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Lunardi N, Jacob A, Elfenbein D, Schneider DF, Long K, Holoubek SA, MacKinney E, Chiu A, Sippel RS, Balentine CJ. Don't chase the adenoma: A probabilistic approach to imaging before parathyroidectomy. Surgery 2024; 175:1299-1304. [PMID: 38433078 DOI: 10.1016/j.surg.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation. METHODS We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022. The predicted probability of patients having single or double adenoma versus hyperplasia was estimated using logistic regression. We then estimated the relationship between the predicted probability of single/double adenoma and the likelihood that sestamibi or 4-dimensional computed tomography was helpful for operative planning. Current Medicare costs and published data on radiation dosing were used to calculate costs and radiation exposure from non-helpful imaging. RESULTS The mean age was 62 ± 13 years; 78% were women. Adenomas were associated with higher mean calcium (11.2 ± 0.74 mg/dL) and parathyroid hormone levels (140.6 ± 94 pg/mL) than hyperplasia (9.8 ± 0.52 mg/dL and 81.4 ± 66 pg/mL). The probability that imaging helped with operative planning increased from 12% to 65%, as the predicted probability of adenoma increased from 30% to 90%. For every 10,000 patients, a selective approach to imaging that considered the preoperative probability of having adenomas could save patients up to $3.4 million and >239,000 millisieverts of radiation. CONCLUSION Rather than imaging all patients with primary hyperparathyroidism, a selective strategy that considers the probability of having adenomas could reduce costs and avoid excess radiation exposure.
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Affiliation(s)
- Nicole Lunardi
- Department of Surgery, University of Texas Southwestern, Dallas, TX; Department of Surgery, North Texas VA Health Care System, Dallas, TX
| | - Allison Jacob
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Dawn Elfenbein
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - David F Schneider
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Kristin Long
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Simon A Holoubek
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Erin MacKinney
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Alexander Chiu
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Rebecca S Sippel
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Courtney J Balentine
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI; Wisconsin Surgical Outcomes Research Program, Madison, WI.
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MacKinney E, Holoubek S, Khokar A, Kuchta K, Moo -Young T, Prinz R, Winchester D. TREATMENT DIFFERENCES AT HIGH VOLUME CENTERS AND LOW VOLUME CENTERS IN NON -METASTATIC AND METASTATIC ADRENOCORTICAL CARCINOMA. Am J Surg 2022; 223:587-588. [DOI: 10.1016/j.amjsurg.2022.02.017] [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: 11/25/2022]
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Lin B, Ciecko AE, MacKinney E, Serreze DV, Chen YG. Congenic mapping identifies a novel Idd9 subregion regulating type 1 diabetes in NOD mice. Immunogenetics 2016; 69:193-198. [PMID: 27796442 DOI: 10.1007/s00251-016-0957-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
Type 1 diabetes (T1D) results from complex interactions between genetic and environmental factors. The nonobese diabetic (NOD) mouse develops spontaneous T1D and has been used extensively to study the genetic control of this disease. T1D is suppressed in NOD mice congenic for the C57BL/10 (B10)-derived Idd9 resistance region on chromosome 4. Previous studies conducted by other investigators have identified four subregions (Idd9.1, Idd9.2, Idd9.3, and Idd9.4) where B10-derived genes suppress T1D development in NOD mice. We independently generated and characterized six congenic strains containing B10-derived intervals that partially overlap with the Idd9.1 and Idd9.4 regions. T1D incidence studies have revealed a new B10-derived resistance region proximal to Idd9.1. Our results also indicated that a B10-derived gene(s) within the Idd9.4 region suppressed the diabetogenic activity of CD4 T cells and promoted CD103 expression on regulatory T cells indicative of an activated phenotype. In addition, we suggest the presence of a B10-derived susceptibility gene(s) in the Idd9.1/Idd9.4 region. These results provide additional information to improve our understanding of the complex genetic control by the Idd9 region.
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Affiliation(s)
- Bixuan Lin
- Department of Pediatrics, Max McGee National Research Center for Juvenile Diabetes, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ashley E Ciecko
- Department of Pediatrics, Max McGee National Research Center for Juvenile Diabetes, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Erin MacKinney
- Department of Pediatrics, Max McGee National Research Center for Juvenile Diabetes, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.,Southern Illinois University School of Medicine, Springfield, IL, 62702, USA
| | | | - Yi-Guang Chen
- Department of Pediatrics, Max McGee National Research Center for Juvenile Diabetes, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
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Sitton MS, MacKinney E, Garcia-Rodriguez L, Kerschner JE. Historical patterns in presentations at the American Society of Pediatric Otolaryngology (ASPO): using a searchable database of the ASPO Program to show the trends of an otolaryngology subspecialty. Int J Pediatr Otorhinolaryngol 2013; 77:1451-3. [PMID: 23845537 DOI: 10.1016/j.ijporl.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/31/2013] [Accepted: 06/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the development of American Society of Pediatric Otolaryngology (ASPO). To utilize a searchable database of meeting programs to demonstrate content presented at a major meeting since its inception. To utilize a searchable database of meeting programs to show trends of pediatric otolaryngology. METHODS Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck masses, and sinus disease. First author, location of first author, length of presentation, and publication status were collected for each podium presentation. RESULTS An average of 49 (range 31-76) podium presentations were presented at each meeting. The average length of podium presentation was 8.3 min (range of 5-20 min). Tonsil and adenoids made up 9% (range 0-22%) of the program, otology made up 26% (range 15-44%) of the program, airway made up 34% (18-48%) the program, head and neck masses made up 8.7% (0-18.5%) of the program, sinus disease made up 6.2% (0-23%) of the program. Fifty-four percent (54%) of podium presentations were published. CONCLUSION This is a unique example of utilizing searchable databases constructed from published programs of a major otolaryngology meeting to assess topics presented and areas of emphasis. The areas of emphasis at ASPO over its 26 years are airway, otology, tonsil and adenoid issues, head and neck masses, and sinus disease in the pediatric population. Percent of time given to each topic has changed from ASPO's beginning to today.
