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Balani A, Sidpra J, Sudhakar S, Biswas A, Öztekin Ö, Capra V, Catala M, Copp AJ, Kumar N, Johal N, Tahir MZ, Thompson D, Pang D, Mirsky DM, Ho ML, Huisman TAGM, Rossi A, Mankad K. International Consensus Statement on the Radiological Evaluation of Dysraphic Malformations of the Spine and Spinal Cord. AJNR Am J Neuroradiol 2024:ajnr.A8117. [PMID: 38360788 DOI: 10.3174/ajnr.a8117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 02/17/2024]
Abstract
Dysraphic malformations of the spine and spinal cord (DMSSC) represent a spectrum of common congenital anomalies typically (though not exclusively) affecting the lower spinal segments. These may be responsible for varying degrees of neurologic, orthopedic, and urologic morbidity. With advances in neuroimaging, it is now possible to better diagnose and evaluate these disorders both prenatally and postnatally. Neuroimaging, performed at the right time and with technique optimization, is integral in guiding clinical management. However, the terminology used to describe these lesions has become increasingly confusing, and there is a lack of consensus regarding the essential radiologic features and their clinical weighting. This variability in radiologic practice risks unstructured decision making and increases the likelihood of suboptimal, less informed clinical management. In this manuscript, the first of a series of consensus statements, we outline a standardized international consensus statement for the radiologic evaluation of children with suspected DMSSC derived from a critical review of the literature, and the collective clinical experience of a multinational group of experts. We provide recommendations for plain radiography, sonography, CT, and MR imaging in the evaluation of DMSSC with an emphasis on technique of imaging and imaging protocols.
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Affiliation(s)
- Ankit Balani
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jai Sidpra
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sniya Sudhakar
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Asthik Biswas
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Özgür Öztekin
- Department of Neuroradiology (Ö.Ö.), Izmir Bakircay University, Izmir, Turkey
| | - Valeria Capra
- Medical Genetics Unit (V.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martin Catala
- Laboratoire de Biologie du Développement (M.C.), UMR 7622 de Sorbonne Université et du CNRS, ERL 1156 de l'INSERM et Institut de Biologie Paris Seine, Paris, France
| | - Andrew J Copp
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neetu Kumar
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Navroop Johal
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dachling Pang
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery (D.P.), University of California, Davis, Davis, California
| | - David M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mai-Lan Ho
- Department of Radiology (M.-L.H.), Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea Rossi
- Neuroradiology Unit (A.R.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (A.R.), University of Genoa, Genoa, Italy
| | - Kshitij Mankad
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
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Kameda-Smith M, Tahir MZ, Kumar A, Thompson D, Pang D. Limited exposure to preserve stability and achieve complete excision of limited dorsal myeloschisis - the "Skip-Hop Laminectomy" technique: a technical note. Childs Nerv Syst 2024; 40:213-218. [PMID: 37428253 DOI: 10.1007/s00381-023-06069-x] [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: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The fibroneural stalk of an LDM has variable thickness, complexity, and length, which can span 5 to 6 vertebral segments from its skin attachment to its "merge point" with the dorsal spinal cord. Therefore, complete resection may require extensive multi-level laminotomies. In this technical note, a modification of the procedure is presented that avoids long segment laminectomies while ensuring complete excision of long LDM stalks. RESULTS An illustrative case of resection of LDM is presented using skip laminectomies. The technique ensures complete removal of the stalk, thus reducing the risk of future intradural dermoid development, while at the same time minimizes the risk for delayed kyphotic deformity. CONCLUSIONS A technique of "skip-hop" proximal and distal short segment laminectomies in cases of LDM optimizes the objectives of complete stalk resection with preservation of spinal integrity.
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Affiliation(s)
- Michelle Kameda-Smith
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - M Zubair Tahir
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Atul Kumar
- Department of Histopathology, London, England
| | - Dominic Thompson
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Dachling Pang
- Great Ormond Street Hospital for Children, London, England.
- Department of Paediatric Neurosurgery, London, England.
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Amarell K, Carrasquilla M, McGunigal M, Pang D, He A, Unger KR. Hypofractionated Intensity Modulated Proton Therapy (IMPT) and Systemic Therapy for Unresectable Hepatobiliary Cancers. Int J Radiat Oncol Biol Phys 2023; 117:e282. [PMID: 37785054 DOI: 10.1016/j.ijrobp.2023.06.1265] [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) Proton therapy offers significantly reduced normal liver dose compared to photon therapy for liver tumors, and therefore has the potential for dose escalation and hypofractionation. Employing IMPT, we have initiated a hypofractionated treatment regimen for unresectable liver cancer at a single academic institution. Here we report our initial results on dosimetry and clinical outcomes of hypofractionated IMPT for unresectable hepatocellular carcinoma (HCC) and cholangiocarcomas (CC). MATERIALS/METHODS We retrospectively reviewed records of consecutive patients treated with IMPT for CC and HCC from 2018 to 2021. Inverse treatment planning with robust optimization, daily image guidance, pencil beam scanning dose delivery were used for all patients. Motion management included 4D-CT and abdominal compression. Toxicity was graded using the Common Terminology Criteria for Adverse Events version 5.0 and survival was calculated using the Kaplan Meier method. RESULTS We identified 15 patients (3 HCC, 4 intrahepatic CC, 8 hilar CC) treated with IMPT to a median dose of 5805 cGy (range, 4500 - 6000 cGy) in 15 fractions. Two had metastatic and 13 had regional disease. Median tumor volume was 91.5 cc (range, 10.92 - 366.31 cc). Prior therapies included: 12 patients received upfront chemotherapy, (gemcitabine plus cisplatin most common), 4 received prior surgery on the liver, and 5 received prior liver directed treatment. With a median follow up of 10 months, the median overall survival (OS) and 1-year OS was 18.7 months and 76% respectively. One patient underwent resection and 1 patient received liver transplant; 7 (47%) patients had disease progression (3 local, 1 regional lymph node, 4 elsewhere liver, 5 distant metastatic). Five patients with CC developed grade 3 toxicity in the form of cholangitis (4) and hemobilia (1). Of these patients, 4 patients were of the hilar type. CONCLUSION Our early results using hypofractionated IMPT for unresectable HCC and CC resulted in encouraging local control rates with an acceptable toxicity profile. Further study is warranted to determine the optimal liver directed therapy for this challenging patient population.
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Affiliation(s)
- K Amarell
- University Hospitals Geauga Medical Center, Chardon, OH
| | - M Carrasquilla
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - M McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - D Pang
- Medstar Georgetown University Hospital, Washington, DC
| | - A He
- Department of Hematology/Oncology Georgetown University Hospital, Washington, DC
| | - K R Unger
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
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Mullins CF, Fuccaro M, Pang D, Min L, Andreou AP, Lambru G. A single infusion of intravenous lidocaine for primary headaches and trigeminal neuralgia: a retrospective analysis. Front Neurol 2023; 14:1202426. [PMID: 37638187 PMCID: PMC10448809 DOI: 10.3389/fneur.2023.1202426] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Intravenous (IV) lidocaine has been used as a transitional treatment in headache and facial pain conditions, typically as an inpatient infusion over several days, which is costly and may increase the risk of adverse effects. Here we report on our experience using a single one-hour IV lidocaine infusion in an outpatient day-case setting for the management of refractory primary headache disorders with facial pain and trigeminal neuralgia. Methods This is a retrospective, single-center analysis on patients with medically refractory headache with facial pain and trigeminal neuralgia who were treated with IV lidocaine between March 2018 and July 2022. Lidocaine 5 mg.kg-1 in 60 mL saline was administered over 1 h, followed by an observation period of 30 min. Patients were considered responders if they reported reduction in pain intensity and/or headache frequency of 50% or greater. Duration of response was defined as short-term (< 2 weeks), medium-term (2-4 weeks) and long-term (> 4 weeks). Results Forty infusions were administered to 15 patients with trigeminal autonomic cephalalgias (n = 9), chronic migraine (n = 3) and trigeminal neuralgia (n = 3). Twelve patients were considered responders (80%), eight of whom were complete responders (100% pain freedom). The average duration of the treatment effect for each participant was 9.5 weeks (range 1-22 weeks). Six out of 15 patients reported mild and self-limiting side effects (40%). Conclusion A single infusion of IV lidocaine might be an effective and safe transitional treatment in refractory headache conditions with facial pain and trigeminal neuralgia. The sustained effect of repeated treatment cycles in some patients may suggest a role as long-term preventive therapy in some patients.
