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Dillione MR, Abrahamsen I, Ho D, Pak K, Fiore B, Sadowski B, Liu S, Foley S, Hogan P, Brandau J, Liebig J, Vicente D, Edson T, Bachmann A. Idiopathic Myointimal Hyperplasia of the Mesenteric Veins: A Rare Disorder Leading to Ischemic Proctitis. Am J Gastroenterol 2024; 119:610. [PMID: 38231406 DOI: 10.14309/ajg.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Maggie R Dillione
- Department of Medicine, Naval Medical Center San Diego, San Diego, California, USA
| | - Imani Abrahamsen
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Dan Ho
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Kevin Pak
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
| | - Benjamin Fiore
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
| | - Brett Sadowski
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
| | - Scott Liu
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California, USA
| | - Sean Foley
- Division of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, California, USA
| | - Patricia Hogan
- Division of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, California, USA
| | - Jack Brandau
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Jonathan Liebig
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Diego Vicente
- Department of Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Theodore Edson
- Department of Surgery, Naval Hospital Camp Pendleton, San Diego, California, USA
| | - Angela Bachmann
- Department of Pathology, Naval Medical Center San Diego, San Diego, California, USA
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Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CFJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg 2024; 279:429-436. [PMID: 37991182 DOI: 10.1097/sla.0000000000006159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To characterize the current state of mental health within the surgical workforce in the United States. BACKGROUND Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. METHODS Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. RESULTS Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. CONCLUSIONS Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.
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Affiliation(s)
- Reagan A Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tianna Herman
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anne Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA
| | | | | | - Diego Vicente
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cornelia L Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Imani E McElroy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jaber Valinejad
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Andres Alban
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Mohammad S Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Erika Rangel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Praveen Kumar A, Vicente D, Liu J, Raj-Kumar PK, Deyarmin B, Lin X, Shriver CD, Hu H. Association of clinicopathologic and molecular factors with the occurrence of positive margins in breast cancer. Breast Cancer Res Treat 2024; 204:15-26. [PMID: 38038766 PMCID: PMC10805852 DOI: 10.1007/s10549-023-07157-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To explore the association of clinicopathologic and molecular factors with the occurrence of positive margins after first surgery in breast cancer. METHODS The clinical and RNA-Seq data for 951 (75 positive and 876 negative margins) primary breast cancer patients from The Cancer Genome Atlas (TCGA) were used. The role of each clinicopathologic factor for margin prediction and also their impact on survival were evaluated using logistic regression, Fisher's exact test, and Cox proportional hazards regression models. In addition, differential expression analysis on a matched dataset (71 positive and 71 negative margins) was performed using Deseq2 and LASSO regression. RESULTS Association studies showed that higher stage, larger tumor size (T), positive lymph nodes (N), and presence of distant metastasis (M) significantly contributed (p ≤ 0.05) to positive surgical margins. In case of surgery, lumpectomy was significantly associated with positive margin compared to mastectomy. Moreover, PAM50 Luminal A subtype had higher chance of positive margin resection compared to Basal-like subtype. Survival models demonstrated that positive margin status along with higher stage, higher TNM, and negative hormone receptor status was significant for disease progression. We also found that margin status might be a surrogate of tumor stage. In addition, 29 genes that could be potential positive margin predictors and 8 pathways were identified from molecular data analysis. CONCLUSION The occurrence of positive margins after surgery was associated with various clinical factors, similar to the findings reported in earlier studies. In addition, we found that the PAM50 intrinsic subtype Luminal A has more chance of obtaining positive margins compared to Basal type. As the first effort to pursue molecular understanding of the margin status, a gene panel of 29 genes including 17 protein-coding genes was also identified for potential prediction of the margin status which needs to be validated using a larger sample set.
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Affiliation(s)
- Anupama Praveen Kumar
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | | | - Jianfang Liu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | - Praveen-Kumar Raj-Kumar
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brenda Deyarmin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
| | - Xiaoying Lin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Hai Hu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber (CSSIMMW), Windber, PA, USA.
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Capacio BA, McCarthy PM, West E, Oseni TO, Jones E, Coleman D, Nelson D, Bingham J, Vicente D, Choi PM. Barriers to Academic Surgery in the US Armed Forces: A Study of the AAS Military Committee. J Surg Res 2024; 293:546-552. [PMID: 37832305 DOI: 10.1016/j.jss.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION The purpose of this study is to explore current perceptions within the military surgery community to stratify key obstacles to pursuing a career in academic surgery and identify opportunities for mitigation. METHODS After receiving institutional review board approval, an anonymous electronic survey was distributed to military surgeons across all branches. Survey response data were collected and analyzed using chi-square test. RESULTS The response rate was approximately 22%. Of those who responded to the survey, most are interested in an academic career (61.5%); however, 64% believe this to be much more difficult as a military surgeon than as a civilian surgeon. The top three perceived obstacles include administrative obstacles (76.4%), operational commitments (65.8%), and lack of funding for academic pursuits (62.7%). Most respondents indicated that they have never received formal education regarding how to apply for research funding (84.5%) and most do not have a research mentor (60.9%). Additionally, 42.9% state that obstacles to an academic career in surgery impact their decision to leave the military. Younger surgeons were more likely to leave the military upon completion of their service commitment (67.9% versus 46.4% aged 20-39 y, P = 0.02). CONCLUSIONS We characterized the perceived challenges to academic surgery within the military. These barriers between academic surgery and military service risk medical force attrition, particularly in future generations of surgeons. Dedicated faculty billets (positions) with limited operational demands as well as associated mentorship and research funding may enhance the retention and productivity of military surgeons.
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Affiliation(s)
- Benedict A Capacio
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Patrick M McCarthy
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Erin West
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Tawakalitu O Oseni
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward Jones
- Department of Surgery, University Of Colorado Denver, Aurora, Colorado
| | - Dawn Coleman
- Division of Vascular Surgery, Duke University, Durham, North Carolina
| | - Daniel Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - Jason Bingham
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Diego Vicente
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Pamela M Choi
- Department of Surgery, Naval Medical Center San Diego, San Diego, California.
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Lee J, Roberson L, Garner R, Kim E, Glaser J, Choi P, Vicente D. Trauma and Critical Care Military-Civilian Publications Increased After the COVID-19 Pandemic: A Literature Review. J Surg Res 2023; 292:97-104. [PMID: 37603939 DOI: 10.1016/j.jss.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION There continues to be a growing demand for military-civilian partnerships (MCPs) in research collaborations developing medical trauma care in domestic and international affairs. The objective of this comprehensive review is to investigate the difference in the quantity of MCP trauma and critical care publications before and after the COVID-19 pandemic. METHODS A systematic literature review was performed for the calendar years 2018 and 2021 utilizing MEDLINE, Cochrane, and EMBASE databases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a three-tiered review of 603 English language articles to identify trauma-related military and/or civilian partners and describe the changes in geographical relationships. RESULTS A total of 96 (2018) and 119 (2021) articles met screening criteria for trauma and critical care studies and were used for final data extraction. Ultimately, 59 (2018) and 71 (2021) papers met the inclusion criteria of identifying trauma/critical care MCPs and identified both military and civilian partners. There was also an increase from 10 (2018) to 17 (2021) publications that mentioned advocacy for MCP. Using the author affiliations, four regional MCP types were recorded: of 2018 articles, locoregional (3.4%), US-national (47.5%), single international country (42.4%), and between multiple countries (6.8%); of 2021 articles, locoregional (15.5%), US-national (38%), single international country (29.6%), and between multiple countries (16.9%). There has been an increase in the number of locoregional and multinational MCPs and an overall increase in the number of collaborative trauma publications and MCP advocacy papers. A national geographical heat map was developed to illustrate the changes from 2018 to 2021. CONCLUSIONS There has been an increase in the number of recorded trauma and critical care MCP publications post-pandemic. The growth in the number of manuscripts in more regions post-pandemic suggests an increase in the recognition of collaborations that contribute not only to conflict readiness but also advancements in trauma and surgical care.
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Affiliation(s)
- Joseph Lee
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Laura Roberson
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Reid Garner
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Eungjae Kim
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Jacob Glaser
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland; Surgery, Providence Regional Medical Center, Everett, Washington
| | - Pamela Choi
- Department of Surgery, Naval Medical Center San Diego, San Diego, California; Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Diego Vicente
- Department of Surgery, Naval Medical Center San Diego, San Diego, California; Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland.
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Manzanal A, Vicente D, Alonso M, Azkue N, Ercibengoa M, Marimón JM. Impact of the progressive uptake of pneumococcal conjugate vaccines on the epidemiology and antimicrobial resistance of invasive pneumococcal disease in Gipuzkoa, northern Spain, 1998-2022. Front Public Health 2023; 11:1238502. [PMID: 37719737 PMCID: PMC10501722 DOI: 10.3389/fpubh.2023.1238502] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives To analyze the impact of pneumococcal conjugate vaccines (PCVs) on the incidence of invasive pneumococcal diseases (IPDs) and pneumococcal antibiotic resistance in Gipuzkoa, northern Spain for a 25 years period. Methods All cases of IPD confirmed by culture between 1998 and 2022 in a population of around 427,416 people were included. Pneumococci were serotyped and antimicrobial susceptibility was assessed by the EUCAST guidelines. Results Overall, 1,516 S. pneumoniae isolates were collected. Annual IPD incidence rates (per 100,000 people) declined from 19.9 in 1998-2001 to 11.5 in 2017-19 (42.2% reduction), especially in vaccinated children (from 46.7 to 24.9) and non-vaccinated older adult individuals (from 48.0 to 23.6). After PCV13 introduction, the decrease in the incidence of infections caused by PCV13 serotypes was balanced by the increase in the incidence of non-PCV13 serotypes. In the pandemic year of 2020, IPD incidence was the lowest: 2.81. The annual incidence rates of penicillin-resistant isolates also decreased, from 4.91 in 1998-2001 to 1.49 in 2017-19 and 0.70 in 2020. Since 2017, serotypes 14, 19A, and 11A have been the most common penicillin-resistant types. The incidence of erythromycin-resistant strains declined, from 3.65 to 1.73 and 0.70 in the same years. Conclusion PCV use was associated with declines in the incidence of IPD and the spread of non-vaccine serotypes, that balanced the beneficial effect off PCV13, some of them showing high rates of antibiotic resistance.
