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Lee EH, Lee JA, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom JS, Song YG, Park SH, Kim JH. Association of body mass index and bloodstream infections in patients on extracorporeal membrane oxygenation: a single-centre, retrospective, cohort study. J Hosp Infect 2023; 140:117-123. [PMID: 37562593 DOI: 10.1016/j.jhin.2023.08.005] [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: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Obesity is associated with poor clinical outcomes in critically ill patients. However, under some clinical conditions, obesity has protective effects. Bloodstream infections (BSI) are among the most common nosocomial infections associated with extracorporeal membrane oxygenation (ECMO). BSI during ECMO is associated with higher mortality rates and poorer clinical outcomes. AIM To analyse whether body mass index (BMI) is associated with BSI during ECMO or with in-hospital mortality. METHODS All adult patients who had received ECMO support for >48 h were included in the analysis. The analysis of total duration of ECMO support, in-hospital mortality and BSI was stratified by BMI category. The Cox proportional hazards model was used to compare the risk of BSI among BMI categories. FINDINGS In total, 473 patients were enrolled in the study. The average age was 56.5 years and 65.3% were men. The total duration of ECMO was approximately 11.8 days, with a mortality rate of 47.1%. The incidence rates of BSI and candidaemia were 20.5% and 5.5%, respectively. The underweight group required ECMO for respiratory support, whereas the overweight and obese groups required ECMO for cardiogenic support (P<0.0001). No significant difference in BSI rate was found (P=0.784). However, after adjusting for clinical factors, patients in Group 4 (BMI 25.0-<30.0 kg/m2) exhibited lower mortality compared with patients in Group 2 (normal BMI) (P=0.004). CONCLUSION BMI was not associated with risk of BSI, but patients with higher BMI showed lower in-hospital mortality associated with ECMO support.
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Affiliation(s)
- E H Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J-S Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Y G Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S H Park
- Chaum Life Centre, CHA University, Seoul, South Korea.
| | - J H Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Lee EH, Lee SK, Cheon JH, Koh H, Lee JA, Kim CH, Kim JN, Lee KH, Lee SJ, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yong DE, Yoon SS, Yeom JS, Choi JY. Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube. J Hosp Infect 2023; 131:234-243. [PMID: 36414164 DOI: 10.1016/j.jhin.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonizing MDRO. AIM To compare the efficacy of different FMT methods to optimize the success rate of decolonization in patients with MDRO carriage. METHODS This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube. FINDINGS A total of 57 patients underwent FMT for MDRO decolonization. The colonoscopy group required the shortest time for decolonization, whereas the EGD group required the longest (24.9 vs 190.4 days, P = 0.022). The decolonization rate in the oral capsule group was comparable to that in the EGD group (84.6% vs 85.7%, P = 0.730). An important clinical factor associated with decolonization failure was antibiotic use after FMT (odds ratio = 6.810, P = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT. CONCLUSION Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonization.
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Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Cheon
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - H Koh
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - C H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J N Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - D E Yong
- Division of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - S S Yoon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, South Korea
| | - J S Yeom
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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3
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Cohilis M, Hong L, Janssens G, Rossomme S, Sterpin E, Lee JA, Souris K. Development and validation of an automatic commissioning tool for the Monte Carlo dose engine in myQA iON. Phys Med 2022; 95:1-8. [PMID: 35051680 DOI: 10.1016/j.ejmp.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 12/14/2022] Open
Abstract
Independent dose verification with Monte Carlo (MC) simulations is an important feature of proton therapy quality assurance (QA). However, clinical integration of such tools often generates an additional and complex workload for medical physicists. The preparation of the necessary clinical inputs, such as the machine beam model, should therefore be automated. In this work, a methodology for automatic MC commissioning has been devised, validated, and developed into a MATLAB tool for the users of myQA iON, the recent QA platform of IBA Dosimetry. With this workflow, all necessary parameters can easily be tuned using dedicated optimization methods. For the geometrical beam parameters (phase space), the assumption of a single or double Gaussian is made. To model the energy spectrum, a Gaussian function is assumed and parameters are optimized using either MC simulations or a library of pre-computed Bragg peaks. For the absolute dose calibration, commissioning fields can be reproduced with the dose engine to retrieve the necessary parameters. We discuss in a first time the tool efficiency and show that one can optimize all parameters in less than 4 min per energy with excellent accuracy. We then validate a beam model obtained with the tool by simulating homogeneous spread-out Bragg peaks (SOBPs) and patient QA plans previously measured in water. An average range agreement of 0.29 ± 0.34 mm is achieved for the SOBPs while 3%/3 mm local gamma passing rates reach 99.3% on average over all 62 measured patient QA planes, which is well within clinical tolerances.
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Affiliation(s)
- M Cohilis
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium
| | - L Hong
- University of Florida Proton Therapy Institute, Jacksonville, FL, USA
| | - G Janssens
- Ion Beam Applications, Louvain-la-Neuve, Belgium
| | - S Rossomme
- Ion Beam Applications, Louvain-la-Neuve, Belgium
| | - E Sterpin
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium; KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - J A Lee
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium
| | - K Souris
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), MIRO Lab, Brussels, Belgium.