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Affiliation(s)
- C. F. Mullins
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M. Fuccaro
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - D. Pang
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - L. Min
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - A. P. Andreou
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - G. Lambru
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Eibach S, Pang D. A New Surgical Paradigm for Postnatal Repair of Open Neural Tube Defects Using Intraoperative Neurophysiology Monitoring. Adv Tech Stand Neurosurg 2023; 47:49-64. [PMID: 37640872 DOI: 10.1007/978-3-031-34981-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving the placode at any cost, which often means stuffing the entire thick and unwieldy but non-functional tissue into a tight dural sac, increasing the likelihood of future tethering of the spinal cord. The same philosophy of attempting to save the whole perimetry of the placode also sometimes leads to inadvertent inclusion of parts of the squamous epithelial membrane surrounding the placode into the reconstructed product, only to form inclusion dermoid cyst causing further injury to the neural tissues. Lastly, unsuccessful neurulation of the caudal primary neural tube almost always adversely affects junctional and secondary neurulation resulting in a defective conus, often with a locally active sacral micturition centre that is isolated from and therefore lacking suprasegmental inhibitory moderation. This frequently leads to the development of a spastic, hyperactive, low-compliance and high-pressure bladder predisposing to upstream kidney damage, without benefits of normal bladder function. We are introducing a new surgical technique designed to minimise or eliminate these three undesirable complications of conventional ONTD closure.
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Affiliation(s)
- Sebastian Eibach
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Dachling Pang
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
- University of California, Davis, Davis, CA, USA
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Pang D, Thompson DNP. The Current Status of the Surgical Management of Complex Spinal Cord Lipomas: Still Navigating the Labyrinth? Adv Tech Stand Neurosurg 2023; 47:145-214. [PMID: 37640875 DOI: 10.1007/978-3-031-34981-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas and describes in some detail the technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas: whether total resection confers better long-term benefits than partial resection and whether total resection does better than conservative treatment, i.e. no surgery, for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the senior author and colleagues' series of over 300 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons so far amply support the author's recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed. We have also recently found that some dorsal lipomas with clear outline of the conus on preoperative imaging had a significantly better long-term prognosis of preserving neurourological functions without surgery. Whether this subset of lipomas should be managed conservatively until symptoms arise is now an open question awaiting a longer follow-up of a larger cohort of such patients.
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Affiliation(s)
- Dachling Pang
- Department of Paediatric Neurosurgery, University of California, Davis, USA
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Dominic N P Thompson
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
- Department of Developmental Neuroscience, University College London-Institute of Child Health, London, UK
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Eibach S, Pang D. Junctional Neural Tube Defect (JNTD): A Rare and Relatively New Spinal Dysraphic Malformation. Adv Tech Stand Neurosurg 2023; 47:129-143. [PMID: 37640874 DOI: 10.1007/978-3-031-34981-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Junctional neurulation completes the sequential embryological processes of primary and secondary neurulation as the intermediary step linking the end of primary neurulation and the beginning of secondary neurulation. Its exact molecular process is a matter of ongoing scientific debate. Abnormality of junctional neurulation-junctional neural tube defect (JNTD)-was first described in 2017 based on a series of three patients who displayed a well-formed secondary neural tube, the conus, that is physically separated by a fair distance from its companion primary neural tube and functionally disconnected from rostral corticospinal control. Several other cases conforming to this bizarre neural tube arrangement have since appeared in the literature, reinforcing the validity of this entity. The clinical, neuroimaging, and electrophysiological features of JNTD, as well as the hypothesis of its embryogenetic mechanism, will be described in this chapter.
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Affiliation(s)
- Sebastian Eibach
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Dachling Pang
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
- Department of Paediatric Neurosurgery, University of California, Davis, USA
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Lee JY, Wang KC, Pang D. Secondary Neurulation Defect: Terminal Myelocystocele, a Biological Leviathan. Adv Tech Stand Neurosurg 2023; 47:225-234. [PMID: 37640877 DOI: 10.1007/978-3-031-34981-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Terminal myelocystocele (TMC) has been a puzzling entity of spinal dysraphism. It is found in the sacrococcygeal region usually forming a subcutaneous hump of various sizes. The wide variation of its morphology has been clarified by defining the essential and nonessential features as described in this chapter. Although it is not a common entity, TMC is attractive in that a highly plausible hypothesis on its pathoembryogenesis has been proposed based on observations on the secondary neurulation of the chick embryo. In this chapter, the embryology will be described, followed by the surgical strategy in accordance with the embryogenesis. The clinical features and prognosis will also be presented in detail.
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Affiliation(s)
- Ji Yeoun Lee
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Neuro-oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Republic of Korea
| | - Dachling Pang
- Department of Paediatric Neurosurgery, University of California, Davis, Davis, CA, USA
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
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Wong ST, Pang D. Focal Spinal Nondisjunctional Disorders: Including a Discussion on the Embryogenesis of Cranial Focal Nondisjunctional Lesions. Adv Tech Stand Neurosurg 2023; 47:65-128. [PMID: 37640873 DOI: 10.1007/978-3-031-34981-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The publication of a comprehensive report on limited dorsal myeloschisis by the senior author (DP) in 2010 has brought full attention to the concept of limited myeloschisis that he first formulated in 1992 and ignited interests in the whole spectrum of focal spinal nondisjunctional disorders. Now that focal nondisjunctional disorders have become well known, new clinical reports on these conditions or relevant subjects are frequently seen. Here we present an updated review on the full spectrum of focal spinal nondisjunctional disorders and extend the scope to include a discussion on the embryogenesis of cranial focal nondisjunctional malformations.