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Affiliation(s)
- Ayla Manzanal
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Diego Vicente
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Marta Alonso
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Nekane Azkue
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Maria Ercibengoa
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
| | - José María Marimón
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
- Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, San Sebastián, Spain
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Williams J, Francis A, Prey B, Conner J, Lammers D, Choi PM, Vicente D, Bingham J, McClellan J. Impact of COVID on surgical case volume at military treatment facilities with surgical residencies. Am J Surg 2023; 225:897-902. [PMID: 36764898 DOI: 10.1016/j.amjsurg.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The Military Health System (MHS) is tasked with the dual mission of providing medical care to beneficiaries while ensuring medical readiness. MHS provides care through a combination of military treatment facilities (MTF) ("direct care"; DC) & off-base civilian facilities ("purchased care"; PC). Given recent concerns regarding low surgical volume at MTFs, we sought to evaluate COVID's impact on elective and non-elective case volume at MTFs with surgical residencies. METHODS Retrospective review of 2017-2021 M2 database was performed on Tricare beneficiaries who underwent bariatric surgery or major colorectal surgery in the DC or PC market at, or, surrounding MTFs with surgical residencies. Procedures were identified using ICD-10 procedure codes and Medicare severity-diagnosis related groups. A detailed analysis was then performed on changes in case volume in the DC and PC markets. RESULTS 5,698 bariatric and 5,517 major colorectal procedures were performed during the study period. There was an 84% vs 20% quarterly decrease in elective bariatric surgeries completed in the DC and PC markets from Q1 to Q2 2020. Pre to post-COVID (Q1 2017 - Q1 2020 vs Q3 2020 - Q4 2021) there was a decrease in the percentage of bariatric surgeries completed in the DC market (74.1% vs 55.0%, p = 0.001). Meanwhile, major colorectal surgery quarterly case volume remained unchanged in the DC (137 vs 125, p = 0.18) and PC (146 v 137, p = 0.13) markets, pre- and post-COVID. DISCUSSION Bariatric surgical case volume at MTFs disproportionately decreased during COVID when compared to the PC market and major colorectal cases. Bariatric case volume has rebounded in PC markets surpassing pre-COVID levels while DC case volume remains depressed. Further attention is warranted regarding decreased elective surgical case volume at MTFs.
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Affiliation(s)
| | | | - Beau Prey
- Madigan Army Medical Center, Tacoma, WA, USA
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Capacio B, Shankara Narayanan J, Vicente D, Liu Y, LaPorte J, Cox B, Jaroch D, Katz S, White RR. Pressure-Enabled Drug Delivery (PEDD) of a class C TLR9 agonist in combination with checkpoint inhibitor therapy in a murine pancreatic cancer model. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
729 Background: Systemic immunotherapy has had limited clinical benefit in pancreatic ductal adenocarcinoma (PDAC). This is thought to be due to its desmoplastic immunosuppressive tumor microenvironment in addition to high intratumoral pressures that limit drug delivery. Recent pre-clinical cancer models and early-phase clinical trials have demonstrated the efficacy of toll-like receptor 9 agonists (TLR9a), including the synthetic CpG oligonucleotide SD101, to stimulate innate and adaptive immune cells and eliminate suppressive myeloid cells. We hypothesized that Pressure Enabled Drug Delivery (PEDD) via Pancreatic Retrograde Venous Infusion (PRVI) of a TLR9a would improve responsiveness to systemic anti-programmed death receptor-1 (PD-1) checkpoint inhibitor therapy in a murine orthotopic PDAC model. Methods: Murine PDAC (KPC4580P) tumors were implanted into the pancreatic tails of C57BL/6J mice and treated 8 days after implantation. Mice were assigned to PRVI saline (pSAL, n=9), systemic anti-PD1 100 mcg/mouse on Day 0, 2 and 4 (sAPD1, n = 6), 30mcg PRVI TLR9a (pTLR9a, n=9), 30mcg systemic TLR9a (sTLR9a, n=7) on Day 0, and combination 30mcg PRVI TLR9a on Day 0 and systemic anti-PD1 100 mcg/mouse on Day 0, 2 and 4 (COMBO, n =9). Fluorescently-labeled TLR9a (radiant efficiency [RE]) was measured on day 1. Blood and tumors were collected at necropsy 12 days after infusion. Results: All mice survived to necropsy. Site of tumor fluorescence measurements revealed higher intensity fluorescence in pTLR9a compared to sTLR9a (7.5x10^5 vs. 2.4x10^5 RE, p= 0.048). Significantly lower MDSCs in the COMBO vs. pSAL are shown. Tumor weights were significantly lower in the COMBO group compared to pSAL (400 vs. 964 mg, p=0.003), and were also lower, although not significantly, than in the pTLR9a (400 vs. 518mg, p=0.50), and sAPD1 (400 vs. 645 mg, p = 0.70) groups. Conclusions: PEDD of TLR9a by PRVI with systemic anti-PD-1 demonstrated improved PDAC tumor control. These results support study of this combination therapy in PDAC patients and expansion of ongoing PEDD clinical trials. [Table: see text]
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Affiliation(s)
| | | | | | - Yujia Liu
- TriSalus Life Sciences, Westminster, CO
| | | | - Bryan Cox
- TriSalus Life Sciences, Westminster, CO
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Bernabé-Caro R, García-Campelo R, Garrido P, Palmero R, Artal Á, Bayona C, Rodríguez-Abreu D, López-Brea M, Paredes A, Vicente D, Sánchez Torres J, Majem M, Diz P, Gordo R, Coca M, de Castro J. EP08.02-131 Alectinib after Crizotinib Failure in Patients with Advanced ALK-Positive NSCLC: Results from the Spanish Early Access Program. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.814] [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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Reck M, Liu S, Owen S, Garon E, Neal J, Vicente D, Mekan S, Safavi F, Fernando N, Mok T. EP08.02-098 Phase 2 EVOKE-02 Study of Sacituzumab Govitecan and Pembrolizumab±Platinum in First-Line Metastatic NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gonzalez L, Pawlik TM, Kibbe MR, Williams B, Vicente D, O'Leary MP, Velopulos CG, Funk LM. The 2020 Pandemics: Lessons Learned in Academic Surgery and Beyond. J Surg Res 2022; 276:A1-A6. [PMID: 35314073 PMCID: PMC8932549 DOI: 10.1016/j.jss.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/08/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
2020 was a significant year because of the occurrence of two simultaneous public health crises: the coronavirus pandemic and the public health crisis of racism brought into the spotlight by the murder of George Floyd. The coronavirus pandemic has affected all aspects of health care, particularly the delivery of surgical care, surgical education, and academic productivity. The concomitant public health crisis of racism and health inequality during the viral pandemic highlighted opportunities for action to address gaps in surgical care and the delivery of public health services. At the 2021 Academic Surgical Congress Hot Topics session on flexibility and leadership, we also explored how our military surgeon colleagues can provide guidance in leadership during times of crisis. The following is a summary of the issues discussed during the session and reflections on the important lessons learned in academic surgery over the past year.
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Affiliation(s)
- Lorena Gonzalez
- Department of Surgery, City of Hope National Medical Center, Duarte, California,Corresponding author. City of Hope South Bay, 5215 Torrance Blvd, Torrance, CA 90503. Tel.: 310-750-1715; fax: 310-939-0934
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Melina R. Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Brian Williams
- Department of Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Diego Vicente
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Michael P. O'Leary
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | | | - Luke M. Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin–Madison, Madison, Wisconsin,Department of Surgery, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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12
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Vallejo P, Cilla G, López-Olaizola M, Vicente D, Marimón JM. Epidemiology and Clinical Features of Listeriosis in Gipuzkoa, Spain, 2010-2020. Front Microbiol 2022; 13:894334. [PMID: 35755994 PMCID: PMC9218358 DOI: 10.3389/fmicb.2022.894334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/29/2022] [Indexed: 12/28/2022] Open
Abstract
Background Listeriosis continues to be one of the most important notifiable foodborne diseases. Nonetheless, in Spain, there are few data on the molecular epidemiology of Listeria monocytogenes infections in recent years. Aim To describe clinical features and the molecular epidemiology of human listeriosis over an 11-year period (2010–2020) in Gipuzkoa, Northern Spain. Methods A total of 111 isolates, all but one from invasive disease, were studied. Serotyping (agglutination and multiplex polymerase chain reaction [PCR]) and multilocus sequence typing were performed for all isolates. Antibiotic susceptibility was assessed by the broth microdilution method. Results The average annual incidence of listeriosis in non-pregnancy-associated cases was 1.55 per 100,000 population, with a 1-month mortality rate of 22.2%. In pregnant women, the average incidence was 0.45 cases per 1,000 pregnancies. Twenty-four sequence types were identified, serotype 4b ST1 (24.3%) being the most frequent followed by 1/2b ST87 (18.9%), which caused two long outbreaks in 2013–2014. A significant association was observed between ST219 and meningitis (p < 0.001). All isolates were susceptible to ampicillin as well as other antibiotics used in listeriosis treatment. Conclusion Despite current control measures, listeriosis continues to be an important cause of mortality in the elderly, preterm birth, and miscarriages in pregnant women. Improvements in the control and diagnosis of listeriosis are needed to reduce the impact of this infection on vulnerable populations.