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Steinl GK, Yeh R, McManus CM, Lee JA, Kuo JH. Variations in the Course of the Carotid Arteries in Patients with Retropharyngeal Parathyroid Adenomas. AJNR Am J Neuroradiol 2021; 42:749-752. [PMID: 33602744 DOI: 10.3174/ajnr.a6995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
The carotid arteries, classically described as taking a relatively straight course through the neck, deviate medially in a minority of patients. At the extreme, the internal carotid arteries may "kiss" in the midline, coming extremely close to the pharyngeal wall. In this clinical report, we describe 5 patients with primary hyperparathyroidism, all with ectopic retropharyngeal parathyroid adenomas but all with varying carotid artery anatomy. We describe these variations using a previously developed clinical grading system that highlights 1) the relationship between carotid artery location and risk of injury during pharyngeal procedures and 2) the importance of universal, objective criteria to classify carotid anatomy. Radiologists should be familiar with variations in carotid anatomy and communicate them to the operative team.
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Affiliation(s)
- G K Steinl
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - R Yeh
- Department of Radiology (R.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - C M McManus
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - J A Lee
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - J H Kuo
- From the Department of Surgery, Division of GI/Endocrine Surgery (G.K.S., C.M.M., J.A.L., J.H.K.), Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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Sterpin E, Rivas ST, Van den Heuvel F, George B, Lee JA, Souris K. Development of robustness evaluation strategies for enabling statistically consistent reporting. Phys Med Biol 2021; 66:045002. [PMID: 33296875 DOI: 10.1088/1361-6560/abd22f] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Robustness evaluation of proton therapy treatment plans is essential for ensuring safe treatment delivery. However, available evaluation procedures feature a limited exploration of the actual robustness of the plan and generally do not provide confidence levels. This study compared established and more sophisticated robustness evaluation procedures, with quantified confidence levels. We have evaluated several robustness evaluation methods for 5 bilateral head-and-neck patients optimized considering spot scanning delivery and with a conventional CTV-to-PTV margin of 4 mm. Method (1) good practice scenario selection (GPSS) (e.g. +/- 4 mm setup error 3% range uncertainty); (2) statistically sound scenario selection (SSSS) either only on or both on and inside isoprobability hypersurface encompassing 90% of the possible errors; (3) statistically sound dosimetric selection (SSDS). In the last method, the 90% best plans were selected according to either target coverage quantified by D 95 (SSDS_D 95) or to an approximation of the final objective function (OF) used during treatment optimization (SSDS_OF). For all methods, we have considered systematic setup and systematic range errors. A mix of systematic and random setup errors were also simulated for SSDS, but keeping the same conventional margin of 4 mm. All robustness evaluations have been performed using the fast Monte Carlo dose engine MCsquare. Both SSSS strategies yielded on average very similar results. SSSS and GPSS yield comparable values for target coverage (within 0.5 Gy). The most noticeable differences were found for the CTV between GPSS, on the one hand, and SSDS_D 95 and SSDS_OF, on the other hand (average worst-case D 98 were 2.8 and 2.0 Gy larger than for GPSS, respectively). Simulating explicitly random errors in SSDS improved almost all DVH metrics. We have observed that the width of DVH-bands and the confidence levels depend on the method chosen to sample the scenarios. Statistically sound estimation of the robustness of the plan in the dosimetric space may provide an improved insight on the actual robustness of the plan for a given confidence level.
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Affiliation(s)
- E Sterpin
- KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - Sara T Rivas
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - F Van den Heuvel
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
- Dept of Haematology/Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - B George
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - J A Lee
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - K Souris
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
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6
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Liu M, Sum M, Cong E, Colon I, Bucovsky M, Williams J, Kepley A, Kuo J, Lee JA, Lazar RM, Marshall R, Silverberg S, Walker MD. Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy. J Endocrinol Invest 2020; 43:369-379. [PMID: 31621051 PMCID: PMC7275118 DOI: 10.1007/s40618-019-01128-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE There are cognitive changes in primary hyperparathyroidism (PHPT) that improve with parathyroidectomy, but the mechanism of cognitive dysfunction has not been delineated. We assessed if cerebrovascular function is impaired in PHPT, improves post-parathyroidectomy and is associated with PTH level and cognitive dysfunction. METHODS This is an observational study of 43 patients with mild hypercalcemic or normocalcemic PHPT or goiter. At baseline, cerebrovascular function (dynamic cerebral autoregulation and vasomotor reactivity) by transcranial Doppler and neuropsychological function were compared between all three groups. A subset underwent parathyroidectomy or thyroidectomy, and was compared 6 months post-operatively. RESULTS Mean cerebrovascular and neuropsychological function was normal and no worse in PHPT compared to controls preoperatively. Higher PTH was associated with worse intracerebral autoregulation (r = - 0.43, p = 0.02) and worse cognitive performance on some tests. Post-parathyroidectomy, mood improved significantly, but changes did not differ compared to those having thyroidectomy (p = 0.84). There was no consistent improvement in cognition or change in vascular function in either surgical group. CONCLUSIONS Although higher PTH was associated with worse intracerebral autoregulation, cerebrovascular function, cognition and mood were normal in mild PHPT. PTX did not improve vascular or cognitive function. The observed improvement in mood cannot be clearly attributed to PTX. Notwithstanding the small sample size, the results do not support changing current criteria for parathyroidectomy to include cognitive complaints. However, the associations between PTH, cognition and cerebral autoregulation merit future studies in those with more severe hyperparathyroidism.
