tetramethyl-hexadecyl) were particularly successful for this purpose across many variations of head group. The phase behavior of the binary system in water of many of these surfactants is relatively simple. Typically, cubic or inverse hexagonal phases exist at the interface with water with the inverse micellar phases present at lower hydration. The inverse liquid crystalline phases were present for a broad range of temperatures and compositions.
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Affiliation(s)
- C Fong
- CSIRO Molecular and Health Technologies, Bag 10, Clayton South, VIC, 3169, Australia.
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