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Affiliation(s)
- Pedro Vallejo
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain.,Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Gustavo Cilla
- Microbiology Department, Infectious Diseases Area, Biodonostia Health Research Institute, Vaccine Preventable Diseases Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Maddi López-Olaizola
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Diego Vicente
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Microbiology Department, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - José María Marimón
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Microbiology Department, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
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13
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Shankara Narayanan JSN, Frizzi K, Erdem S, Ray P, Jaroch D, Cox B, Katz S, Vicente D, White R. Oxaliplatin-induced peripheral neuropathy can be minimized by pressurized regional intravascular delivery in an orthotopic murine pancreatic cancer model. Discov Oncol 2022; 13:21. [PMID: 35384564 PMCID: PMC8986945 DOI: 10.1007/s12672-022-00483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE There is a great need to reduce the toxicity of chemotherapy used in the management of pancreatic ductal adenocarcinoma (PDAC). Here we explore if regional pressurized delivery of oxaliplatin can minimize peripheral neuropathy in mice. METHODS We used an orthotopic PDAC mouse model and delivered a single dose of oxaliplatin through the portal vein using a pressure-enabled system (pancreatic retrograde venous infusion, PRVI). We analyzed the effects of PRVI on tumor burden and peripheral neuropathy using histopathological and functional assays. RESULTS Tumor weights in mice treated with 2 mg/kg oxaliplatin using PRVI were significantly lower than in mice treated with the same dose systemically. This resulted in reduced peripheral neuropathy signatures in PRVI mice compared to the 20 mg/kg systemic dose required to achieve similar tumor control. CONCLUSION Regional delivery of highly cytotoxic agents using PRVI can reduce the therapeutic dose of these drugs, thereby lowering toxic side effects.
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Affiliation(s)
| | - Katie Frizzi
- Department of Pathology, University of California, San Diego, CA, USA
| | - Suna Erdem
- Moores Cancer Center, University of California, 3855 Health Sciences Dr, Rm 2336, La Jolla, San Diego, CA, 92037, USA
| | - Partha Ray
- Moores Cancer Center, University of California, 3855 Health Sciences Dr, Rm 2336, La Jolla, San Diego, CA, 92037, USA
| | - David Jaroch
- TriSalus™ Life Sciences, Inc, Westminster, CO, USA
| | - Bryan Cox
- TriSalus™ Life Sciences, Inc, Westminster, CO, USA
| | - Steven Katz
- TriSalus™ Life Sciences, Inc, Westminster, CO, USA
- Immuno-Oncology Institute, Roger Williams Medical Center, Providence, RI, USA
| | - Diego Vicente
- Moores Cancer Center, University of California, 3855 Health Sciences Dr, Rm 2336, La Jolla, San Diego, CA, 92037, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rebekah White
- Moores Cancer Center, University of California, 3855 Health Sciences Dr, Rm 2336, La Jolla, San Diego, CA, 92037, USA.
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14
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Senan S, Özgüroğlu M, Daniel D, Villegas A, Vicente D, Murakami S, Hui R, Faivre-Finn C, Paz-Ares L, Wu YL, Mann H, Dennis PA, Antonia SJ. Outcomes with durvalumab after chemoradiotherapy in stage IIIA-N2 non-small-cell lung cancer: an exploratory analysis from the PACIFIC trial. ESMO Open 2022; 7:100410. [PMID: 35247871 PMCID: PMC9058904 DOI: 10.1016/j.esmoop.2022.100410] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background The phase III PACIFIC trial (NCT02125461) established consolidation durvalumab as standard of care for patients with unresectable, stage III non-small-cell lung cancer (NSCLC) and no disease progression following chemoradiotherapy (CRT). In some cases, patients with stage IIIA-N2 NSCLC are considered operable, but the relative benefit of surgery is unclear. We report a post hoc, exploratory analysis of clinical outcomes in the PACIFIC trial, in patients with or without stage IIIA-N2 NSCLC. Materials and methods Patients with unresectable, stage III NSCLC and no disease progression after ≥2 cycles of platinum-based, concurrent CRT were randomized 2 : 1 to receive durvalumab (10 mg/kg intravenously; once every 2 weeks for up to 12 months) or placebo, 1-42 days after CRT. The primary endpoints were progression-free survival (PFS; assessed by blinded independent central review according to RECIST version 1.1) and overall survival (OS). Treatment effects within subgroups were estimated by hazard ratios (HRs) from unstratified Cox proportional hazards models. Results Of 713 randomized patients, 287 (40%) had stage IIIA-N2 disease. Baseline characteristics were similar between patients with and without stage IIIA-N2 NSCLC. With a median follow-up of 14.5 months (range: 0.2-29.9 months), PFS was improved with durvalumab versus placebo in both patients with [HR = 0.46; 95% confidence interval (CI), 0.33-0.65] and without (HR = 0.62; 95% CI 0.48-0.80) stage IIIA-N2 disease. Similarly, with a median follow-up of 25.2 months (range: 0.2-43.1 months), OS was improved with durvalumab versus placebo in patients with (HR = 0.56; 95% CI 0.39-0.79) or without (HR = 0.78; 95% CI 0.57-1.06) stage IIIA-N2 disease. Durvalumab had a manageable safety profile irrespective of stage IIIA-N2 status. Conclusions Consistent with the intent-to-treat population, treatment benefits with durvalumab were confirmed in patients with stage IIIA-N2, unresectable NSCLC. Prospective studies are needed to determine the optimal treatment approach for patients who are deemed operable. The PACIFIC trial established durvalumab after CRT as standard of care for unresectable, stage III NSCLC. The optimum multimodal treatment strategy for patients with potentially resectable, stage IIIA-N2 NSCLC is unknown. Survival benefit with durvalumab was observed in patients with stage IIIA-N2, unresectable NSCLC in this post hoc analysis. Durvalumab after CRT also exhibited a manageable safety profile in this subpopulation from PACIFIC. Studies of surgical vs. non-surgical strategies are needed to establish the best approach for potentially operable patients.
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Affiliation(s)
- S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - M Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - D Daniel
- Tennessee Oncology, Chattanooga, USA; Sarah Cannon Research Institute, Nashville, USA
| | - A Villegas
- Cancer Specialists of North Florida, Jacksonville, USA
| | - D Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - R Hui
- Westmead Hospital and the University of Sydney, Sydney, Australia
| | - C Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - L Paz-Ares
- Universidad Complutense, CiberOnc, CNIO and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Y L Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - H Mann
- AstraZeneca, Cambridge, UK
| | | | - S J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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15
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Garcia-Zamalloa A, Vicente D, Arnay R, Arrospide A, Taboada J, Castilla-Rodríguez I, Aguirre U, Múgica N, Aldama L, Aguinagalde B, Jimenez M, Bikuña E, Basauri MB, Alonso M, Perez-Trallero E. Diagnostic accuracy of adenosine deaminase for pleural tuberculosis in a low prevalence setting: A machine learning approach within a 7-year prospective multi-center study. PLoS One 2021; 16:e0259203. [PMID: 34735491 PMCID: PMC8568264 DOI: 10.1371/journal.pone.0259203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the performance of adenosine deaminase in pleural fluid combined with other parameters routinely measured in clinical practice and assisted by machine learning algorithms for the diagnosis of pleural tuberculosis in a low prevalence setting, and secondly, to identify effusions that are non-tuberculous and most likely malignant. PATIENTS AND METHODS We prospectively analyzed 230 consecutive patients diagnosed with lymphocytic exudative pleural effusion from March 2013 to June 2020. Diagnosis according to the composite reference standard was achieved in all cases. Pre-test probability of pleural tuberculosis was 3.8% throughout the study period. Parameters included were: levels of adenosine deaminase, pH, glucose, proteins, and lactate dehydrogenase, red and white cell counts and lymphocyte percentage in pleural fluid, as well as age. We tested six different machine learning-based classifiers to categorize the patients. Two different classifications were performed: a) tuberculous/non-tuberculous and b) tuberculous/malignant/other. RESULTS Out of a total of 230 patients with pleural effusion included in the study, 124 were diagnosed with malignant effusion and 44 with pleural tuberculosis, while 62 were given other diagnoses. In the tuberculous/non-tuberculous classification, and taking into account the validation predictions, the support vector machine yielded the best result: an AUC of 0.98, accuracy of 97%, sensitivity of 91%, and specificity of 98%, whilst in the tuberculous/malignant/other classification, this type of classifier yielded an overall accuracy of 80%. With this three-class classifier, the same sensitivity and specificity was achieved in the tuberculous/other classification, but it also allowed the correct classification of 90% of malignant cases. CONCLUSION The level of adenosine deaminase in pleural fluid together with cell count, other routine biochemical parameters and age, combined with a machine-learning approach, is suitable for the diagnosis of pleural tuberculosis in a low prevalence scenario. Secondly, non-tuberculous effusions that are suspected to be malignant may also be identified with adequate accuracy.