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Affiliation(s)
- M Liu
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Sum
- Division of Endocrinology, Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA
| | - E Cong
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - I Colon
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J Williams
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - A Kepley
- Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - J Kuo
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - R M Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - R Marshall
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - S Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M D Walker
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
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Pemberton CJ, Lee JA, Aldous S, Skelton L, Frampton CM, Than M, Troughton RW, Adamson P, Richards AM. P1756The protein APRIL predicts adverse outcomes in DAPT patients better than NT-proBNP and troponin. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0509] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Dual antiplatelet therapy (DAPT) is a mainstay of post-ACS treatment. However, prediction of adverse events in these patients needs improving. We show here that the TNFα-related protein APRIL (which is produced in platelets and atherosclerotic plaque) is a superior predictor of MACE and new MI in DAPT recipients post-ACS.
Methods
We prospectively recruited 518 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated to have ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for APRIL measurements using a two site ELISA. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP were also measured. Statistical assessments were made using SPSS v23 (IBM). Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative diagnostic abilities of APRIL, hsTnT, NT-proBNP and hsTnI were assessed using receiver operator curve (ROC) area under the curve (AUC) analysis. The comparative power of each biomarker (log values) to predict new MACE, MI, bleeding and mortality in 1) the whole group and in 2) DAPT recipients alone, within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT, with APRIL and NT-proBNP each included in additional multivariate analyses.
Results
Of the 518 recruited patients (median age 63 (IQR: 54–73, 35% female), 152 were adjudicated to have ACS (29%, 115 MI, 37 UAP). Presentation APRIL levels were higher in those with a cardiac versus non-cardiac cause for presentation (3.0, (2.0–4.7) vs. 2.4, (1.6–3.8) ng/mL, P=0.001) and positively correlated with hsTnT and NT-proBNP (all P<0.001), but it did not add to the hsTnI (ROC = 0.96) or hsTnT (ROC =0.92) assisted diagnosis of ACS. In all 518 patients, in the multivariate regression model, APRIL was a significant independent predictor of mortality (n=54, P=0.032), new MI (n=43, P=0.006), new ADHF (n=24, P=0.016) and MACE (n=71, P=0.005) that was additive to NT-proBNP and troponin. In DAPT recipients alone (n=156), APRIL was the only biomarker to independently predict new MI (n=27, 95% CI: 1.125–3.982, P=0.020) and MACE (n=37, 95% CI: 1.058–3.389, P=0.031). None of the markers, only age, predicted bleeding episodes.
Conclusion
APRIL is an platelet/plaque derived marker that provides independent risk assessment in ACS patients. In DAPT recipients, the ability of APRIL to predict new MI and MACE is superior to that of cardiac troponins and NT-proBNP and could be used to identify high risk individuals.
Acknowledgement/Funding
Health Research Council of New Zealand; Heart Foundation of New Zealand
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Affiliation(s)
- C J Pemberton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J A Lee
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - L Skelton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - C M Frampton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - R W Troughton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - P Adamson
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - A M Richards
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
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Pemberton CJ, Lee JA, Aldous S, Appleby S, Chew-Harris J, Than M, Troughton RW, Richards AM. P3408The signal peptide of CNP is a novel predictor of MI, MACE and bleeding risk in chest pain patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
CNP is an important vascular and cardiac derived member of the natriuretic peptide family. We have previously provided the first reports that the signal peptide of CNP (CNPsp) is present in the human circulation and is elevated in those with chest pain suspicious of ACS. Here, show that CNPsp levels are highly predictive of new MI, MACE and post-index bleeding in patients presenting with potential ACS.
Methods
We prospectively recruited 493 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated as ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for CNPsp measurements using our validated, specific assay. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP (both Roche Cobas e411) were also measured. Statistical assessments were made using SPSS v23. Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative abilities of CNPsp, hsTnT, NT-proBNP and hsTnI (log values) to predict new MACE, MI, bleeding and mortality within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT and NT-proBNP, with CNPsp added to into the multivariate analyses.
Results
Of the 493 recruited patients (median age 63 (IQR: 54–73, 35% female), 148 were adjudicated to have ACS (30%, 109 MI, 39 UAP). Presentation CNPsp levels were not higher in those with adjudicated ACS versus non-ACS (51, (45–65) vs. 50, (42–63) pmol/L, P=0.412), did not correlate with hsTnI, hsTnT or NT-proBNP, but were significantly lower in those with a history of MI (49, (42–59) vs. 51, (43–64) pmol/L, P=0.044). In contrast, they were significantly higher in those with ECG ST-depression (56, (47–85) vs. 50 (42–62) pmol/L, P=0.038). In the multivariate regression model of all 493 patients, lower values of CNPsp were a significant multivariate predictor of new MI (n=37, 95% CI: 0.06–0.89, P=0.038), MACE (n=64, 95% CI: 0.08–0.81, P=0.020) and new bleeding (n=40, 95% CI: 0.05–0.63, P=0.005) within 2 years of presentation. This predictive ability was additive and independent from NT-proBNP and troponin.
Conclusion
This is the first report that CNPsp measurement provides meaningful and independent risk assessment of important outcomes in ACS patients. In particular, the fact that lower levels of CNPsp are predictive of negative MI, MACE and bleeding outcomes suggests that CNPsp may have an unappreciated protective role in the cardiovascular system.