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Affiliation(s)
- Sui-To Wong
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
| | - Dachling Pang
- University of California, Davis, Davis, CA, USA
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Shao Z, Huang T, Fan Z, Wang Y, Yan X, Yang H, Wang S, Pang D, Li H, Wang H, Geng C, Huang L, Siddiqui A, Wang B, Xie B, Sun G, Restuccia E. 1MO The fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in Chinese patients (pts) with HER2-positive early breast cancer (EBC): Primary analysis of the phase III, randomised FDChina study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Liuru T, Pang D, Zhang J, Shao G, Li J, Liu Z, Sun Z. EP02.03-015 Fully Robotic Arm Robot Assisted Lung Surgery Exploration. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.371] [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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De Vloo P, Sharma J, Alderson L, Jankovic I, Tahir MZ, Desai D, Pang D, Thompson DNP. Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience. Childs Nerv Syst 2022; 38:1113-1123. [PMID: 35262755 DOI: 10.1007/s00381-022-05483-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/28/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and low surgical morbidity. We adopted this technique in 2011, and aim to describe our first results. METHODS In this monocentric retrospective audit, we included dorsal, transitional, chaotic, and caudal-type lumbosacral lipomas. Exclusion criteria were previously operated lipomas, pure filar lipomas, and concomitant major congenital anatomical urogenital/gastrointestinal abnormalities. Neuro-uro-orthopaedic status at presentation and at three months, one year and last postoperative follow-up, intraoperative electrophysiology, and extent of resection were collected. RESULTS From January 2011 to September 2019, 91 patients were operated (median age 2y2m; 63 transitional; 14 caudal; 8 dorsal; 6 chaotic). Preoperatively, 67% were symptomatic. Preoperative and one-year postoperative rates of impaired ambulation (44% to 43%), hypoesthesia (8% to 5%), urodynamic/uroradiological abnormalities (49% to 37%), and foot/ankle deformities (8% to 5%) were comparable, whilst pain improved (25% to 5%) but catheterisation rates increased (21% to 36%). 23/92 (25%) suffered wound-related complications. 2/91 (2%) developed symptomatic re-tethering requiring second surgery. Mean cord/sac ratio was 0.47. 43% had > 20 mm3 residual fat, which improved with increasing surgical experience. CONCLUSION Radical lipoma resection, guided by intraoperative neuromonitoring, with reconstruction of the neural placode and expansion duraplasty is technically feasible and results in low rates of late deterioration and re-tethering. Lipoma-type and pre-operative status are important outcome predictors. Operative risks are not insignificant. Future studies need to determine appropriate selection criteria for surgery.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. .,Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
| | - Julia Sharma
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,Department of Neurosurgery, Valley Childrens Hospital, Madera, CA, USA
| | - Lucy Alderson
- Department of Physiotherapy, Great Ormond Street Hospital for Children, London, UK
| | - Ivana Jankovic
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,Institute of Child Health, University College London, London, UK
| | - Divyesh Desai
- Department of Physiotherapy, Great Ormond Street Hospital for Children, London, UK.,Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Dachling Pang
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,Department of Physiotherapy, Great Ormond Street Hospital for Children, London, UK
| | - Dominic N P Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,Department of Physiotherapy, Great Ormond Street Hospital for Children, London, UK
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Abstract
Abstract
Background
Ageing leads to inactivity and conditions like heart disease, type II diabetes, and risk of falls. Regular physical activity (PA) helps with a renewed feeling of ability, efficient blood circulation, balance, and coordination. In the UK, physical inactivity is the fourth largest killer of the elderly. This study examines some physical activity determinants in older people.
Methods
A cross-sectional analysis of the UKUS cohort study Wave 2 (2010-12) with participants aged 65 and above was done. The descriptive analyses involved crosstabulations and pictorials in SPSS and Microsoft Office. Data was dichotomised for 2x2 tables in OpenEpi for the univariate analyses. Multivariate analysis was via ordinal logistic regression in SPSS. As Wave 2 had no variable describing PA, a ‘total physical activity' (TPA) score was created. TPA is composed of the addition of the total walking score (TWS), total hobbies/sports score (THSS), ‘total physicality score' (TPS), and total sport frequency (TSF). All five variants were created by indexing available proxy variables unique to each category. Results were reported with odds ratios and 95% confidence intervals.
Results
Univariate analysis with TPA showed an association with some variables like income, OR = 15.25 (8.57-27.12), social interaction, OR = 2.11 (1.46-3.05), family interaction, OR = 2.69(1.45-4.98), wellbeing, OR = 312(157.5-617.9), physical health, OR = 2.84(1.39-5.81) and emotional health, OR = 2.42(1.21-5.07). Multivariable analysis after adjusting for age and sex yielded no significant associations between most PA and predictors. Some significant associations include TWS and social class, AOR= 2.59 (P = 0.013), green food consumption, and TPS, AOR= 1.47 (P < 0.05).
Conclusions
In general, higher income, gross personal income, social class, wellbeing, and green food consumption seemed to produce greater odds of participating in all physical activities.
Key messages
These findings suggest the need for other social determinants to be thoroughly investigated. There is also a need for older adults to be well provided for so these determinants of health can improve their quality of life.
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Affiliation(s)
- M Ikpeme
- Faculty of Medicine, Imperial College London, London, UK
- FACE, University of Hull, Hull, UK
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - D Pang
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Zhang J, Shao G, Liu Z, Liuru T, Liang Y, Kong F, Pang D. P02.01 CT Integrated Bronchoscopy Manual Spraying Pigment Labeling to Localize of Small Pulmonary Nodules. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Malik K, Eseonu KC, Pang D, Fakouri B, Panchmatia JR. Is Preexisting Cervical Degeneration a Risk Factor for Poor Prognosis in Whiplash-Associated Disorder? Int J Spine Surg 2021; 15:710-717. [PMID: 34281955 PMCID: PMC8375694 DOI: 10.14444/8093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The term whiplash describes the acceleration-deceleration mechanism of injury to the cervical spine. Whiplash injuries present with a variety of clinical and psychological manifestations, collectively termed as whiplash-associated disorders (WADs). Although largely self-limiting, some patients may experience long-lasting symptoms. This review aimed to summarize the current literature regarding the predictive value of cervical degeneration in the prognosis of patients with WAD. METHODS A comprehensive search of the literature was performed. Nine studies were identified, including 894 patients, with an age range between 16 and 76 years. RESULTS A statistically significant association was found between moderate facet joint degeneration and nonrecovery. Although no association was established between isolated disc degeneration and nonrecovery, total cervical degeneration (facet joint + disc degeneration) was shown to correlate with nonrecovery.All included studies demonstrated the lack of correlation between preexisting disc degeneration and clinical outcomes. Four studies showed a significant correlation between cervical degeneration and poor prognosis following whiplash injury. A significantly higher proportion of patients who remained symptomatic at 2 years following a whiplash injury had preexisting degenerative changes. CONCLUSIONS This review highlights the presence of significant variability in the existing literature concerning WAD in terms of study methodology, definitions of cervical degeneration, and outcome measures. Degenerative changes of the facet joint lead to alterations in its biomechanics. Several cadaveric, biomechanical, and clinical studies have demonstrated facet joints as a source of pain in patients with chronic WAD. We present moderate evidence to suggest that preexisting facet joint degeneration is a negative prognostic indicator for long-lasting symptoms in WAD. Conversely, preexisting disc degeneration is not associated with chronicity of WAD symptoms. We propose facet joint instability due to facet joint capsule rupture as a potential mechanism for nonrecovery. Further studies are needed to inform our knowledge of the long-term sequelae of WAD among patients with preexisting cervicalspine degeneration.
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Affiliation(s)
- Khalid Malik
- Speciality Registrar, Trauma and Orthopaedics, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - K. C. Eseonu
- Senior Spinal Fellow, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - D. Pang
- Consultant Pain Physician, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - B. Fakouri
- Consultant Spine Surgeon and Lead for Spine Surgery, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - J. R. Panchmatia
- Consultant Spine Surgeon, Guy's & St. Thomas' Hospitals, London, United Kingdom
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Zhang F, Pang D, Kong F. P03.06 Nausea in Patients Had Thoracomy: A Pilot Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zhang J, Shao G, Luo Q, Zhang F, Chen W, Wang W, Li S, Pang D, Kong F. P11.02 Patient Reported Outcome Measures (PROM) after Thoracic Surgery: A Pilot Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pang D, Chen W, Zhang J, Yang L, Shao G, Liuru T, Xu L, Xu W, Zhao C, Luo M, Ma L, Zhang F, Liang Z, Li S, Kong F. P07.08 IDO Immune Suppression and Post Surgical Toxicity in Patients with Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.419] [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: 11/15/2022]
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21
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Wong ST, Pang D. Focal Spinal Nondisjunction in Primary Neurulation : Limited Dorsal Myeloschisis and Congenital Spinal Dermal Sinus Tract. J Korean Neurosurg Soc 2021; 64:151-188. [PMID: 33715322 PMCID: PMC7969048 DOI: 10.3340/jkns.2020.0117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022] Open
Abstract
Spinal dysraphic lesions due to focal nondisjunction in primary neurulation are commonly encountered in paediatric neurosurgery, but the “fog-of-war” on these conditions was only gradually dispersed in the past 10 years by the works of the groups led by the senior author and Prof. Kyu-Chang Wang. It is now clear that limited dorsal myeloschisis and congenital spinal dermal sinus tract are conditions at the two ends of a spectrum; and mixed lesions of them with various configurations exist. This review article summarizes the current understanding of these conditions’ embryogenetic mechanisms, pathological anatomy and clinical manifestations, and their management strategy and surgical techniques.