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Affiliation(s)
- Alberto Garcia-Zamalloa
- Internal Medicine Service, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain.,Mycobacterial Infection Study Group (GEIM), From the Spanish Infectious Diseases Society, Spain
| | - Diego Vicente
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain.,Faculty of Medicine, University of the Basque Country, UPV/EHU, Gipuzkoa, Donostia, Spain
| | - Rafael Arnay
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Arantzazu Arrospide
- Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Osakidetza/Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Arrasate-Mondragon, Spain.,Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Biodonostia Health Research Institute, Donostia, Spain.,Kronikgune Institute for Health Services Research, Bizkaia/Barakaldo, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Jorge Taboada
- Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain
| | - Iván Castilla-Rodríguez
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Urko Aguirre
- Kronikgune Institute for Health Services Research, Bizkaia/Barakaldo, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain.,Osakidetza/Basque Health Service, Research Unit, Galdakao University Hospital, Bizkaia, Spain
| | - Nekane Múgica
- Pneumology Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa. Spain
| | - Ladislao Aldama
- Pneumology Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa. Spain
| | - Borja Aguinagalde
- Thoracic Surgery Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa, Spain
| | - Montserrat Jimenez
- Epidemiological Surveillance Unit, Health Department, Basque Government, Gipuzkoa, Spain
| | - Edurne Bikuña
- Epidemiological Surveillance Unit, Health Department, Basque Government, Gipuzkoa, Spain
| | - Miren Begoña Basauri
- Biochemistry Laboratory, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain
| | - Marta Alonso
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain
| | - Emilio Perez-Trallero
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain
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16
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Chick RC, Adams AM, Peace KM, Kemp Bohan PM, Schwantes IR, Clifton GT, Vicente D, Propper B, Newhook T, Grubbs EG, Bednarski BK, Vreeland TJ. Using the Flipped Classroom Model in Surgical Education: Efficacy and Trainee Perception. J Surg Educ 2021; 78:1803-1807. [PMID: 34210646 DOI: 10.1016/j.jsurg.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/03/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the feasibility, efficacy, and learner perception of the flipped classroom model for teaching conferences within surgical training programs. DESIGN For the flipped classroom conferences, video lectures were prepared by a faculty member, and sent to all attendees at least 2 days prior to lecture. The conference time was then spent going over cases and questions, rather than traditional lecture. We conducted a qualitative survey to assess learner's perceptions and pre-lecture quizzes to assess trainee preparedness. SETTING The comparison of pre-conference quizzes between flipped classroom and traditional models was carried out at Brooke Army Medical Center (BAMC) in San Antonio, TX, a tertiary care facility with a general surgery residency program. The survey was conducted at BAMC and within the Complex General Surgical Oncology fellowship program at University of Texas MD Anderson Cancer Center, where a flipped classroom model was similarly employed. PARTICIPANTS Surgical residents BAMC participated in pre-lecture quizzes. BAMC residents and MD Anderson fellows were invited to complete the online survey. RESULTS Lecture videos did not increase mean preparation time (1.53 vs. 1.46 hours without vs. with video, p = 0.858), but did increase mean quiz scores from 67% to 80% (p = 0.031) with 32/35 learners utilizing videos. Videos increased the proportion of learners who self-reported preparing at all from 42% to 95% (p = 0.28), and preparing for at least one hour for conference from 23% to 49% (p = 0.014). Of survey respondents, 90% said videos were very helpful, 90% would use them weekly if available, and 90% prefer this format to traditional lecture. CONCLUSIONS Utilization of a flipped classroom method was well received and preferred by surgical trainees, and it increased performance on pre-conference quizzes without increasing preparation time. Although creation of video lectures is work-intensive for lecturers, these results suggest it is more effective for learner preparation. These results could be generalizable to surgical residents nationwide as technology utilization increases in surgical education.
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Affiliation(s)
- R C Chick
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - A M Adams
- US Army Brooke Army Medical Center, San Antonio, Texas.
| | - K M Peace
- US Army Brooke Army Medical Center, San Antonio, Texas
| | | | - I R Schwantes
- Carver College of Medicine, University of Iowa, Iowa City, Lowa
| | - G T Clifton
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - D Vicente
- Naval Medical Center San Diego, San Diego, California
| | - B Propper
- US Army Brooke Army Medical Center, San Antonio, Texas
| | - T Newhook
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - E G Grubbs
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B K Bednarski
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - T J Vreeland
- US Army Brooke Army Medical Center, San Antonio, Texas
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17
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López-Olaizola M, Aguirre-Quiñonero A, Canut A, Barrios JL, Cilla G, Vicente D, Marimón JM. Haemophilus influenzae Type a Sequence Type 23, Northern Spain. Emerg Infect Dis 2021; 27:2504-2506. [PMID: 34424176 PMCID: PMC8386772 DOI: 10.3201/eid2709.204247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Two consecutive cases of Haemophilus influenzae type a sequence type 23 invasive infection in 2 children attending the same daycare in 2019 triggered epidemiologic surveillance of H. influenzae infections in northern Spain. Despite the invasiveness potential of this virus strain, we detected no additional cases for 2013–2020.
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18
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Vicente D, Maves R, Elster E, Shwayhat A. U.S. Navy's Response to a Shipboard Coronavirus Outbreak: Considerations for a Medical Management Plan at Sea. Mil Med 2021; 186:23-26. [PMID: 33252640 PMCID: PMC7798889 DOI: 10.1093/milmed/usaa455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/25/2020] [Accepted: 11/17/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Diego Vicente
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 34800 San Diego, CA 92134, USA.,Department of Surgery, Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD 4301 Bethesda, MD 20814, USA
| | - Ryan Maves
- Department of Medicine, Naval Medical Center San Diego, San Diego, CA 34800 San Diego, CA 92134, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 4301 Bethesda, MD 20814, USA
| | - Eric Elster
- Department of Surgery, Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD 4301 Bethesda, MD 20814, USA
| | - Alfred Shwayhat
- Department of Medicine, Naval Medical Center San Diego, San Diego, CA 34800 San Diego, CA 92134, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 4301 Bethesda, MD 20814, USA
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19
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Nadal E, Bosch-Barrera J, Cedrés S, Coves J, García-Campelo R, Guirado M, López-Castro R, Ortega AL, Vicente D, de Castro-Carpeño J. SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020). Clin Transl Oncol 2021; 23:980-987. [PMID: 33538989 PMCID: PMC8057959 DOI: 10.1007/s12094-020-02532-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
Mesothelioma is a rare and aggressive tumour with dismal prognosis arising in the pleura and associated with asbestos exposure. Its incidence is on the rise worldwide. In selected patients with early-stage MPM, a maximal surgical cytoreduction in combination with additional antitumour treatment may be considered in selected patients assessed by a multidisciplinary tumor board. In patients with unresectable or advanced MPM, chemotherapy with platinum plus pemetrexed is the standard of care. Currently, no standard salvage therapy has been approved yet, but second-line chemotherapy with vinorelbine or gemcitabine is commonly used. Novel therapeutic approaches based on dual immunotherapy or chemotherapy plus immunotherapy demonstrated promising survival benefit and will probably be incorporated in the future.
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Affiliation(s)
- E. Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Duran i Reynals, Avda Gran Via 199-203, l’Hospitalet de Llobregat, Barcelona, Spain
| | - J. Bosch-Barrera
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Josep Trueta, Girona, Spain
| | - S. Cedrés
- Department of Medical Oncology, Vall d’Hebron Institute of Oncology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - J. Coves
- Department of Medical Oncology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - R. García-Campelo
- Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - M. Guirado
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - R. López-Castro
- Department of Medical Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A. L. Ortega
- Department of Medical Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - D. Vicente
- Department of Clinical Oncology, Hospital Universitario Virgen de Macarena, Sevilla, Spain
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20
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Spigel DR, Vicente D, Ciuleanu TE, Gettinger S, Peters S, Horn L, Audigier-Valette C, Pardo Aranda N, Juan-Vidal O, Cheng Y, Zhang H, Shi M, Luft A, Wolf J, Antonia S, Nakagawa K, Fairchild J, Baudelet C, Pandya D, Doshi P, Chang H, Reck M. Second-line nivolumab in relapsed small-cell lung cancer: CheckMate 331 ☆. Ann Oncol 2021; 32:631-641. [PMID: 33539946 DOI: 10.1016/j.annonc.2021.01.071] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with relapsed small-cell lung cancer (SCLC) have few treatment options and dismal survival. Phase I/II data show activity of nivolumab in previously treated SCLC. PATIENTS AND METHODS CheckMate 331 is a randomized, open-label, phase III trial of nivolumab versus standard chemotherapy in relapsed SCLC. Patients with relapse after first-line, platinum-based chemotherapy were randomized 1 : 1 to nivolumab 240 mg every 2 weeks or chemotherapy (topotecan or amrubicin) until progression or unacceptable toxicity. Primary endpoint was overall survival (OS). RESULTS Overall, 284 patients were randomized to nivolumab and 285 to chemotherapy. Minimum follow-up was 15.8 months. No significant improvement in OS was seen with nivolumab versus chemotherapy [median OS, 7.5 versus 8.4 months; hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.72-1.04; P = 0.11]. A survival benefit with nivolumab was suggested in patients with baseline lactate dehydrogenase ≤ upper limit of normal and in those without baseline liver metastases. OS (nivolumab versus chemotherapy) was similar in patients with programmed death-ligand 1 combined positive score ≥1% versus <1%. Median progression-free survival was 1.4 versus 3.8 months (HR, 1.41; 95% CI, 1.18-1.69). Objective response rate was 13.7% versus 16.5% (odds ratio, 0.80; 95% CI, 0.50-1.27); median duration of response was 8.3 versus 4.5 months. Rates of grade 3 or 4 treatment-related adverse events were 13.8% versus 73.2%. CONCLUSION Nivolumab did not improve survival versus chemotherapy in relapsed SCLC. No new safety signals were seen. In exploratory analyses, select baseline characteristics were associated with improved OS for nivolumab.