Acknowledgement/Funding
Health Research Council of New Zealand; Heart Foundation of New Zealand
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Affiliation(s)
- C J Pemberton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J A Lee
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - S Aldous
- Christchurch Hospital, Christchurch, New Zealand
| | - S Appleby
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - J Chew-Harris
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - R W Troughton
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
| | - A M Richards
- University of Otago, Christchurch School of Medicine & Health Sciences, Christchurch, New Zealand
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Pemberton CJ, Lee JA, Jardine R, Skelton L, Frampton CM, Troughton RW, Richards AM. P2791The TNF receptor TACI is a novel inflammatory predictor of heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C J Pemberton
- University of Otago Christchurch, Christchurch, New Zealand
| | - J A Lee
- University of Otago Christchurch, Christchurch, New Zealand
| | - R Jardine
- University of Otago Christchurch, Christchurch, New Zealand
| | - L Skelton
- University of Otago Christchurch, Christchurch, New Zealand
| | - C M Frampton
- University of Otago Christchurch, Christchurch, New Zealand
| | - R W Troughton
- University of Otago Christchurch, Christchurch, New Zealand
| | - A M Richards
- University of Otago Christchurch, Christchurch, New Zealand
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Chang SH, Freeman NLB, Lee JA, Stoll CRT, Calhoun AJ, Eagon JC, Colditz GA. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev 2018; 19:529-537. [PMID: 29266740 PMCID: PMC5880318 DOI: 10.1111/obr.12647] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [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: 07/21/2017] [Revised: 10/05/2017] [Accepted: 10/23/2017] [Indexed: 01/06/2023]
Abstract
The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m-2 . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
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Affiliation(s)
- S-H Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - N L B Freeman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Center for Advanced Methods Development, RTI International, NC, USA
| | - J A Lee
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, AR, USA
| | - C R T Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - A J Calhoun
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - J C Eagon
- Minimally Invasive and Bariatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - G A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Brousmiche S, Souris K, de Xivry JO, Lee JA, Macq B, Seco J. Combined influence of CT random noise and HU-RSP calibration curve nonlinearities on proton range systematic errors. Phys Med Biol 2017; 62:8226-8245. [PMID: 28817383 DOI: 10.1088/1361-6560/aa86e9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Proton range random and systematic uncertainties are the major factors undermining the advantages of proton therapy, namely, a sharp dose falloff and a better dose conformality for lower doses in normal tissues. The influence of CT artifacts such as beam hardening or scatter can easily be understood and estimated due to their large-scale effects on the CT image, like cupping and streaks. In comparison, the effects of weakly-correlated stochastic noise are more insidious and less attention is drawn on them partly due to the common belief that they only contribute to proton range uncertainties and not to systematic errors thanks to some averaging effects. A new source of systematic errors on the range and relative stopping powers (RSP) has been highlighted and proved not to be negligible compared to the 3.5% uncertainty reference value used for safety margin design. Hence, we demonstrate that the angular points in the HU-to-RSP calibration curve are an intrinsic source of proton range systematic error for typical levels of zero-mean stochastic CT noise. Systematic errors on RSP of up to 1% have been computed for these levels. We also show that the range uncertainty does not generally vary linearly with the noise standard deviation. We define a noise-dependent effective calibration curve that better describes, for a given material, the RSP value that is actually used. The statistics of the RSP and the range continuous slowing down approximation (CSDA) have been analytically derived for the general case of a calibration curve obtained by the stoichiometric calibration procedure. These models have been validated against actual CSDA simulations for homogeneous and heterogeneous synthetical objects as well as on actual patient CTs for prostate and head-and-neck treatment planning situations.
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Affiliation(s)
- S Brousmiche
- Ion Beam Applications, Louvain-la-Neuve, Belgium
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Walker MD, Saeed I, Lee JA, Zhang C, Hans D, Lang T, Silverberg SJ. Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism. Osteoporos Int 2016; 27:3063-71. [PMID: 27198233 PMCID: PMC5555733 DOI: 10.1007/s00198-016-3637-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 01/31/2023]
Abstract
UNLABELLED Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS). INTRODUCTION The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT. METHODS This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively. RESULTS In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p = 0.05), were less likely to use vitamin D supplementation (p < 0.01), and had better renal function (p = 0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20-29 ng/ml (p = 0.002) and 25OHD ≥30 ng/ml (p < 0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20-29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p < 0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status. CONCLUSION In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - I Saeed
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C Zhang
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - D Hans
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - T Lang
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - S J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Abstract
The concentration of the dose delivered by protons at the end of their path, the Bragg peak, has the potential to improve external radiotherapy treatments. Unfortunately, the main strength of the protons, their finite range, is also their greatest weakness. Any uncertainty on the range may lead to inadequate target coverage or excessive toxicity. The uncertainties have multiple origins and include, among others, ballistic errors, morphological modifications or inaccurate estimations of the physical quantities necessary to predict the proton range. Uncertainties have been part of daily practice in conventional radiotherapy with X-rays for a long time. However, dose distributions delivered with X-rays are much less sensitive to uncertainties than the ones delivered with protons. This relative insensitivity enabled the management of uncertainties through safety margins using a simple formalism. The conditions of validity of this formalism are much more restrictive for proton therapy, leading to the need of developing new tools and adapted strategies to manage accurately these uncertainties. The objective of this paper is to present a vision for the management of uncertainties in proton therapy in the continuity of formalisms established for X-rays. The latter are first summarized before discussing the necessary developments in order to consistently apply them to protons.
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Affiliation(s)
- E Sterpin
- Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, O&N I Herestraat 49, 3000 Leuven, Belgique; Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique.
| | - A Barragan
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - K Souris
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - J A Lee
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
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Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Abstract P3-12-17: Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-17] [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
Aim: Although modern radiotherapy such as field-in-field technique decreased the radiation toxicity, skin reaction is still frequent and main problem during adjuvant whole breast irradiation. Our study investigated various radiation dosimetric and clinical parameters as the risk factors of severe skin reaction.