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Affiliation(s)
- Sui-To Wong
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Dachling Pang
- Department of Paediatric Neurosurgery, University of California, Davis, CA, USA.,Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK
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22
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Abstract
INTRODUCTION An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded, flat, and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving function at any cost, which often means stuffing the entire thick and unwieldy but non-functional placode into a tight dural sac, increasing the likelihood of future tethering of the spinal cord. The same philosophy of attempting to save the whole perimetry of the placode also sometimes leads to inadvertent inclusion of parts of the squamous epithelial membrane surrounding the placode into the reconstructed product, only to form inclusion dermoid cyst causing further injury to the neural tissues. Lastly, defective closure of the caudal primary neural tube usually results in abolition of secondary and junctional neurulation, leaving a defective conus and sacral nerve roots, clinically presenting in most cases with neurogenic bladder and bowel dysfunction. Preserving this trapped but locally active sacral micturition center, isolated from suprasegmental inhibitory moderation, leads to a spastic, hyperactive, low compliance, and high-pressure bladder predisposing to upstream kidney damage, without benefits of normal bladder function. METHOD AND MATERIAL We report the post-natal surgical treatment of 8 newborn infants with ONTD, in which we resected the non-functional portion of the neural placode identified as such by direct spinal cord/placode and nerve root stimulation, as well as by transcortical evoked motor responses to check for suprasegmental corticospinal connectivity. Any part of the placode without local function or upstream connections was resected, and the small caudal spinal cord stump closed with pia-to-pia microsutures. The patients were followed for pre- and post-operative neuro-urological status and with serial magnetic resonance imaging (MRI) at 3 weeks, 6 months, and 2 years post-repair. Follow-up period ranged from birth to 3 years (mean of 24 months). RESULTS Of the 8 patients analyzed, 7 had a terminal and one a segmental ONTD. Pre-operative neurological level ranged from L4 to S2. Applying our new surgical paradigm, we found no neurological worsening post-operatively. All patients had a neurogenic bladder and bowel dysfunction but none had a high-pressure bladder on urodynamics studies. Early and late MRIs all showed a loose and capacious neural placode to dural sac relationship. None had an inclusion dermoid cyst. CONCLUSION We propose a new paradigm for the surgical repair of open neural tube defects with intraoperative neuromonitoring and introduce a safe and reliable technique of placode debulking.
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Affiliation(s)
- Sebastian Eibach
- Macquarie Neurosurgery, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Greg Moes
- Neuropathology, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA.,Adjunct Faculty of Neuropathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yong Jin Hou
- Intraoperative Neurophysiology, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
| | - John Zovickian
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
| | - Dachling Pang
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, London, WC1N3JH, UK. .,Paediatric Neurosurgery, University of California, Davis, CA, USA.
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Tian ZZ, Pang D, Liu HN, Zhou L, Zheng YY. [Effect of enhanced recovery after surgery for elderly patients with hemiarthroplasty for the treatment of femoral neck fracture]. Zhonghua Yi Xue Za Zhi 2020; 100:2903-2907. [PMID: 32993248 DOI: 10.3760/cma.j.cn112137-20200308-00647] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effect of enhanced recovery after surgery (ERAS) for the elderly patients with femoral neck fracture. Methods: A total of 92 elderly patients with femoral neck fracture who received hemiarthroplasty from July 2018 to December 2018 in Beijing Jishuitan Hospital were enrolled in this study. The average age of the participants was (75±6) years, including 31 males and 61 females, and 72(78.3%) of the patients complicated with comorbidity. According to the perioperative management method, the patients were divided into the observational group (47 cases with ERAS) and the control group (45 cases with normal management). The data related to operation, hospitalization, complication and nursing satisfaction were compared between the 2 groups. The visual analogue scale (VAS) was used for pain evaluation. The Harris scores for hip joint and EQ-5D index scores were applied to evaluate the clinical outcomes. The follow-up were performed periodically for 3 months. The measurement data in accordance with normal distribution and homogeneity of variance were compared with t test. Results: All the surgeries completed successfully and no patient died during perioperative period. Compared with the control group, the operation rate in 48 hours (χ(2)=17.781, P<0.01), bed days (Z=-4.987, P<0.01), and medical costs (Z=-4.315, P<0.01) favored that in the observational group. The incidence of complication and nursing satisfaction showed no significant difference between the two groups (31.1% vs 14.9%, 86.7% vs 95.7%, χ(2)=3.432, 1.380, both P>0.05). The perioperative VAS score was lower in the observational group. The Harris scores were higher in the observational group after 1 months (t=4.458, P<0.01), however the quality of life for 2 groups was similar at all time points (t=1.293, 1.227, both P>0.05). Conclusion: ERAS can improve hip function and reduce the hospital stays and medical costs for patients underwent HA operation.
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Affiliation(s)
- Z Z Tian
- Department of General Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - D Pang
- School of Nursing, Peking University, Beijing 100191, China
| | - H N Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L Zhou
- Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Y Y Zheng
- Department of General Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
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Kang M, Pang D. Commissioning and beam characterization of the first gantry-mounted accelerator pencil beam scanning proton system. Med Phys 2020; 47:3496-3510. [PMID: 31840264 DOI: 10.1002/mp.13972] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/29/2019] [Accepted: 12/05/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To present and discuss beam characteristics and commissioning process of the first gantry-mounted accelerator single room pencil beam scanning (PBS) proton system. METHODS The Mevion HYPERSCAN employs a design configuration with a synchrocyclotron mounted on the gantry to eliminate the traditional beamline and a nozzle that contains the dosimetry monitoring chambers, the energy modulator (Energy Selector (ES)), and an Adaptive Aperture (AA). To characterize the beam, we measured the integrated depth dose (IDDs) for 12 energies, from highest energy of 227 MeV down to 28 MeV with a range difference ~ 2 cm between the adjacent energies, using a large radius Bragg peak chamber; single-spot profiles in air at five locations along the beam central axis using radiochromic EBT3 film and cross compared with a scintillation detector; and determined the output using a densely packed spot map. To access the performance of AA, we measured interleaf leakage and the penumbra reduction effect. Monte Carlo simulation using TOPAS was performed to study spot size variation along the beam path, beam divergence, and energy spectrum. RESULTS This proton system is calibrated to deliver 1 Gy dose at 5 cm depth in water using the highest beam energy by delivering 1 MU/spot to a 10 × 10 cm2 map with a 2.5 mm spot spacing. The spot size in air varies from 4 mm to 26 mm from 227 MeV to 28 MeV at the isocenter plane with the nozzle retracted 23.6 cm from isocenter. The beam divergence of 28 MeV beam is ~ 52.7 mrad, which is nearly 22 times that of 227 MeV proton beam. The binary design of the ES has resulted in shifts of the effective SSD toward the isocenter as the energy is modulated lower. The peaks of IDD curves have a constant 80%-80% width of 8.4 mm at all energies. The interleaf leakage of the AA is less than 1.5% at the highest energy; and the AA can reduce the penumbra by 2 mm to 13 mm for the 227 and 28 MeV energies at isocenter plane in air. CONCLUSIONS The unique design of the HYPERSCAN proton system has yielded beam characteristics significantly different from that of other proton systems in terms of the Bragg peak shapes, spot sizes, and the penumbra sharpening effect of the AA. The combination of the ES and AA has made PBS implementation possible without using beam transport line and range shifter devices. Different considerations may be required in treatment planning optimization to account for different design and beam characteristics.
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Affiliation(s)
- M Kang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - D Pang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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Eibach S, Pang D. Do junctional neural tube defect and segmental spinal dysgenesis have the same pathoembryological background? Childs Nerv Syst 2020; 36:1095-1096. [PMID: 31950249 DOI: 10.1007/s00381-020-04512-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sebastian Eibach
- Department of Clinical Medicine, Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia.
- Neurosurgery, Macquarie University Hospital, Sydney, Australia.
- Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia.
| | - Dachling Pang
- Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK
- Paediatric Neurosurgery, University of California, Davis, USA
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Abstract
This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas, and describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas : whether total resection confers better long term benefits than partial resection, and whether total resection does better than conservative treatment, i.e., no surgery, for asymptomatic lipomas. Accordingly, the 24 years progression-free survival data of the author and colleagues’ series of over 350 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons amply support the author’s recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.
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Affiliation(s)
- Dachling Pang
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK.,Department of Paediatric Neurosurgery, University of California, Davis, CA, USA
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Abstract
This article recounts the author's personal views and recollections of the history, conception of embryogenetic theories, application of intraoperative electrophysiology, and development of prospective treatment recommendations of several important spinal dysraphic malformations, including limited dorsal myeloschisis, dermal sinus tract, retained medullary cord, terminal myelocystocoele, and complex spinal cord lipomas.
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Affiliation(s)
- Dachling Pang
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK.,Department of Paediatric Neurosurgery, University of California, Davis, CA, USA
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Abstract
Junctional neurulation represents the most recent adjunct to the well-known sequential embryological processes of primary and secondary neurulation. While its exact molecular processes, occurring at the end of primary and the beginning of secondary neurulation, are still being actively investigated, its pathological counterpart -junctional neural tube defect (JNTD)- had been described in 2017 based on three patients whose well-formed secondary neural tube, the conus, is widely separated from its corresponding primary neural tube and functionally disconnected from corticospinal control from above. Several other cases conforming to this bizarre neural tube arrangement have since appeared in the literature, reinforcing the validity of this entity. The cardinal clinical, neuroimaging, and electrophysiological features of JNTD, and the hypothesis of its embryogenetic mechanism, form part of this review.
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Affiliation(s)
- Sebastian Eibach
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Neurosurgery, Macquarie University Hospital, Sydney, Australia.,Department of Paediatric Neurosurgery, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Dachling Pang
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK.,Department of Paediatric Neurosurgery, University of California, Davis, CA, USA
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Masannat YA, Agrawal A, Maraqa L, Fuller M, Down SK, Tang SSK, Pang D, Kontos M, Romics L, Heys SD. Multifocal and multicentric breast cancer, is it time to think again? Ann R Coll Surg Engl 2020; 102:62-66. [PMID: 31891668 PMCID: PMC6937617 DOI: 10.1308/rcsann.2019.0109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/22/2022] Open
Abstract
Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.
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Affiliation(s)
- YA Masannat
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - A Agrawal
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Maraqa
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fuller
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - SK Down
- James Paget University Hospitals NHS Foundation Trust, Great, UK
- University of East Anglia, Norwich Medical School, Athens, Greece
| | - SSK Tang
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - D Pang
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - M Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - L Romics
- New Victoria Hospital and Queen Elizabeth University Hospital, Glasgow, UK
| | - SD Heys
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
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30
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Abstract
This review summarizes the classification, anatomy, and embryogenesis of complex spinal cord lipomas, and it describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas: whether total resection confers better long-term benefits than partial resection and whether total resection fares better than conservative treatment-i.e., no surgery-for asymptomatic lipomas. Accordingly, the 24-year progression-free survival data of the author and colleagues' series of over 300 cases of total resection are compared with historical data from multiple series (including the author and colleagues' own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of nonsurgical treatment of equivalent numbers of patients. These comparisons amply support the author's recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even this aggressive surgical approach and consequently projects worse results (admittedly of a small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.
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Shao Z, Pang D, Yang H, Li W, Wang S, Cui S, Liao N, Wang Y, Wang C, Chang YC, Wang H, Kang SY, Jiang Z, Li J, Zhou J, Althaus B, Mao Y, Eng-Wong J. Abstract P6-17-17: Pertuzumab, trastuzumab, and docetaxel for HER2-positive early or locally advanced breast cancer in the neoadjuvant setting: Efficacy and safety analysis of a randomized phase III study in Asian patients (PEONY). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Pertuzumab and trastuzumab (P and H; F. Hoffmann-La Roche Ltd, Basel, CH) bind to distinct HER2 subdomains and have complementary modes of anticancer activity in HER2-positive breast cancer (BC). A global Phase II study (NeoSphere) reported that neoadjuvant treatment with P+H+docetaxel (D) significantly increased breast pathologic complete response (bpCR) vs H+D in patients (pts) with early/locally advanced/inflammatory HER2-positive BC (Gianni et al. Lancet Oncol 2012). PEONY (NCT02586025), a randomized, multicenter, double-blind, placebo-controlled, Phase III trial conducted in an Asian population (mainland China, Taiwan, Korea, Thailand), primarily compared the efficacy, safety, and tolerability of P+H+D vs placebo (Pla)+H+D in the neoadjuvant setting. We present data from the primary analysis.
Methods
Pts with centrally confirmed HER2-positive early (T2–3, N0–1)/locally advanced (T2–3, N2 or N3; T4, any N) BC were randomized 2:1 to 4 cycles of P+H+D or Pla+H+D every 3 weeks, before surgery: P, 840 mg loading/420 mg maintenance doses (or Pla); H, 8 mg/kg loading/6 mg/kg maintenance; D, 75 mg/m2. Post-surgery, pts received 3 cycles of fluorouracil, epirubicin, and cyclophosphamide followed by 13 cycles of P+H or Pla+H for up to 1 year (total of 17 HER2-targeted therapy cycles). The primary endpoint was total pCR rate (tpCR; absence of any residual invasive cancer in the breast and lymph nodes [ypT0/is, ypN0]) assessed by independent review committee (IRC) when pts completed surgery with a tpCR assessment. Missing/invalid assessments were considered residual disease.
Results
A total of 329 pts were randomized: 219 to P, 110 to Pla. Baseline characteristics were well balanced. Most pts had early BC (69.6%) and were from mainland China (79.3%). In the intention-to-treat population, the tpCR rate by IRC was 39.3% in the P arm and 21.8% in the Pla arm; a clinically and statistically significant difference of 17.5% (95% CI 6.9–28.0; p=0.0014). The local pathologist-assessed tpCR rates were 39.3% and 20.9%, respectively. A consistent treatment benefit of P vs Pla was observed in subgroups. Incidences of grade ≥3 adverse events (Aes) were 48.6% in the P arm and 41.8% in the Pla arm. Of the most common grade 3 Aes (≥3% of pts), neutropenia was higher in the P arm (38.1% vs 32.7%). Of the most common any-grade Aes (≥5%), diarrhea was higher in the P arm (38.5% vs 16.4%). No heart failure (New York Heart Association Functional Classification III or IV) or significant left ventricular ejection fraction decline events (≥10 percentage points from baseline and to <50%) were observed during neoadjuvant therapy.
Conclusions
PEONY met its primary endpoint: P+H+D resulted in a clinically meaningful and statistically significant improvement in the tpCR rate by IRC vs Pla+H+D for the neoadjuvant treatment of HER2-positive early/locally advanced BC in Asian pts. Safety data were in line with the known P safety profile and generally comparable between treatment arms. Results were similar to NeoSphere, and confirm that P+H+D provides superior anticancer activity to H+D alone.
Citation Format: Shao Z, Pang D, Yang H, Li W, Wang S, Cui S, Liao N, Wang Y, Wang C, Chang Y-C, Wang H, Kang SY, Jiang Z, Li J, Zhou J, Althaus B, Mao Y, Eng-Wong J. Pertuzumab, trastuzumab, and docetaxel for HER2-positive early or locally advanced breast cancer in the neoadjuvant setting: Efficacy and safety analysis of a randomized phase III study in Asian patients (PEONY) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-17.