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Affiliation(s)
- Matthew S Sitton
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States.
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Feng Q, Jiang L, Berg RL, Antonik M, MacKinney E, Gunnell-Santoro J, McCarty CA, Wilke RA. A common CNR1 (cannabinoid receptor 1) haplotype attenuates the decrease in HDL cholesterol that typically accompanies weight gain. PLoS One 2010; 5:e15779. [PMID: 21209828 PMCID: PMC3013130 DOI: 10.1371/journal.pone.0015779] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 11/26/2010] [Indexed: 12/12/2022] Open
Abstract
We have previously shown that genetic variability in CNR1 is associated with low HDL dyslipidemia in a multigenerational obesity study cohort of Northern European descent (209 families, median = 10 individuals per pedigree). In order to assess the impact of CNR1 variability on the development of dyslipidemia in the community, we genotyped this locus in all subjects with class III obesity (body mass index >40 kg/m(2)) participating in a population-based biobank of similar ancestry. Twenty-two haplotype tagging SNPs, capturing the entire CNR1 gene locus plus 15 kb upstream and 5 kb downstream, were genotyped and tested for association with clinical lipid data. This biobank contains data from 645 morbidly obese study subjects. In these subjects, a common CNR1 haplotype (H3, frequency 21.1%) is associated with fasting TG and HDL cholesterol levels (p = 0.031 for logTG; p = 0.038 for HDL-C; p = 0.00376 for log[TG/HDL-C]). The strength of this relationship increases when the data are adjusted for age, gender, body mass index, diet and physical activity. Mean TG levels were 160±70, 155±70, and 120±60 mg/dL for subjects with 0, 1, and 2 copies of the H3 haplotype. Mean HDL-C levels were 45±10, 47±10, and 48±9 mg/dL, respectively. The H3 CNR1 haplotype appears to exert a protective effect against development of obesity-related dyslipidemia.
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Affiliation(s)
- Qiping Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Lan Jiang
- Department of Molecular Physiology and Biophysics, Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Richard L. Berg
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - Melissa Antonik
- Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Erin MacKinney
- Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Jennifer Gunnell-Santoro
- Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Catherine A. McCarty
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - Russell A. Wilke
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Zhang Y, Sonnenberg GE, Baye TM, Littrell J, Gunnell J, DeLaForest A, MacKinney E, Hillard CJ, Kissebah AH, Olivier M, Wilke RA. Obesity-related dyslipidemia associated with FAAH, independent of insulin response, in multigenerational families of Northern European descent. Pharmacogenomics 2010; 10:1929-39. [PMID: 19958092 DOI: 10.2217/pgs.09.122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED A more thorough understanding of the genetic architecture underlying obesity-related lipid disorders could someday facilitate cardiometabolic risk reduction through early clinical intervention based upon improved characterization of individual risk. In recent years, there has been tremendous interest in understanding the endocannabinoid system as a novel therapeutic target for the treatment of obesity-related dyslipidemia. AIMS N-arachidonylethanolamine activates G-protein-coupled receptors within the endocannabinoid system. Fatty acid amide hydrolase (FAAH) is a primary catabolic regulator of N-acylethanolamines, including arachidonylethanolamine. Genetic variants in FAAH have inconsistently been associated with obesity. It is conceivable that genetic variability in FAAH directly influences lipid homeostasis. The current study characterizes the relationship between FAAH and obesity-related dyslipidemia, in one of the most rigorously-phenotyped obesity study cohorts in the USA. MATERIALS & METHODS Members of 261 extended families (pedigrees ranging from 4 to 14 individuals) were genotyped using haplotype tagging SNPs obtained for the FAAH locus, including 5 kb upstream and 5 kb downstream. Each SNP was tested for basic obesity-related phenotypes (BMI, waist and hip circumference, waist:hip ratio, fasting glucose, fasting insulin and fasting lipid levels) in 1644 individuals within these 261 families. Each SNP was also tested for association with insulin responsiveness using data obtained from a frequently sampled intravenous glucose tolerance test in 399 individuals (32 extended families). RESULTS A well characterized coding SNP in FAAH (rs324420) was associated with increased BMI, increased triglycerides, and reduced levels of high-density lipoprotein cholesterol. Mean (standard deviation) high-density lipoprotein cholesterol level was 40.5 (14.7) mg/dl for major allele homozygotes, 39.1 (10.4) mg/dl for heterozygotes, and 34.8 (8.1) mg/dl for minor allele homozygotes (p < 0.01, Family-Based Association Test). This SNP was not associated with insulin sensitivity, acute insulin response to intravenous glucose, glucose effectiveness or glucose disposition index. CONCLUSION Genetic variability in FAAH is associated with dyslipidemia, independent of insulin response.
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Affiliation(s)
- Yi Zhang
- Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226, USA
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