Methods: From January 2012 to December 2014, total 219 patients with breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients took both whole breast irradiation (50 Gy/25 fractions) and boost to the tumor bed (10 - 15 Gy). Skin reaction was measured by comparing the photography of radiation field between the first day of whole breast irradiation and boost therapy. For each axilla and inferior fold, the intensity (score 1 to 5) and extent (score 0 to 1) of erythema were recorded and summed. The severe skin reaction was defined as score 5 or 6. The relations of various radiation dosimetric parameters for radiotherapy planning, personal breast characteristics and clinical factors to severe skin reaction were evaluated using the Logistic regression tests.
Results: Total 75 (34%) and 57 (26%) patients showed the severe skin reaction to axilla and inferior fold, respectively. The variables of P < 0.2 in univariate analyses including age, the body mass index, the breast height, the V100, the calculated point dose in radiation planning system, the breast separation, the field size, and the gradient of inferior fold entered the multivariate analyses. Age (P=0.013 (OR = 0.950, 95% CI 0.913 - 0.989)), the body mass index (P = 0.015 (OR = 1.123, 95% CI 1.023 - 1.233)), the calculated axilla point dose (P = 0.091 (OR = 1.064, 95% CI 0.990 - 1.142)), and the gradient of inferior fold (P = 0.073 (OR = 1.029, 95% CI 0.997 - 1.063)) were risk factors for severe axilla skin reaction, whereas age (P = 0.018 (OR = 0.948, 95% CI 0.907 - 0.991)) and the V100 (P < 0.001 (OR = 1.005, 95% CI 1.003 - 1.007)) were for severe inferior fold skin reaction.
Conclusion: In addition to clinical factor and personal breast characteristics, the radiation dosimetric parameters such as calculated point dose and V100 could be another predictive factors of severe skin reaction.
Citation Format: Yoon WS, Lee NK, Lee JA, Yang DS, Kim CY, Son GS, Chang YW. Can radiation dosimetric parameters explain severe skin reaction during adjuvant whole breast irradiation applying field-in-field technique?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-17.
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Affiliation(s)
- WS Yoon
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - NK Lee
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - JA Lee
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - DS Yang
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - CY Kim
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - GS Son
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
| | - YW Chang
- Ansan Hospital, Korea University, Ansan, Gyeonggi-do, Korea
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Barragán AM, Differding S, Janssens G, Lee JA, Sterpin E. Feasibility and robustness of dose painting by numbers in proton therapy with contour-driven plan optimization. Med Phys 2015; 42:2006-17. [PMID: 25832091 DOI: 10.1118/1.4915082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To prove the ability of protons to reproduce a dose gradient that matches a dose painting by numbers (DPBN) prescription in the presence of setup and range errors, by using contours and structure-based optimization in a commercial treatment planning system. METHODS For two patients with head and neck cancer, voxel-by-voxel prescription to the target volume (GTVPET) was calculated from (18)FDG-PET images and approximated with several discrete prescription subcontours. Treatments were planned with proton pencil beam scanning. In order to determine the optimal plan parameters to approach the DPBN prescription, the effects of the scanning pattern, number of fields, number of subcontours, and use of range shifter were separately tested on each patient. Different constant scanning grids (i.e., spot spacing = Δx = Δy = 3.5, 4, and 5 mm) and uniform energy layer separation [4 and 5 mm WED (water equivalent distance)] were analyzed versus a dynamic and automatic selection of the spots grid. The number of subcontours was increased from 3 to 11 while the number of beams was set to 3, 5, or 7. Conventional PTV-based and robust clinical target volumes (CTV)-based optimization strategies were considered and their robustness against range and setup errors assessed. Because of the nonuniform prescription, ensuring robustness for coverage of GTVPET inevitably leads to overdosing, which was compared for both optimization schemes. RESULTS The optimal number of subcontours ranged from 5 to 7 for both patients. All considered scanning grids achieved accurate dose painting (1% average difference between the prescribed and planned doses). PTV-based plans led to nonrobust target coverage while robust-optimized plans improved it considerably (differences between worst-case CTV dose and the clinical constraint was up to 3 Gy for PTV-based plans and did not exceed 1 Gy for robust CTV-based plans). Also, only 15% of the points in the GTVPET (worst case) were above 5% of DPBN prescription for robust-optimized plans, while they were more than 50% for PTV plans. Low dose to organs at risk (OARs) could be achieved for both PTV and robust-optimized plans. CONCLUSIONS DPBN in proton therapy is feasible with the use of a sufficient number subcontours, automatically generated scanning patterns, and no more than three beams are needed. Robust optimization ensured the required target coverage and minimal overdosing, while PTV-approach led to nonrobust plans with excessive overdose. Low dose to OARs can be achieved even in the presence of a high-dose escalation as in DPBN.