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Affiliation(s)
- Z Shao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - D Pang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - H Yang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - W Li
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - S Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - S Cui
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - N Liao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - C Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y-C Chang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - H Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - SY Kang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Z Jiang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Li
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Zhou
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - B Althaus
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y Mao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Eng-Wong
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
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Pang D, Yan T, Trevisi E, Krizsan S. Effect of grain- or by-product-based concentrate fed with early- or late-harvested first-cut grass silage on dairy cow performance. J Dairy Sci 2018; 101:7133-7145. [DOI: 10.3168/jds.2018-14449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
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Xiao X, Zhang L, Chen X, Cui L, Zhu H, Pang D, Yang Y, Wang Q, Wang M, Gao C. Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience. Scand J Surg 2017; 107:158-165. [PMID: 29141518 DOI: 10.1177/1457496917738922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. MATERIALS AND METHODS We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. RESULTS All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p < 0.001). CONCLUSION Our novel classification system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.
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Affiliation(s)
- X Xiao
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China.,2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - L Zhang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - X Chen
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - L Cui
- 3 Department of Urology, General Hospital of Civil Aviation Administration of China, Beijing, China
| | - H Zhu
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - D Pang
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Y Yang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Q Wang
- 4 Department of Cardiac Surgery, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - M Wang
- 5 Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - C Gao
- 6 Department of Cardiac Surgery, Chinese PLA General Hospital, Beijing, China
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Lee JY, Kim SW, Kim SP, Kim H, Cheon JE, Kim SK, Paek SH, Pang D, Wang KC. A rat model of chronic syringomyelia induced by epidural compression of the lumbar spinal cord. J Neurosurg Spine 2017; 27:458-467. [DOI: 10.3171/2016.9.spine16188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere has been no established animal model of syringomyelia associated with lumbosacral spinal lipoma. The research on the pathophysiology of syringomyelia has been focused on Chiari malformation, trauma, and inflammation. To understand the pathophysiology of syringomyelia associated with occult spinal dysraphism, a novel animal model of syringomyelia induced by chronic mechanical compression of the lumbar spinal cord was created.METHODSThe model was made by epidural injection of highly concentrated paste-like kaolin solution through windows created by partial laminectomy of L-1 and L-5 vertebrae. Behavioral outcome in terms of motor (Basso-Beattie-Bresnahan score) and urinary function was assessed serially for 12 weeks. Magnetic resonance images were obtained in some animals to confirm the formation of a syrinx and to monitor changes in its size. Immunohistochemical studies, including analysis for glial fibrillary acidic protein, NeuN, CC1, ED-1, and caspase-3, were done.RESULTSBy 12 weeks after the epidural compression procedure, syringomyelia formation was confirmed in 85% of the rats (34 of 40) on histology and/or MRI. The syrinx cavities were found rostral to the epidural compression. Motor deficit of varying degrees was seen immediately after the procedure in 28% of the rats (11 of 40). In 13 rats (33%), lower urinary tract dysfunction was seen. Motor deficit improved by 5 weeks after the procedure, whereas urinary dysfunction mostly improved by 2 weeks. Five rats (13%, 5 of 40) died 1 month postoperatively or later, and 3 of the 5 had developed urinary tract infection. At 12 weeks after the operation, IHC showed no inflammatory process, demyelination, or accelerated apoptosis in the spinal cords surrounding the syrinx cavities, similar to sham-operated animals.CONCLUSIONSA novel experimental model for syringomyelia by epidural compression of the lumbar spinal cord has been created. The authors hope that it will serve as an important research tool to elucidate the pathogenesis of this type of syringomyelia, as well as the CSF hydrodynamics of the lumbar spinal cord.
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Affiliation(s)
- Ji Yeoun Lee
- Departments of 1Anatomy and
- 2Neural Development and Anomaly Laboratory, Seoul National University College of Medicine
- 3Division of Pediatric Neurosurgery,
| | - Shin Won Kim
- 2Neural Development and Anomaly Laboratory, Seoul National University College of Medicine
| | - Saet Pyoul Kim
- Departments of 1Anatomy and
- 2Neural Development and Anomaly Laboratory, Seoul National University College of Medicine
| | | | | | - Seung-Ki Kim
- 3Division of Pediatric Neurosurgery,
- 5Department of Neurosurgery, Seoul National University Children's Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- 5Department of Neurosurgery, Seoul National University Children's Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Dachling Pang
- 6Department of Pediatric Neurosurgery, University of California, Davis; and
- 7Regional Center of Pediatric Neurosurgery, Oakland Medical Center, Kaiser Foundation Hospitals of Northern California, Oakland, California
| | - Kyu-Chang Wang
- 2Neural Development and Anomaly Laboratory, Seoul National University College of Medicine
- 3Division of Pediatric Neurosurgery,
- 5Department of Neurosurgery, Seoul National University Children's Hospital and Seoul National University College of Medicine, Seoul, Korea
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Eibach S, Moes G, Hou YJ, Zovickian J, Pang D. Unjoined primary and secondary neural tubes: junctional neural tube defect, a new form of spinal dysraphism caused by disturbance of junctional neurulation. Childs Nerv Syst 2017; 33:1633-1647. [PMID: 27796548 DOI: 10.1007/s00381-016-3288-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/10/2016] [Accepted: 10/20/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Primary and secondary neurulation are the two known processes that form the central neuraxis of vertebrates. Human phenotypes of neural tube defects (NTDs) mostly fall into two corresponding categories consistent with the two types of developmental sequence: primary NTD features an open skin defect, an exposed, unclosed neural plate (hence an open neural tube defect, or ONTD), and an unformed or poorly formed secondary neural tube, and secondary NTD with no skin abnormality (hence a closed NTD) and a malformed conus caudal to a well-developed primary neural tube. METHODS AND RESULTS We encountered three cases of a previously unrecorded form of spinal dysraphism in which the primary and secondary neural tubes are individually formed but are physically separated far apart and functionally disconnected from each other. One patient was operated on, in whom both the lumbosacral spinal cord from primary neurulation and the conus from secondary neurulation are each anatomically complete and endowed with functioning segmental motor roots tested by intraoperative triggered electromyography and direct spinal cord stimulation. The remarkable feature is that the two neural tubes are unjoined except by a functionally inert, probably non-neural band. CONCLUSION The developmental error of this peculiar malformation probably occurs during the critical transition between the end of primary and the beginning of secondary neurulation, in a stage aptly called junctional neurulation. We describe the current knowledge concerning junctional neurulation and speculate on the embryogenesis of this new class of spinal dysraphism, which we call junctional neural tube defect.
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Affiliation(s)
- Sebastian Eibach
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
- Paediatric Neurosurgery, Altona Children's Hospital, Hamburg, Germany
| | - Greg Moes
- Neuropathology, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
- Adjunct Faculty of Neuropathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yong Jin Hou
- Intraoperative Neurophysiology, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
| | - John Zovickian
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
| | - Dachling Pang
- Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA.
- Paediatric Neurosurgery, University of California, Davis, CA, USA.
- Great Ormond Street Hospital for Children, NHS Trust, London, UK.
- Department of Paediatric Neurosurgery, Kaiser Permanente Medical Centre, Third Floor, Suite 39, 3600 Broadway, Oakland, CA, 94611, USA.
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Pang D. Editorial comment to article: Pediatric Thoracic SCIWORA After Back Bend During Dance Practice: A Retrospective Case Series and Analysis of Trauma Mechanisms. Childs Nerv Syst 2017; 33:1199. [PMID: 28578508 DOI: 10.1007/s00381-017-3465-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Dachling Pang
- Paediatric Neurosurgery, University of California, Davis, Davis, CA, 95616, USA. .,Paediatric Neurosurgery, Kaiser Permanente Hospitals, Oakland, CA, USA. .,NHS Trust, Great Ormond Street Hospital for Children, London, UK.