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Affiliation(s)
- D R Spigel
- Oncology Department, Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, USA.
| | - D Vicente
- Department of Medical Oncology, Hosp Univ Virgen Macarena, Seville, Spain
| | - T E Ciuleanu
- Medical Oncology, Prof. Dr. Ion Chiricuta Institute of Oncology and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - S Gettinger
- Medical Oncology, Yale Cancer Center, New Haven, USA
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Horn
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | | | - N Pardo Aranda
- Thoracic Unit, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Y Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
| | - H Zhang
- Department of Oncology, Tangdu Hospital, Xi'an, Shaanxi, China
| | - M Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - A Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - J Wolf
- Clinic I for Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - K Nakagawa
- Department of Medical Oncology, Kindai University Hospital, Osaka, Japan
| | - J Fairchild
- Clinical Development, Bristol Myers Squibb, Princeton, USA
| | - C Baudelet
- Global Drug Development, Biometrics & Data Sciences, Bristol Myers Squibb, Princeton, USA
| | - D Pandya
- Translational Pathology, Bristol Myers Squibb, Princeton, USA
| | - P Doshi
- Translational Medicine, Bristol Myers Squibb, Princeton, USA
| | - H Chang
- Translational Bioinformatics, Bristol Myers Squibb, Princeton, USA
| | - M Reck
- Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
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White MG, Lee A, Vicente D, Hall C, Kim MP, Katz MHG, Lee JE, Ikoma N, Lucci A, Tzeng CWD. Measurement of Portal Vein Blood Circulating Tumor Cells is Safe and May Correlate With Outcomes in Resected Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 2021; 28:4615-4622. [PMID: 33415562 DOI: 10.1245/s10434-020-09518-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study investigated the safety and feasibility of intraoperative portal vein blood (PVB) collection at the time of pancreatic ductal adenocarcinoma (PDAC) resection. Relationships of circulating tumor cells (CTCs) in PVB and peripheral blood (PB) with overall survival (OS) and recurrence-free survival were studied. METHODS Patients undergoing PDAC resection were offered enrollment in a prospective liquid biopsy protocol. The patients had PB drawn before incision and PVB drawn before tumor mobilization, then again immediately after resection. Using standard CellSearch protocols, CTCs were identified and compared with OS. RESULTS Of the 34 patients enrolled in this study, 23 (68%) underwent pancreaticoduodenectomy, 8 (23%) underwent distal pancreatectomy, and 3 (9%) underwent total pancreatectomy. Peripheral blood was available for 22 (65%) and PVB for 31 (91%) of the patients. No bleeding or thrombotic complications occurred with the PVB draws. The CTC counts per 7.5 mL of PVB collected before and after resection were highly correlated (R2 = 0.89). The study found CTCs in 11 (50%) of 22 PB samples and 22 (71%) of 31 PVB samples. The OS rate at 18 months was 92% for the patients with < 3 CTCs, 71% for the patients with ≥ 3 CTCs per 7.5 mL of PB (p = 0.30), 100% for the patients without PVB CTCs, and 70% for the patients with PVB CTCs (p < 0.01). CONCLUSIONS Collection of PVB during PDAC resection is safe. In this pilot study, PVB CTC counts but not PB CTC counts were significantly correlated with OS. This opens the door for future studies on selective omission of adjuvant chemotherapy for patients treated preoperatively and tailored surveillance intensity for patients without PVB CTCs at PDAC resection.
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Affiliation(s)
- Michael G White
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diego Vicente
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Carolyn Hall
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Paz-Ares L, Kim T, Vicente D, Felip E, Lee D, Lee K, Lin CC, Flor M, Di Nicola M, Alvarez R, Helwig C, Ojalvo L, Gulley J, Cho B. MO01.27 Three-Year Follow-up of Bintrafusp Alfa, a Bifunctional Fusion Protein Targeting TGF-β and PD-L1, as Second-Line (2L) Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Vicente D, Schobel S, Anfossi S, Hensman H, Lisboa F, Davis T, John Dente C, Douglas Kirk A, Calin G, Andrew Elster E. Characterization of Cellular and Viral MicroRNA in Polytrauma Patients. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nouioui I, Cortés-Albayay C, Neumann-Schaal M, Vicente D, Cilla G, Klenk HP, Marimón JM, Ercibengoa M. Genomic Virulence Features of Two Novel Species Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., Isolated from Patients with Chronic Pulmonary Diseases. Microorganisms 2020; 8:microorganisms8101517. [PMID: 33019781 PMCID: PMC7600791 DOI: 10.3390/microorganisms8101517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/15/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Strains 335427T and 234509T, isolated from two 76-year-old patients with chronic pulmonary diseases, were the subject of polyphasic taxonomic studies and comparative genomic analyses for virulence factors. The 16 rRNA gene sequence similarity between strains 335427T and 234509T and their closest phylogenetic neighbors Nocardia asiatica NBRC 100129T and Nocardia abscessus NBRC 100374T were 99.5% and 100%, respectively. Digital DNA-DNA hybridization values between the aforementioned studied strains were well below the 70% threshold for assigning prokaryotic strains to a novel species. Strains 335427T and 234509T have genome sizes of 8.49 Mpb and 8.07 Mpb, respectively, with G + C content of 68.5%. Isolate 335427T has C16:0, C18:1 ω9c, C18:0 and C18:0 10 methyl as major fatty acids (>15%) and mycolic acids formed of 52-54 carbon atoms. However, only C18:1 ω9c was detected for isolate 234509T, which had mycolic acids with 44-56 carbon. Based on phenotypic and genetic data, strains 335427T (DSM 109819T = CECT 9924T) and 234509T (DSM 111366T = CECT 30129T) merit recognition as novel species, which are named Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., respectively. All the strains studied had homologous VF-associated genes to those described in M. tuberculosis, including experimentally verified virulence genes in humans related to tuberculosis. The narGHIJ (nitrate reduction pathway) and gvpAFGOJLMK (gas vesicles) genetic maps of strains 335427T, 234509T, NBRC 100129T and NBRC 100374T showed the same syntenic block and raise the question of whether their functions are interlinked during the infection of the human host. However, further research is required to decipher the role of the gas vesicle in the pathogenicity mechanism of Nocardia spp.
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Affiliation(s)
- Imen Nouioui
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
- Correspondence: (I.N.); (M.E.)
| | - Carlos Cortés-Albayay
- Laboratory of Microbial Complexity and Functional Ecology, Antofagasta Institute, University of Antofagasta, Antofagasta 1240000, Chile;
| | - Meina Neumann-Schaal
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
| | - Diego Vicente
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Gustavo Cilla
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Hans-Peter Klenk
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Jose María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Maria Ercibengoa
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
- Correspondence: (I.N.); (M.E.)
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Faivre-Finn C, Vicente D, Kurata T, Planchard D, Paz-Ares L, Vansteenkiste J, Spigel D, Garassino M, Reck M, Senan S, Naidoo J, Rimner A, Wu YL, Gray J, Özgüroğlu M, Lee K, Newton M, Wang L, Thiyagarajah P, Antonia S. LBA49 Durvalumab after chemoradiotherapy in stage III NSCLC: 4-year survival update from the phase III PACIFIC trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Paz-Ares L, Kim T, Vicente D, Felip E, Lee D, Lee K, Lin CC, Flor M, Di Nicola M, Alvarez R, Helwig C, Ojalvo L, Gulley J, Cho B. 1272P Three-year follow-up of bintrafusp alfa, a bifunctional fusion protein targeting TGF-β and PD-L1, for second-line (2L) treatment of non-small cell lung cancer (NSCLC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1586] [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] Open
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Narayanan JSNS, Vicente D, Ray P, Whisenant T, White R. Abstract 2221: Combining irreversible electroporation with TLR7 and CD40 agonists confers systemic anti-tumor immunity in a murine pancreatic cancer model. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Pancreatic Cancer (PC) has a highly immunosuppressive microenvironment with a low mutational burden and has so far been resistant to immunotherapy. Irreversible electroporation (IRE) is a non-thermal method of inducing tumor cell death, without damage to adjacent blood vessels, that is being used clinically for selected patients with locally advanced PC. Despite local control rates greater than 90%, most IRE patients develop distant recurrence, emphasizing the need for better methods to treat micrometastatic disease. Using an immunocompetent mouse model of PC, we have previously shown that IRE induces complete regression in 25-33% of subcutaneous tumors, and complete responders are protected from a tumor rechallenge. However, IRE alone did not produce significant therapeutic immunity (abscopal effects) against concomitant distant tumors. We hypothesized that combination of IRE with innate immune stimulators would also enhance the adaptive immune response.
Methods: We used a cell line generated from a genetically engineered (KPC) mouse establish bilateral flank tumors. The “primary” tumor was treated with IRE alone or in combination with local delivery of a toll-like receptor 7 (TLR7) agonist (1V270) and CD40 agonistic antibody (CD40Ab). 15 parameter procartaplex (Thermo) was used for cytokine analysis and RNA-Seq was performed using an Illumina MiSeq 1000 platform with total RNA from excised tumor all on day 7 post procedure.
Results: We observed complete regression in 8/10 tumors treated with the combination (Combo) of IRE, 1V270 and CD40Ab compared to 3/10 in IRE alone. However, the combo was much more effective than IRE alone at inducing regression of the untreated secondary flank tumor, including complete regression of 7/10 untreated tumors. CD40Ab alone had minimal effect on local or secondary tumor growth. Analysis of systemic cytokines using multiplex analysis showed 112 fold increase in IFNy levels in plasma with the Combo compared to untreated mice (P<0.001) and a 39 fold increase compared to IRE alone (P<0.001). Other factors of Th1 response such as IP-10 and IL12-P70 were also significantly (P<0.001) higher in the Combo group compared to IRE alone along with TNFa (elevated 3.2 fold vs IRE). RNA-Seq of the whole tumor followed by gene set enrichment analysis showed significant elevation in Type II interferon, (P<0.0001), IL2 (P<0.0001), and apoptosis (P=0.0001) pathways in the Combo group. Both IRE alone and the Combo group complete responders were protected from tumor growth after immediate rechallenge (14 days) and delayed rechallenge (180 days). However, flow cytometric analysis of the splenocytes revealed that the combo group had more CD44+CD62L+CD8+ central memory T-cells (16%) in contrast to IRE alone (11%).
Conclusion: These data suggest that local delivery of CD40Ab and TLR7 agonists augment the systemic immune effects of IRE and have the potential to improve the overall survival of patients undergoing IRE for locally advanced PC by reducing distant recurrence.