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Affiliation(s)
- A M Barragán
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - S Differding
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - G Janssens
- Ion Beam Applications S.A., Louvain-la-Neuve 1348, Belgium
| | - J A Lee
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
| | - E Sterpin
- Center of Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels B-1200, Belgium
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Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ, Bilezikian JP, Silverberg SJ. Low vitamin D levels have become less common in primary hyperparathyroidism. Osteoporos Int 2015; 26:2837-43. [PMID: 26084258 PMCID: PMC4793903 DOI: 10.1007/s00198-015-3199-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED We compared temporal trends in serum 25-hydroxyvitamin D and parathyroid hormone (PTH) in two primary hyperparathyroidism (PHPT) cohorts recruited 20 years apart. The prevalence of 25-hydroxyvitamin D levels <20 and <30 ng/mL declined by 30-50 %, respectively, and was accompanied by lower PTH. In the older cohort, higher PTH may be due to lower 25-hydroxyvitamin D. INTRODUCTION Vitamin D deficiency may exacerbate PHPT. Whether there have been temporal trends in 25-hydroxyvitamin D (25OHD) levels in PHPT is unclear. The prevalence of low vitamin D levels (25OHD <20 and <30 ng/mL) and associated biochemical and bone mineral density (BMD) profiles were assessed in two PHPT cohorts recruited over 20 years apart. METHODS This is a cross-sectional comparison of serum 25OHD levels, calciotropic hormones, and BMD between two PHPT cohorts recruited at the same hospital: the "old" (N = 103) and "new" (N = 100) cohorts were enrolled between 1984 and 1991 and between 2010 and 2014, respectively. RESULTS Mean 25OHD levels were 26 % higher in the new cohort (23 ± 10 vs. 29 ± 10 ng/mL, p < 0.0001). Levels of 25OHD <20 and <30 ng/mL declined from 46 and 82 %, respectively, to 19 and 54 % (both p < 0.0001). Supplemental vitamin D use was common in the new (64 %) but not the old cohort (0 %). The new cohort demonstrated 33 % lower serum PTH levels (p < 0.0001). Neither serum nor urine calcium differed. BMD was higher in the new cohort at all skeletal sites (all p < 0.001). CONCLUSION With the rise in vitamin D supplementation over the last two decades, low 25OHD levels are no longer common in PHPT patients in the New York area. Those with 25OHD <20 and <30 ng/mL have declined by over 50 and 30 %, respectively. The lower mean PTH levels in the new cohort are most likely accounted for by higher vitamin D intake. Whether improved vitamin D status also underlies the relatively higher BMD in the more vitamin D replete cohort of PHPT patients is unknown.
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Affiliation(s)
- M D Walker
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA.
| | - E Cong
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - J A Lee
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - A Kepley
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - C Zhang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - D J McMahon
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - J P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
| | - S J Silverberg
- Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PH 8 West - 864, New York, NY, 10032, USA
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Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, Lee JA, Fan G, Tan YP, Yong WS, Madhukumar P, Loo SK, Ang SF, Wong M, Chay WY, Ooi WS, Dent RA, Yap YS, Ng R, Chan A. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol 2015; 26:1446-51. [PMID: 25922060 PMCID: PMC4478978 DOI: 10.1093/annonc/mdv206] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [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: 11/13/2014] [Accepted: 04/20/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Existing evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. PATIENTS AND METHODS Chemotherapy-receiving breast cancer patients (stages I-III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain. RESULTS Ninety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1β was associated with poorer response speed performance (estimate: -0.78; 95% confidence interval (CI) -1.34 to -0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1β and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022). CONCLUSIONS While elevated concentrations of IL-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes.
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Affiliation(s)
- Y T Cheung
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - T Ng
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - M Shwe
- Department of Pharmacy, National University of Singapore, Singapore
| | - H K Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - M T Cham
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - J A Lee
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - G Fan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Y P Tan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - W S Yong
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - P Madhukumar
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - S K Loo
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - S F Ang
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M Wong
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W Y Chay
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W S Ooi
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R A Dent
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Y S Yap
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R Ng
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - A Chan
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
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Song EJ, Lee JA, Park JJ, Kim HJ, Kim NS, Byun KS, Choi GS, Moon TK. A study on seasonal variation of skin parameters in Korean males. Int J Cosmet Sci 2014; 37:92-7. [DOI: 10.1111/ics.12174] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E. J. Song
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - J. A. Lee
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - J. J. Park
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - H. J. Kim
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - N. S. Kim
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - K. S. Byun
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
| | - G. S. Choi
- Department of Dermatology; Inha University College of Medicine; Incheon South Korea
| | - T. K. Moon
- Ellead Co., Ltd.; 325, Hwangsaeul-ro Bundang-gu Seongnam-si Gyeonggi-do 463-824 Korea
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Epelboym I, DiNorcia J, Winner M, Lee MK, Lee JA, Schrope BA, Chabot JA, Allendorf JD. Neoadjuvant therapy and vascular resection during pancreaticoduodenectomy: shifting the survival curve for patients with locally advanced pancreatic cancer. World J Surg 2014; 38:1184-95. [PMID: 24305935 DOI: 10.1007/s00268-013-2384-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure. METHODS We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not. RESULTS Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA- patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA- group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA- patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival. CONCLUSIONS Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria.