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Steagall PV, Monteiro BP, Ruel HLM, Beauchamp G, Luca G, Berry J, Little S, Stiles E, Hamilton S, Pang D. Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals. J Small Anim Pract 2017; 58:380-388. [DOI: 10.1111/jsap.12674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- P. V. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - B. P. Monteiro
- Department of Biomedical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - H. L. M. Ruel
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - G. Beauchamp
- Department of Public Health, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - G. Luca
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - J. Berry
- Douglas Animal Hospital; Fredericton New Brunswick E3G 7J2 Canada
| | - S. Little
- Bytown Cat Hospital; Ottawa Ontario K1K 1G6 Canada
| | - E. Stiles
- Sherwood Park Animal Hospital; Montreal Quebec H9W 2E4 Canada
| | - S. Hamilton
- Atlantic Veterinary College; University of Prince Edward Island; Charlottetown Prince Edward Island C1A 4P3 Canada
| | - D. Pang
- Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta T2N 1N4 Canada
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Abstract
INTRODUCTION Limited dorsal myeloschisis (LDM) originates from undisjointed neural and cutaneous ectoderms during primary neurulation. Its hallmark is a fibroneural stalk causing tethering on the dorsal spinal cord rostral to the conus. Its treatment is a relatively straightforward resection of the LDM stalk from the spinal cord. METHODS AND RESULTS On reviewing our series of 75 cases of LDMs, we found that the majority of LDM stalks have only a glioneuronal core within a fibrous stroma, but a small number have been found to have elements of dermoid cyst or a complete dermal sinus tract either contiguous with the fibroneural stalk or incorporated within its glial matrix, not surprising considering the original continuum of cutaneous and neural ectoderm in LDMs' embryogenesis. The dermoid element can be microscopic and escape casual observation, but could grow to large intradural dermoid cysts if part of the dermoid invested LDM stalk is left inside the dura. CONCLUSIONS We present our series of LDMs associated with dermoid elements and recommend excising the entire length of the intradural LDM stalk from its dural entry point to its merge point with the spinal cord during the initial treatment to avoid secondary deterioration and additional surgery.
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Affiliation(s)
- Sebastian Eibach
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA.,Paediatric Neurosurgery, Altona Children's Hospital, Hamburg, Germany
| | - Greg Moes
- Neuropathology, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA.,Adjunct Faculty of Neuropathology, Stanford University School of Medicine, Stanford, USA
| | - John Zovickian
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA
| | - Dachling Pang
- Paediatric Neurosurgery, Regional Centre of Paediatric Neurosurgery, Kaiser Foundation Hospitals of Northern California, Oakland, CA, USA. .,Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, UK. .,Paediatric Neurosurgery, University of California, Davis, CA, USA. .,Department of Paediatric Neurosurgery, Kaiser Permanente Medical Centre, Third Floor, Suite 39, 3600 Broadway, Oakland, CA, 94611, USA.
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Luo A, Eibach S, Zovickian J, Pang D. Traumatic Posterior Fossa Subdural Hygroma and Secondary Occlusive Hydrocephalus. Pediatr Neurosurg 2017; 52:336-342. [PMID: 28848151 DOI: 10.1159/000479330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infratentorial subdural hygromas causing secondary occlusive hydrocephalus are extremely rare in children. Only a handful of cases have been reported in the literature. METHODS We present a case of a 6-month-old infant with an occipital fracture and slow enlargement of a posterior fossa subdural hygroma that culminated in obstructive hydrocephalus. We give a review of the literature on post-traumatic posterior fossa hygroma with secondary occlusive hydrocephalus and discuss its pathogenesis and the mechanism of its later resolution, as well as the available treatment options. RESULTS A temporary external ventricular drain led to acute relief of the hydrocephalus and subsequent complete resolution of the subdural hygroma. CONCLUSION Temporary external ventricular drain placement led to complete resolution of the subdural hygroma and hydrocephalus. We recommend close clinical follow-up, and imaging if indicated, for as long as 4 weeks after trauma with occipital skull fractures.
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Affiliation(s)
- Anqi Luo
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Janowski E, Timofeeva O, Chasovskikh S, Goldberg M, Kim A, Banovac F, Pang D, Dritschilo A, Unger K. Yttrium-90 radioembolization for colorectal cancer liver metastases in KRAS wild-type and mutant patients: Clinical and ccfDNA studies. Oncol Rep 2016; 37:57-65. [PMID: 28004119 PMCID: PMC5355723 DOI: 10.3892/or.2016.5284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Patients with unresectable, chemo-refractory colorectal cancer liver metastases (CRCLM) have limited local treatment options. We report our institutional experience on the efficacy of resin-based yttrium-90 (90Y) radioembolization for the treatment of CRCLM and our findings on associated circulating cell-free DNA (ccfDNA) studies. A total of 58 patients treated with 90Y for CRCLM at the Medstar Georgetown University Hospital had a median survival of 6 months [95% confidence interval (CI), 4.55–7.45 months] after treatment, with a 12-month survival rate of 33%. The median survival from treatment stratified by mutational status was longer in the wild-type (WT) as compared to the KRAS mutant patients at 7 vs. 5 months, but did not achieve statistical significance (p=0.059). Median tumor local control duration after 90Y treatment was 2 months (95% CI, 0.34–3.66 months) for the entire cohort and was longer in the WT vs. the mutant patients (2 vs. 1 month, respectively, p=0.088). Plasma was prospectively collected from a subset of 9 patients both before and after single lobe treatment, and ccfDNA concentration and fragmentation index (FI) were measured using quantitative PCR and atomic-force microscopy (AFM). In the WT and KRAS mutant patients, DNA FI was reduced from a median of 0.73–0.65 after treatment. A reduction in DNA FI after single lobe treatment was associated with an improved overall survival (p=0.046). Analysis by AFM of paired pre- and post-treatment samples from KRAS mutant and WT patients revealed a larger average decrease in fragment size in the WT patients (p=0.013). 90Y radioembolization extends local control for CRCLM, however, KRAS mutant tumors may be more radio-resistant to treatment. Changes in the FI of patients following treatment were noted and may be evaluated in a larger study for relevance as a biomarker of response.
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Affiliation(s)
- E Janowski
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - O Timofeeva
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - S Chasovskikh
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - M Goldberg
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - A Kim
- Department of Interventional Radiology, Georgetown University Hospital, Washington, DC, USA
| | - F Banovac
- Department of Interventional Radiology, Vanderbilt University Hospital, Nashville, TN, USA
| | - D Pang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - A Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - K Unger
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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Wu B, Kusters M, Kunze-busch M, Dijkema T, McNutt T, Sanguineti G, Pang D. MO-G-201-01: A Multi-Institutional Study Investigating the Performance of a Knowledge-Based Planning System Against Pinnacle Auto-Planning Engine in SIB-IMRT for the Head-And-Neck Cancer. Med Phys 2016. [DOI: 10.1118/1.4957367] [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: 11/07/2022] Open
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Yan K, Campbell L, Rashid A, Wu B, Pang D, Gurka M, Collins S, Unger K. Patient Specific Model Predictive of Gastrointestinal Toxicity Following Stereotactic Body Radiation Therapy (SBRT) for Pancreatic Cancer: Preliminary Factor Study. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhao L, Zhang S, An X, Tan W, Pang D, Ouyang H. Toxicological effects of benzo[a]pyrene on DNA methylation of whole genome in ICR mice. Cell Mol Biol (Noisy-le-grand) 2015; 61:115-119. [PMID: 26522067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
It has been well known that alterations in DNA methylation - an important regulator of gene transcription - lead to cancer. Therefore a change in the level of DNA methylation of whole genome has been considered as a biomarker of carcinogenesis. Previously, a large number of experimental results in genetic toxicology have showed that benzo[a]pyrene could cause DNA mutation and fragmentation. However, there was little to no studies on alterations in DNA methylation of genome directly result from exposure to benzo[a]pyrene. In this paper, possible mechanisms of alterations in whole genomic DNA methylation by benzo[a]pyrene were investigated using ICR mice after benzo[a]pyrene exposure. The blood, liver, pancreas, skin, lung and bladder of ICR mice were removed and checked after a fixed time interval (6 hours) of benzo[a]pyrene exposure, and whole genomic DNA methylation level was determined by high performance liquid chromatography (HPLC). The results exhibited tissue specificity, that is, the level of whole genomic DNA methylation decreases significantly in blood and liver, rather than pancreas, lung, skin and bladder of ICR mice. This study investigated the direct relationship between aberrant DNA methylation level and benzo[a]pyrene exposure, which might be helpful to clarify the toxicological mechanism of benzo[a]pyrene in epigenetic perspectives.