Citation Format: Jayanth Surya Narayanan Shankara Narayanan, Diego Vicente, Partha Ray, Thomas Whisenant, Rebekah White. Combining irreversible electroporation with TLR7 and CD40 agonists confers systemic anti-tumor immunity in a murine pancreatic cancer model [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2221.
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Paz-Ares L, Spira A, Raben D, Planchard D, Cho BC, Özgüroğlu M, Daniel D, Villegas A, Vicente D, Hui R, Murakami S, Spigel D, Senan S, Langer CJ, Perez BA, Boothman AM, Broadhurst H, Wadsworth C, Dennis PA, Antonia SJ, Faivre-Finn C. Outcomes with durvalumab by tumour PD-L1 expression in unresectable, stage III non-small-cell lung cancer in the PACIFIC trial. Ann Oncol 2020; 31:798-806. [PMID: 32209338 DOI: 10.1016/j.annonc.2020.03.287] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the PACIFIC trial, durvalumab significantly improved progression-free and overall survival (PFS/OS) versus placebo, with manageable safety, in unresectable, stage III non-small-cell lung cancer (NSCLC) patients without progression after chemoradiotherapy (CRT). We report exploratory analyses of outcomes by tumour cell (TC) programmed death-ligand 1 (PD-L1) expression. PATIENTS AND METHODS Patients were randomly assigned (2:1) to intravenous durvalumab 10 mg/kg every 2 weeks or placebo ≤12 months, stratified by age, sex, and smoking history, but not PD-L1 status. Where available, pre-CRT samples were tested for PD-L1 expression (immunohistochemistry) and scored at pre-specified (25%) and post hoc (1%) TC cut-offs. Treatment-effect hazard ratios (HRs) were estimated from unstratified Cox proportional hazards models (Kaplan-Meier-estimated medians). RESULTS In total, 713 patients were randomly assigned, 709 of whom received at least 1 dose of study treatment durvalumab (n = 473) or placebo (n = 236). Some 451 (63%) were PD-L1-assessable: 35%, 65%, 67%, 33%, and 32% had TC ≥25%, <25%, ≥1%, <1%, and 1%-24%, respectively. As of 31 January 2019, median follow-up was 33.3 months. Durvalumab improved PFS versus placebo (primary-analysis data cut-off, 13 February 2017) across all subgroups [HR, 95% confidence interval (CI); medians]: TC ≥25% (0.41, 0.26-0.65; 17.8 versus 3.7 months), <25% (0.59, 0.43-0.82; 16.9 versus 6.9 months), ≥1% (0.46, 0.33-0.64; 17.8 versus 5.6 months), <1% (0.73, 0.48-1.11; 10.7 versus 5.6 months), 1%-24% [0.49, 0.30-0.80; not reached (NR) versus 9.0 months], and unknown (0.59, 0.42-0.83; 14.0 versus 6.4 months). Durvalumab improved OS across most subgroups (31 January 2019 data cut-off; HR, 95% CI; medians): TC ≥ 25% (0.50, 0.30-0.83; NR versus 21.1 months), <25% (0.89, 0.63-1.25; 39.7 versus 37.4 months), ≥1% (0.59, 0.41-0.83; NR versus 29.6 months), 1%-24% (0.67, 0.41-1.10; 43.3 versus 30.5 months), and unknown (0.60, 0.43-0.84; 44.2 versus 23.5 months), but not <1% (1.14, 0.71-1.84; 33.1 versus 45.6 months). Safety was similar across subgroups. CONCLUSIONS PFS benefit with durvalumab was observed across all subgroups, and OS benefit across all but TC <1%, for which limitations and wide HR CI preclude robust conclusions.
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Affiliation(s)
- L Paz-Ares
- Hospital Universitario 12 de Octubre, Lung Cancer Unit CNIO-H12o, CiberOnc and Universidad Complutense, Madrid, Spain.
| | - A Spira
- Virginia Health Specialists, Fairfax, USA
| | - D Raben
- Department of Radiation Oncology, University of Colorado Denver, Aurora, USA
| | - D Planchard
- Gustave Roussy, Department of Medical Oncology, Thoracic Unit, Villejuif, France
| | - B C Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - M Özgüroğlu
- Istanbul University - Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - D Daniel
- Tennessee Oncology, Chattanooga and Sarah Cannon Research Institute, Nashville, USA
| | - A Villegas
- Cancer Specialists of North Florida, Jacksonville, USA
| | - D Vicente
- Department of Clinical Oncology, H.U.V. Macarena, Seville, Spain
| | - R Hui
- Westmead Hospital and University of Sydney, Sydney, Australia
| | | | - D Spigel
- Tennessee Oncology, Chattanooga and Sarah Cannon Research Institute, Nashville, USA
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - C J Langer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - B A Perez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | | | | | | | | | - S J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - C Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
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Vicente D, Shankara Narayanan J, Ray P, Chai LF, Erdem S, Carr M, Capacio B, Cox B, Jaroch D, Katz SC, White RR. Comparison of gemcitabine delivery and tumor response in a pressurized pancreatic retrograde venous infusion versus systemic infusion in an orthotopic murine model. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
737 Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with limited response to systemic therapy (ST). Elevated tumor interstitial fluid pressures (IFP) inhibit penetration of ST. Regional Pressure Enabled Drug Delivery has recently demonstrated improved response for liver tumors in a clinical trial. However, this delivery method has not been evaluated in PDAC. We compared gemcitabine (Gem) by systemic delivery vs. a novel pressurized Pancreatic Retrograde Venous Infusion (PRVI) method in an orthotopic PDAC mouse model. Methods: PDAC murine cell line (KPC4580P) tumors were transplanted onto the pancreatic tail of C57BL/6J mice. Groups of 15 mice were randomly assigned to PRVI Gem, PRVI saline (Control), or intraperitoneal Gem (Systemic) groups. Five mice from the PRVI and Systemic groups were randomly selected after one hour post infusion to evaluate Gem tumor concentrations by liquid chromatography - tandem mass spectrometry (ng/mg), and the remainder of mice were euthanized after 7 days to evaluate treatment response. Results: Tumor concentrations of Gem were significantly higher following PRVI compared to Systemic (128 vs. 19, p < 0.01) at one hour after treatment. Seven days after treatment, PRVI Gem mice demonstrated lower mean tumor volume (mm3) than Systemic Gem and Control mice (274 vs. 857 vs. 629, p < 0.01), respectively. Histologic evaluation of tumors demonstrated decreased cellularity in the PRVI Gem mice compared to Systemic and Control mice (35 vs. 78 vs. 71%, p = 0.01), respectively. No differences were seen in Ki67% or immune cell infiltrate between groups. Conclusions: PRVI delivery resulted in increased PDAC Gem concentrations and improved treatment responses with decreased tumor burden and cellularity. These findings suggest that pressurized regional chemotherapy infusion overcomes the elevated PDAC IFP and justifies additional translational pre-clinical studies with other chemotherapeutics (including immunomodulating antibodies) with different physicochemical properties.
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Affiliation(s)
| | | | | | | | | | | | | | - Bryan Cox
- TriSalus Life Sciences, Westminster, CO
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Wang R, Song S, Harada K, Ghazanfari Amlashi F, Badgwell B, Pizzi MP, Xu Y, Zhao W, Dong X, Jin J, Wang Y, Scott A, Ma L, Huo L, Vicente D, Blum Murphy M, Shanbhag N, Tatlonghari G, Thomas I, Rogers J, Kobayashi M, Vykoukal J, Estrella JS, Roy-Chowdhuri S, Han G, Zhang S, Mao X, Song X, Zhang J, Gu J, Johnson RL, Calin GA, Peng G, Lee JS, Hanash SM, Futreal A, Wang Z, Wang L, Ajani JA. Multiplex profiling of peritoneal metastases from gastric adenocarcinoma identified novel targets and molecular subtypes that predict treatment response. Gut 2020; 69:18-31. [PMID: 31171626 PMCID: PMC6943252 DOI: 10.1136/gutjnl-2018-318070] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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: 12/07/2018] [Revised: 03/14/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Peritoneal carcinomatosis (PC) occurs frequently in patients with gastric adenocarcinoma (GAC) and confers a poor prognosis. Multiplex profiling of primary GACs has been insightful but the underpinnings of PC's development/progression remain largely unknown. We characterised exome/transcriptome/immune landscapes of PC cells from patients with GAC aiming to identify novel therapeutic targets. DESIGN We performed whole-exome sequencing (WES) and whole transcriptome sequencing (RNA-seq) on 44 PC specimens (43 patients with PC) including an integrative analysis of WES, RNA-seq, immune profile, clinical and pathological phenotypes to dissect the molecular pathogenesis, identifying actionable targets and/or biomarkers and comparison with TCGA primary GACs. RESULTS We identified distinct alterations in PC versus primary GACs, such as more frequent CDH1 and TAF1 mutations, 6q loss and chr19 gain. Alterations associated with aggressive PC phenotypes emerged with increased mutations in TP53, CDH1, TAF1 and KMT2C, higher level of 'clock-like' mutational signature, increase in whole-genome doublings, chromosomal instability (particularly, copy number losses), reprogrammed microenvironment, enriched cell cycle pathways, MYC activation and impaired immune response. Integrated analysis identified two main molecular subtypes: 'mesenchymal-like' and 'epithelial-like' with discriminating response to chemotherapy (31% vs 71%). Patients with the less responsive 'mesenchymal-like' subtype had high expression of immune checkpoint T-Cell Immunoglobulin And Mucin Domain-Containing Protein 3 (TIM-3), its ligand galectin-9, V-domain Ig suppressor of T cell activation (VISTA) and transforming growth factor-β as potential therapeutic immune targets. CONCLUSIONS We have uncovered the unique mutational landscape, copy number alteration and gene expression profile of PC cells and defined PC molecular subtypes, which correlated with PC therapy resistance/response. Novel targets and immune checkpoint proteins have been identified with a potential to be translated into clinics.