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Affiliation(s)
- Irene Epelboym
- Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA,
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Yang DS, Yoon WS, Lee JA, Lee NK, Lee S, Kim CY, Yim HJ, Lee SH, Chung HH, Cha SH. The effectiveness of gadolinium MRI to improve target delineation for radiotherapy in hepatocellular carcinoma: a comparative study of rigid image registration techniques. Phys Med 2014; 30:676-81. [PMID: 24870246 DOI: 10.1016/j.ejmp.2014.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 12/20/2013] [Revised: 04/14/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022] Open
Abstract
To achieve consistent target delineation in radiotherapy for hepatocellular carcinoma (HCC), image registration between simulation CT and diagnostic MRI was explored. Twenty patients with advanced HCC were included. The median interval between MRI and CT was 11 days. CT was obtained with shallow free breathing and MRI at exhale phase. On each CT and MRI, the liver and the gross target volume (GTV) were drawn. A rigid image registration was taken according to point information of vascular bifurcation (Method[A]) and pixel information of volume of interest only including the periphery of the liver (Method[B]) and manually drawn liver (Method[C]). In nine cases with an indefinite GTV on CT, a virtual sphere was generated at the epicenter of the GTV. The GTV from CT (VGTV[CT]) and MRI (VGTV[MR]) and the expanded GTV from MRI (V+GTV[MR]) considering geometrical registration error were defined. The underestimation (uncovered V[CT] by V[MR]) and the overestimation (excessive V[MR] by V[CT]) were calculated. Through a paired T-test, the difference between image registration techniques was analyzed. For method[A], the underestimation rates of VGTV[MR] and V+GTV[MR] were 16.4 ± 8.9% and 3.2 ± 3.7%, and the overestimation rates were 16.6 ± 8.7% and 28.4 ± 10.3%, respectively. For VGTV[MR] and V+GTV[MR], the underestimation rates and overestimation rates of method[A] were better than method[C]. The underestimation rates and overestimation rates of the VGTV[MR] were better in method[B] than method[C]. By image registration and additional margin, about 97% of HCC could be covered. Method[A] or method[B] could be recommended according to physician preference.
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Affiliation(s)
- D S Yang
- Department of Radiation Oncology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - W S Yoon
- Department of Radiation Oncology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea.
| | - J A Lee
- Department of Radiation Oncology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - N K Lee
- Department of Radiation Oncology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - S Lee
- Department of Radiation Oncology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - C Y Kim
- Department of Radiation Oncology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - H J Yim
- Department of Internal Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - S H Lee
- Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - H H Chung
- Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - S H Cha
- Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
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Zink AM, Wohlleber E, Engels H, Rødningen OK, Ravn K, Heilmann S, Rehnitz J, Katzorke N, Kraus C, Blichfeldt S, Hoffmann P, Reutter H, Brockschmidt FF, Kreiß-Nachtsheim M, Vogt PH, Prescott TE, Tümer Z, Lee JA. Microdeletions including FMR1 in three female patients with intellectual disability - further delineation of the phenotype and expression studies. Mol Syndromol 2014; 5:65-75. [PMID: 24715853 DOI: 10.1159/000357962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
Fragile X syndrome (FXS) is one of the most common causes of intellectual disability/developmental delay (ID/DD), especially in males. It is caused most often by CGG trinucleotide repeat expansions, and less frequently by point mutations and partial or full deletions of the FMR1 gene. The wide clinical spectrum of affected females partly depends on their X-inactivation status. Only few female ID/DD patients with microdeletions including FMR1 have been reported. We describe 3 female patients with 3.5-, 4.2- and 9.2-Mb de novo microdeletions in Xq27.3-q28 containing FMR1. X-inactivation was random in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute threshold below which signs of FXS present. Since FMR1 expression is known to be highly variable between unrelated females, and since FMR1 mRNA levels have been suggested to be more similar among family members, we further explored the possibility of an intrafamilial effect. Interestingly, FMR1 mRNA levels in all 3 patients were significantly lower than in their respective mothers, which was shown to be specific for patients with microdeletions containing FMR1.
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Affiliation(s)
- A M Zink
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - E Wohlleber
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - H Engels
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - O K Rødningen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - K Ravn
- Applied Human Molecular Genetics, Kennedy Center, Glostrup, Denmark
| | - S Heilmann
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Department of Genomics, Life & Brain Center, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - J Rehnitz
- Molecular Genetics and Infertility Unit, Department of Gynecology, Endocrinology and Reproductive Medicine, University Women Hospital, Heidelberg, Germany
| | - N Katzorke
- Molecular Genetics and Infertility Unit, Department of Gynecology, Endocrinology and Reproductive Medicine, University Women Hospital, Heidelberg, Germany
| | - C Kraus
- Institute of Human Genetics, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
| | - S Blichfeldt
- Pediatric Department L55, Glostrup University Hospital, Glostrup, Denmark
| | - P Hoffmann
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Department of Genomics, Life & Brain Center, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Medical Genetics, Department of Biomedicine, University Hospital, Basel, Switzerland
| | - H Reutter
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Department of Neonatology, Children's Hospital, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - F F Brockschmidt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Department of Genomics, Life & Brain Center, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - M Kreiß-Nachtsheim
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - P H Vogt
- Molecular Genetics and Infertility Unit, Department of Gynecology, Endocrinology and Reproductive Medicine, University Women Hospital, Heidelberg, Germany
| | - T E Prescott
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Z Tümer
- Applied Human Molecular Genetics, Kennedy Center, Glostrup, Denmark ; Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J A Lee
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Department of Genomics, Life & Brain Center, Rheinische Friedrich-Wilhelms-University, Bonn, Germany ; Greenwood Genetic Center, Greenwood, S.C., USA
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Lee JA, Park HS. Relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents. Nutr Metab Cardiovasc Dis 2014; 24:65-71. [PMID: 24188647 DOI: 10.1016/j.numecd.2013.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The increasing prevalence of obesity has been paralleled by a trend of reduced sleep duration. Sleep is considered a modulator of neuroendocrine function. The aim of this study was to determine the relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents. METHODS AND RESULTS This study was based on data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV. Data from 1187 adolescents aged 12-18 years were included in the analysis. Subjects were classified according to self-reported sleep duration: ≤ 5 h, 6-7 h, 8-9 h, and ≥ 10 h. We analysed the association between sleep duration, overweight, and metabolic syndrome after adjustment for potential confounding variables. Body mass index (BMI), waist circumference (WC), and diastolic blood pressure (DBP) were higher in subjects who slept ≤ 5 h, and triglyceride level was higher in subjects who slept ≥ 10 h. According to logistic regression analysis, subjects who slept ≤ 5 h had a higher risk of overweight (odds ratio (OR) 2.04, 95% confidence interval (CI) 1.17-3.57) and elevated blood pressure (BP) (OR 2.11, 95% CI 1.22-3.65). We did not find any association between sleep duration and metabolic syndrome. Subjects who slept ≥ 10 h had a higher risk of hypertriglyceridemia (OR 2.17, 95% CI 1.14-4.13). CONCLUSION Short sleep duration was associated with overweight in adolescents. Although there was no association between sleep duration and metabolic syndrome, short sleep duration was associated with elevated BP and long sleep duration was associated with hypertriglyceridemia.