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Affiliation(s)
- L Zhao
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Veterinary Medicine, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - S Zhang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - X An
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - W Tan
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - D Pang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - H Ouyang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China hongsheng_ouyang@sina.com
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Abstract
This article shows the long-term advantage of total resection of complex spinal cord lipomas over partial resection and over non-surgical treatment for children with asymptomatic lipomas. The classification, embryogenesis, and technique of total resection of complex lipomas are described. The 20-year outcome of 315 patients who had total resection is measured by overall progression-free survival (PFS, Kaplan-Meier), and by subgroup Cox multivariate hazard analysis for the influence of four variables: lipoma type, symptoms, prior surgery, and post-operative cord-sac ratio. These results are compared to 116 patients who underwent partial resection, and to two published series of asymptomatic lipomas followed without surgery. The PFS after total resection for all lipomas is 88.1% over 20 years vs. 34.6% for partial resection at 10.5 years (p < 0.0001). The PFS for total resection of asymptomatic virgin lipomas rose to 98.8% vs. 60% and 67% for non-surgical treatment. Partial resection also compares poorly to non-surgical treatment for asymptomatic lipomas. Multivariate analyses show that a low cord-sac ratio is the only independent variable that predicts good outcome. Pre-operative profiling shows the ideal patient for total resection is a young child with a virgin asymptomatic lipoma, who, with a PFS of 99.2%, is essentially cured. The technique of total resection can be learned by any neurosurgeon. Its long-term protection against symptomatic recurrence is better than partial resection and conservative management. The surgery should be done at diagnosis, except for asymptomatic small infants in whom surgery should be postponed till 6 months to minimize morbidity.
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Affiliation(s)
- Dachling Pang
- Regional Centre of Pediatric Neurosurgery, Kaiser Permanente Medical Center
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Sun S, Liang X, Zhang X, Liu T, Shi Q, Song Y, Jiang Y, Wu H, Jiang Y, Lu X, Pang D. Phosphoglycerate kinase-1 is a predictor of poor survival and a novel prognostic biomarker of chemoresistance to paclitaxel treatment in breast cancer. Br J Cancer 2015; 112:1332-9. [PMID: 25867275 PMCID: PMC4402453 DOI: 10.1038/bjc.2015.114] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023] Open
Abstract
Background: Phosphoglycerate kinase-1 (PGK1) has been recently documented in various malignancies; however, the molecular mechanisms of the variable PGK1 expression and its clinical significance in terms of survival status remain unclear. Methods: Real-time quantitative PCR (real-time qPCR) and western blotting were used to verify PGK1 expression in 46 fresh breast cancer tissues and matched normal tissues. A tissue microarray (TMA) comprising 401 breast cancer tissues and 123 matched normal tissues was investigated by immunohistochemistry for PGK1 expression. Then, the correlation between PGK1 expression and the clinicopathologic features was analysed. Results: PGK1 mRNA and protein expression were significantly increased in breast cancer tissues compared with that in normal breast tissues. High PGK1 expression was significantly associated with higher histologic grade (P=0.009) and positive status of ER (P=0.004), Her-2 (P=0.026) and P53 (P=0.012). High levels of PGK1 expression were associated with worse overall survival (OS, P=0.02). Furthermore, patients who underwent paclitaxel chemotherapy with high levels PGK1 expression had shorter OS than did those with low levels of PGK1 expression (P<0.001). Multivariate analysis indicated that PGK1 (P=0.001) was an independent predictor in the patients treated with paclitaxel. Conclusions: PGK1 is a prognostic biomarker of chemoresistance to paclitaxel treatment in breast cancer.
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Affiliation(s)
- S Sun
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Liang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - T Liu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Q Shi
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Song
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Jiang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - H Wu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Jiang
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Lu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - D Pang
- 1] Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China [2] North China Translational Medicine Research and Cooperation Center (NTMRC), Harbin 150081, China
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Li J, Shao Z, Yang S, Jiang J, Wang C, Liu Y, Fu P, Pang D, Sheng Y. P082 CBCSG-10, the addition of capecitabine to adjuvant chemotherapy in triple-negative breast cancer. Breast 2015. [DOI: 10.1016/s0960-9776(15)70127-x] [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: 11/16/2022] Open
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Abstract
Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.
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Affiliation(s)
- Sui-To Wong
- Department of Paediatric Neurosurgery, Regional Center for Paediatric Neurosurgery and
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Abstract
The authors report the first case of unilateral traumatic rupture of the C-2 neurocentral synchondrosis. A 26-month-old child was in a vehicular collision that caused his head to be rotated sharply to the left with the neck flexed. He had severe neck pain but was neurologically normal. Computerized tomography scanning showed rupture of the left C-2 neurocentral synchondrosis, a right C-2 pars interarticularis fracture, and anterior angulation of C-2 on C-3. The neck injury was unrecognized until postinjury Day 9 when an MRI study showed a tear of the posterior longitudinal ligament at C2-3 and separation of the C-2 body from the inferior anular epiphysis. A second CT showed widening of the synchondrosis fracture, increased angulation of C-2 on C-3, and distraction of the right C-2 pars fracture. The mechanism of the neurocentral synchondrosis fracture is thought to be hyperflexion-axial loading combined with leftward rotation, which provided the lateral force that overcame the cartilaginous synchondrosis and extruded the lateral mass. The patient underwent open reduction and posterior fusion of C1-3, and was maintained in a halo jacket for 4 months, when CT scans demonstrated solid C1-C3 fusion and ossification of the injured synchondrosis. Unilateral traumatic rupture of the C-2 neurocentral synchondrosis is one component of several injuries involving C-2 sustained before synchondrosis closure. The resulting C2-3 relationship is highly unstable. Reduction and C1-C3 fusion are necessary in patients with significant displacement of the adjacent bony units.
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Affiliation(s)
- Sui-To Wong
- Department of Pediatric Neurosurgery, Regional Center for Pediatric Neurosurgery
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Abstract
The embryology of the bony craniovertebral junction (CVJ) is reviewed with the purpose of explaining the genesis and unusual configurations of the numerous congenital malformations in this region. Functionally, the bony CVJ can be divided into a central pillar consisting of the basiocciput and dental pivot; and a two-tiered ring revolving round the central pivot, comprising the foramen magnum rim and occipital condyles above, and the atlantal ring below. Embryologically, the central pillar and the surrounding rings descend from different primordia, and accordingly, developmental anomalies at the CVJ can also be segregated into those affecting the central pillar and the surrounding rings, respectively. A logical classification of this seemingly unwieldy group of malformations is thus possible based on their ontogenetic lineage, morbid anatomy, and clinical relevance. Representative examples of the main constituents of this classification scheme are given, and their surgical treatments are selectively discussed.
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Affiliation(s)
- Dachling Pang
- Department of Paediatric Neurosurgery, University of California, Davis, CA, USA,
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Cook EJ, Randhawa G, Large S, Guppy A, Chater AM, Pang D. Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0-15. BMJ Open 2013; 3:e004106. [PMID: 24327365 PMCID: PMC3863119 DOI: 10.1136/bmjopen-2013-004106] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England. SETTING NHS Direct, England, UK. PARTICIPANTS AND METHODS CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0-15 during the combined four '1-month' periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call. RESULTS For infants aged <1, highest CRs were found for 'crying' for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to 'skin/hair/nails' and 'colds/flu/sickness' for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4-15 in the 15:00-23:00 period and in children aged <1 in the 7:00-15:00 period. CONCLUSIONS This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services.
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Affiliation(s)
- E J Cook
- Department of Psychology, University of Bedfordshire, Luton, Bedfordshire, UK
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