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Affiliation(s)
| | - Shumei Song
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Kazuto Harada
- GI Medical Oncology, UT MDACC, Houston, Texas, USA,Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | | | | | | | - Yan Xu
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Wei Zhao
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | | | | | - Ying Wang
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Ailing Scott
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Lang Ma
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Longfei Huo
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | | | | | | | | | - Irene Thomas
- GI Medical Oncology, UT MDACC, Houston, Texas, USA
| | - Jane Rogers
- Pharmacy Clinical Programs, UT MDACC, Houston, TX, USA
| | | | - Jody Vykoukal
- Clinical Cancer Prevention, UT MDACC, Houston, Texas, USA
| | | | | | | | | | - Xizeng Mao
- Genomic Medicine, UT MDACC, Houston, Texas, USA
| | | | | | - Jian Gu
- Epidemiology, UT MDACC, Houston, Texas, USA
| | | | | | - Guang Peng
- Clinical Cancer Prevention, UT MDACC, Houston, Texas, USA
| | - Ju-Seog Lee
- Systems Biology, UT MDACC, Houston, Texas, USA
| | - Samir M Hanash
- Clinical Cancer Prevention, UT MDACC, Houston, Texas, USA
| | | | - Zhenning Wang
- Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang, China
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Abstract
A nosocomial case of Legionella pneumophila pneumonia likely caused by a serogroup 3 strain was detected by a urinary antigen test in Spain in 2018. Although Legionella bacteria could not be isolated from respiratory samples, molecular methods implicated the sink faucet of the patient's room as the probable infection source.
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Vicente D, Lee AJ, Hall CS, Lucci A, Lee JE, Kim MP, Katz MH, Hurd MW, Maitra A, Rhim, MD AD, Tzeng CWD. Circulating Tumor Cells and Transforming Growth Factor Beta in Resected Pancreatic Adenocarcinoma. J Surg Res 2019; 243:90-99. [DOI: 10.1016/j.jss.2019.04.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
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Wu YL, Gray J, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee K, Cho B, Planchard D, Paz-Ares L, Faivre-Finn C, Vansteenkiste J, Spigel D, Taboada M, Dennis P, Özgüroğlu M, Antonia S. Three-year overall survival update from the PACIFIC trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz438.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guirado M, Majem M, Massuti Sureda B, de las Penas Bataller R, Ortega Granados A, Isla Casado M, Domine Gomez M, Marse Fabregat R, Sala M, Paredes Lario A, Moran Bueno M, Vazquez Estevez S, Coves Sarto J, Gonzalez-Larriba J, Sanchez Torres J, Vicente D, Farre Bernado N, Fernandez-Fornos L, Varcarcel F, Provencio M. NORA trial (GECP 15/02): Updated results of the Spanish Lung Cancer Group (SLCG) phase II trial of concurrent chemo-radiotherapy (CT-RT) with cisplatin (P) plus metronomic oral vinorelbine (mOV) for unresectable locally advanced non-small cell lung cancer (LA-NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paz-Ares L, Vicente D, Tafreshi A, Robinson A, Soto Parra H, Mazières J, Hermes B, Cicin I, Medgyasszay B, Beatrix B, Rodríguez Cid J, Okamoto I, Lee S, Ramlau R, Vladimirov V, Cheng Y, Deng X, Bas T, Piperdi B, Halmos B. Pembrolizumab (pembro) + chemotherapy (chemo) in metastatic squamous NSCLC: Final analysis and progression after the next line of therapy (PFS2) in KEYNOTE-407. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Narayanan JSS, Ray P, Hayashi T, Whisenant TC, Vicente D, Carson DA, Miller AM, Schoenberger SP, White RR. Irreversible Electroporation Combined with Checkpoint Blockade and TLR7 Stimulation Induces Antitumor Immunity in a Murine Pancreatic Cancer Model. Cancer Immunol Res 2019; 7:1714-1726. [PMID: 31409607 DOI: 10.1158/2326-6066.cir-19-0101] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/26/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022]
Abstract
Irreversible electroporation (IRE) is a nonthermal ablation technique that is used clinically in selected patients with locally advanced pancreatic cancer, but most patients develop recurrent distant metastatic disease. We hypothesize that IRE can induce an in situ vaccination effect by releasing tumor neoantigens in an inflammatory context. Using an immunocompetent mouse model, we demonstrated that IRE alone produced complete regression of subcutaneous tumors in approximately 20% to 30% of mice. IRE was not effective in immunodeficient mice. Mice with complete response to IRE demonstrated prophylactic immunity and remained tumor free when rechallenged with secondary tumors on the contralateral flank. CD8+ T cells from IRE-responsive mice were reactive against peptides representing model-inherent alloantigens and conferred protection against tumor challenge when adoptively transferred into immunocompromised, tumor-naïve mice. Combining IRE with intratumoral Toll-like receptor-7 (TLR7) agonist (1V270) and systemic anti-programmed death-1 receptor (PD)-1 checkpoint blockade resulted in improved treatment responses. This combination also resulted in elimination of untreated concomitant distant tumors (abscopal effects), an effect not seen with IRE alone. These results suggest that the systemic antitumor immune response triggered by IRE can be enhanced by stimulating the innate immune system with a TLR7 agonist and the adaptive immune system with anti-PD-1 checkpoint blockade simultaneously. Combinatorial approaches such as this may help overcome the immunosuppressive pancreatic cancer microenvironment.
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Affiliation(s)
| | - Partha Ray
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Tomoko Hayashi
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Thomas C Whisenant
- Department of Computational Biology, University of California San Diego, San Diego, California
| | - Diego Vicente
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Dennis A Carson
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Aaron M Miller
- Moores Cancer Center, University of California San Diego, San Diego, California.,La Jolla Institute of Allergy and Immunology, La Jolla, California
| | | | - Rebekah R White
- Moores Cancer Center, University of California San Diego, San Diego, California.
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Vidaur L, Totorika I, Montes M, Vicente D, Rello J, Cilla G. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis. Ann Intensive Care 2019; 9:86. [PMID: 31342206 PMCID: PMC6656825 DOI: 10.1186/s13613-019-0559-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/09/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022] Open
Abstract
Background Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce. Methods This is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3. Results The 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62 years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60 years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14 days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p < 0.05). The levels of C-reactive protein, however, were similar. Conclusion Human metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship. Electronic supplementary material The online version of this article (10.1186/s13613-019-0559-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Loreto Vidaur
- Critical Care Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain. .,CIBERES, Institute of Health Carlos III, Madrid, Spain.
| | - Izarne Totorika
- Critical Care Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
| | - Milagrosa Montes
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
| | - Diego Vicente
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain.,Faculty of Medicine, University of Basque Country (UPV/EHU), San Sebastian, Guipuzcoa, Spain
| | - Jordi Rello
- CIBERES, Institute of Health Carlos III, Madrid, Spain.,Research Institute Vall d`Hebron University Hospital (VHIR), Barcelona, Spain
| | - Gustavo Cilla
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
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Cho B, Reinmuth N, Lee K, Ahn MJ, Luft A, Van den Heuvel M, Dols MC, Smolin A, Vicente D, Moiseyenko V, Antonia S, Moulec SL, Robinet G, Natale R, Garon E, Nakagawa K, Liu F, Thiyagarajah P, Peters S, Rizvi N. Efficacy and safety of first-line durvalumab (D) ± tremelimumab (T) vs platinum-based chemotherapy (CT) based on clinical characteristics in patients with metastatic (m) NSCLC: Results from MYSTIC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz094.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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39
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Garassino M, Paz-Ares L, Hui R, Faivre-Finn C, Spira A, Planchard D, Ozguroglu M, Daniel D, Vicente D, Murakami S, Rydén A, Zhang Y, O’Brien C, Dennis P, Antonia S. Patient-reported outcomes (PROs) with durvalumab by PD-L1 expression in unresectable, stage III NSCLC (PACIFIC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz094.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Vicente D, Basterretxea M, de la Caba I, Sancho R, López-Olaizola M, Cilla G. Low antimicrobial resistance rates of Mycobacterium tuberculosis complex between 2000 and 2015 in Gipuzkoa, northern Spain. Enferm Infecc Microbiol Clin 2019; 37:574-579. [PMID: 30850232 DOI: 10.1016/j.eimc.2019.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although the incidence of tuberculosis (TB) has declined, TB drug resistance remains a major problem. The TB rate in Gipuzkoa (northern Spain) is higher than the European average. The objective of this study was to determine the antimicrobial susceptibility of 1855 Mycobacterium tuberculosis complex isolates (94.5% of confirmed cases between 2000 and 2015). METHODS Susceptibility testing was performed using the agar proportion method and a commercial broth system (MGIT 960). In isoniazid- or rifampicin-resistant strains, we studied genetic determinants of drug resistance and genotype (MIRU-VNTR). RESULTS The annual mean incidence of TB was 24.5 cases per 100,000 population on average, and tended to decrease. The multidrug-resistant TB rate was 0.5% (9/1855), and no extensively drug-resistant TB strains were detected. Rates of resistance to isoniazid and rifampicin were 3.9% (range, 3.4-4.3%) and 0.6% (range, 0.4-1.4%), respectively. TB resistance was more common among foreign-born individuals and those who had received previous TB treatment. Genotyping of 102 resistant strains showed predominance of the Euro-American lineage, although 4/9 multidrug-resistant strains had Eastern lineages (2 East African-Indian, and 2 East Asian [Beijing]). CONCLUSIONS In Gipuzkoa, with a moderate incidence of TB, resistance was very low, mostly being detected among individuals who were born abroad or who had a history of TB treatment.
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Affiliation(s)
- Diego Vicente
- Departmento de Microbiología, Hospital Universitario Donostia, Donostia-San Sebastián, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco, Leioa, Spain.
| | - Mikel Basterretxea
- Departmento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Gipuzkoa, Donostia-San Sebastián, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Idoia de la Caba
- Departmento de Microbiología, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Rosa Sancho
- Departmento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Gipuzkoa, Donostia-San Sebastián, Spain
| | - Maddi López-Olaizola
- Departmento de Microbiología, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Gustavo Cilla
- Departmento de Microbiología, Hospital Universitario Donostia, Donostia-San Sebastián, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
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Ercibengoa M, Alonso M, Vicente D, Morales M, Garcia E, Marimón JM. Utility of MALDI-TOF MS as a new tool for Streptococcus pneumoniae serotyping. PLoS One 2019; 14:e0212022. [PMID: 30753210 PMCID: PMC6372175 DOI: 10.1371/journal.pone.0212022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
Nowadays, more than 95 different Streptococcus pneumoniae serotypes are known, being less than one third responsible for the majority of severe pneumococcal infections. After the introduction of conjugate vaccines, a change in the epidemiology of the serotypes causing invasive pneumococcal disease has been observed making the surveillance of circulating serotypes especially relevant. Some recent studies have used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) technology to identify the most frequent pneumococcal serotypes that cause invasive disease. The objectives of this study were to evaluate the efficacy of previously described discriminatory peaks determined by MALDI-TOF MS for the identification of serotypes 6B, 19F, 19A and 35B using reference and clinical isolates and to try to identify other discriminatory peaks for serotypes 11A, 19F and 19A using transformed pneumococcal strains. Most of the proposed peaks defined in the literature for the identification of serotypes 6B, 19F, 19A, 35B were not found in the spectra of the 10 reference isolates nor in those of the 60 clinical isolates tested corresponding to these four serotypes. The analysis and comparison of the mass spectra of genetically modified pneumococci (transformed strains) did not allow the establishment of new discriminatory peaks for serotypes 11A, 19F, and 19A. MALDI-TOF MS in the usual range of 2,000 to 20,000 m/z did not prove to be a valid technique for direct S. pneumoniae serotyping.
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Affiliation(s)
- María Ercibengoa
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Preventive Medicine and Health Public Department, University of Basque Country UPV/EHU, San Sebastián, Spain
- * E-mail:
| | - Marta Alonso
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
| | - Diego Vicente
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Preventive Medicine and Health Public Department, University of Basque Country UPV/EHU, San Sebastián, Spain
| | - Maria Morales
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Departamento de Biotecnología Microbiana y de Plantas, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Ernesto Garcia
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Departamento de Biotecnología Microbiana y de Plantas, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Jose María Marimón
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
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Vicente D, Patino M, Marcus R, Lillmoe H, Limani P, Newhook T, Lee A, Tzeng CW, Segraves-Chun Y, Tweardy D, Gottumukkala V, Vauthey JN, Aloia T, Cata JP. Impact of epidural analgesia on the systemic biomarker response after hepatic resection. Oncotarget 2019; 10:584-594. [PMID: 30728909 PMCID: PMC6355178 DOI: 10.18632/oncotarget.26549] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/22/2018] [Indexed: 12/30/2022] Open
Abstract
Background Perioperative inflammation is associated with poor oncologic outcomes. Regional analgesia has been shown mitigate some of these inflammatory changes and be associated with better oncologic outcomes in patients with hepatic malignancies. The mechanism for this effect, however, remains unclear. The authors sought to compare systemic biomarker concentrations in a comprehensive and oncologically relevant panel in the perioperative setting between patients undergoing thoracic epidural analgesia (TEA) and intra-venous patient- controlled analgesia (IV-PCA) for resection of hepatic metastatic disease. Results Clinicopathologic variables and baseline biomarkers were similar between TEA (n = 46) and IV-PCA (n = 16) groups. Of the biomarkers which were significantly changed from baseline, there was a lower fold change from baseline in the TEA patients compared to IV-PCA including IL-6 (13.5vs19.1), MCP-1 (1.9vs3.0), IL-8 (2.4vs3.0), and Pentraxin-3 (10.8vs15.6). Overall decreased systemic concentrations of TGFb signaling were noted in TEA patients on POD1 TGFb3 (243.2 vs. 86.0, p = 0.005), POD3 TGFb1 (6558.0 vs. 2063.3, p = 0.004), POD3 TGFb2 (468.3 vs. 368.9, p = 0.036), POD3 TGFb3 (132.2 vs. 77.8, p = 0.028), and POD5 TGFb3 (306.5 vs. 92.2, p = 0.032). POD1 IL-12p70 concentrations were significantly higher in TEA patients (8.3 vs. 1.6, p = 0.024). Conclusion Epidural analgesia damped the postoperative inflammatory response and systemic immunosuppressive signaling, as well as promoted Th1 systemic signaling early in the post-operative period after hepatic resection for metastatic disease. These differences elaborate on known mechanisms for improved oncologic outcomes with regional anesthesia, and may be considered for biomarker monitoring of effective regional anesthesia in oncologic surgery. Materials and Methods Patient data, including clinicopathologic variables were collected for this study from the database of a randomized controlled trial comparing perioperative outcomes in patients undergoing hepatic resection with TEA vs. IV-PCA. Patients undergoing resection for metastatic disease were selected for this study. Plasma concentrations (pg/mL) of well-studied biomarkers (IL-1b/2/4/5/6/7/8/10/12p70/13/17, MCP-1 IFNγ, TNFα, MIP-1b, GM-CSF, G-CSF, VEGF, Resistin, TGFb1, TGFb2, and TGFb3), as well as novel perioperative markers (CXCL12, CXCL10, Omentin-1, sLeptin R, Vaspin, Pentraxin-3, Galactin-3, FGF-23, PON-1, FGF-21) were measured preoperatively, and on postoperative day (POD)1, POD3, and POD5 using multiplex bead assays. Clinicopathologic variables and perioperative variations in these biomarkers were compared between TEA vs IV-PCA groups.
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Affiliation(s)
- Diego Vicente
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Miguel Patino
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Marcus
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lillmoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preparim Limani
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andy Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Segraves-Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Tweardy
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Reck M, Vicente D, Ciuleanu T, Gettinger S, Peters S, Horn L, Audigier-Valette C, Pardo N, Juan-Vidal O, Cheng Y, Zhang H, Shi M, Wolf J, Antonia S, Nakagawa K, Selvaggi G, Baudelet C, Chang H, Spigel D. Efficacy and safety of nivolumab (nivo) monotherapy versus chemotherapy (chemo) in recurrent small cell lung cancer (SCLC): Results from CheckMate 331. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy511.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rizvi N, Chul Cho B, Reinmuth N, Lee K, Ahn MJ, Luft A, van den Heuvel M, Cobo M, Smolin A, Vicente D, Moiseyenko V, Antonia S, Le Moulec S, Robinet G, Natale R, Nakagawa K, Zhao L, Stockman P, Chand V, Peters S. Durvalumab with or without tremelimumab vs platinum-based chemotherapy as first-line treatment for metastatic non-small cell lung cancer: MYSTIC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy511.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Provencio M, Cheema P, Vansteenkiste J, Cho B, Zhou C, Yu J, Martin C, Park K, He Y, Hu Y, Vicente D, Miranda M, Rigas J, de Marinis F. ASTRIS global real world study of osimertinib in patients (pts) with EGFR T790M non-small cell lung cancer (NSCLC): Subpopulation analyses. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy446.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Vicente D, Ikoma N, Badgwell BD. ASO Author Reflections: Survival Impacts of Therapy and Complications in Gastric Adenocarcinoma. Ann Surg Oncol 2018; 25:753-754. [PMID: 30374929 DOI: 10.1245/s10434-018-6956-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Diego Vicente
- The Department of Surgery at Uniformed Services, University of the Health Sciences & The Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Spigel D, Vansteenkiste J, Reck M, Wakelee H, Özgüroğlu M, Daniel D, Villegas A, Vicente D, Hui R, Murakami S, Paz-Ares L, Poole L, Wadsworth C, Dennis P, Antonia S. P1.16-05 Effect of Induction Chemotherapy in the PACIFIC Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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48
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Mazières J, Kowalski D, Luft A, Vicente D, Tafreshi A, Gümüş M, Laktionov K, Hermes B, Cicin I, Rodríguez-Cid J, Wilson J, Kato T, Ramlau R, Novello S, Reddy S, Piperdi B, Li X, Burke T, Paz-Ares L. Health-related quality of life (HRQoL) for pembrolizumab or placebo plus carboplatin and paclitaxel or nab-paclitaxel in patients with metastatic squamous NSCLC: Data from KEYNOTE-407. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Ercibengoa M, Vicente D, Arranz L, Ugarte ASD, Marimon JM. Primary Cutaneous Nocardia brasiliensis in a Spanish Child. Clin Lab 2018; 64:1769-1772. [PMID: 30336526 DOI: 10.7754/clin.lab.2018.180531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report a case of a primary cutaneous nocardiosis by autochthonous Nocardia brasiliensis in a Spanish immunocompetent 9-year-old boy. METHODS N. brasiliensis caused cellulitis showing the patient recovery after drainage and treatment with trimethoprim-sulfamethoxazole. Nocardia grew in pure culture and its identification was confirmed by sequencing (16S rRNA) and by MALDI-TOF MS (Bruker, Daltonics, Germany). CONCLUSIONS In Spain although N. brasiliensis cutaneous infections in children are very infrequent should not be ruled out when an insect bite, stuck with a pine needle or an animal scratch has existed and the wound evolution is torpid.
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Bondarenko I, Juan-Vidal O, Pajkos G, Kryzhanivska A, Pápai Székely Z, Vicente D, Vynnychenko I, Jones S, Wang Y, Jiang H, Reinmuth N. Preliminary efficacy of durvalumab plus tremelimumab in platinum-refractory/resistant ED-SCLC from arm A of the phase II BALTIC study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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