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Affiliation(s)
- J A Lee
- Department of Family Medicine, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - H S Park
- Department of Family Medicine, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
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Sok JC, Lee JA, Dasari S, Joyce S, Contrucci SC, Egloff AM, Trevelline BK, Joshi R, Kumari N, Grandis JR, Thomas SM. Collagen type XI α1 facilitates head and neck squamous cell cancer growth and invasion. Br J Cancer 2013; 109:3049-56. [PMID: 24231953 PMCID: PMC3859935 DOI: 10.1038/bjc.2013.624] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although it is well established that the extracellular matrix affects tumour progression, not much is known about the various components and their effect on head and neck squamous cell carcinoma (HNSCC) progression. Levels of collagen type XI α1 (colXIα1), a minor fibrillar collagen, have been shown to be increased in tumour compared with normal tissue in several cancers, including colorectal, breast, and non-small cell lung cancer. Currently, the functional significance of colXIα1 is not understood. METHODS We examined the expression levels of colXIα1 mRNA and elucidated the functional role of colXIα1 in HNSCC. Cell proliferation, invasion, and migration were examined with and without colXIα1 knockdown with siRNA in HNSCC cells. RESULTS Our data demonstrate that colXIα1 expression is increased in tumour samples compared with levels in normal adjacent tissue in 16/23 HNSCC patients. In addition, colα11 is increased in HNSCC cell lines compared with normal immortalised epithelial cells and is increased in tumour-derived fibroblasts compared with normal fibroblasts. Using an siRNA approach, we demonstrate that colXIα1 contributes to proliferation, migration, and invasion of HNSCC. CONCLUSION Our cumulative findings suggest that colXIα1 contributes to HNSCC tumorigenesis and may serve as a potential therapeutic target.
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Affiliation(s)
- J C Sok
- Department of Otolaryngology, University of Pittsburgh and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA
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Lee SH, Lee JA, Park HS, Song YS, Jang YJ, Kim JH, Lee YJ, Heo Y. Associations among SPARC mRNA expression in adipose tissue, serum SPARC concentration and metabolic parameters in Korean women. Obesity (Silver Spring) 2013; 21:2296-302. [PMID: 23666856 DOI: 10.1002/oby.20183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 11/12/2012] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Secreted protein acidic and rich in cysteine (SPARC) is expressed in most tissues and is also secreted by adipocytes. The associations of SPARC mRNA expression in visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), serum SPARC concentration, and metabolic parameters in Korean women are investigated. DESIGN AND METHODS This is a cross-sectional study. Fifty-eight women were recruited, of whom 15 women who underwent bariatric surgery for morbid obesity (BMI mean ± SD: 40.2±5.7 kg/m(2) ), 16 who underwent metabolic surgery for type 2 diabetes (BMI: 28.9±4.5 kg/m(2) ), and, as a control group, 27 who underwent gynecological surgery (BMI: 22.7±2.4 kg/m(2) ). Anthropometric variables, metabolic parameters, SPARC mRNA expression in adipose tissue, and serum SPARC concentration were measured. RESULTS In all subjects, SPARC mRNA expression was significantly higher in SAT than in VAT. Serum SPARC concentrations (mean ± SE) in morbidly obese subjects, subjects with type 2 diabetes, and normal weight subjects were 267.3±40.2 ng/mL, 130.4±33.0 ng/mL, and 53.1±2.8 ng/mL, respectively. SPARC mRNA in SAT was significantly correlated with BMI, whereas SPARC mRNA in VAT was significantly correlated with BMI and VAT area. Serum SPARC concentration was significantly correlated with BMI, waist circumference, total adipose tissue area, and SAT area. After BMI adjustment, serum SPARC concentration was significantly correlated with fasting insulin concentration and HOMA-IR score. Multivariate regression analysis showed that BMI and HOMA-IR were independently associated with serum SPARC concentration. CONCLUSIONS Serum SPARC concentration is significantly correlated with obesity indices and might be influenced by insulin resistance. These findings suggest that SPARC may contribute to the metabolic dysregulation associated with obesity in humans.
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MESH Headings
- Adipose Tissue/metabolism
- Adult
- Asian People
- Case-Control Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/ethnology
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/surgery
- Female
- Gene Expression
- Humans
- Metabolism/genetics
- Middle Aged
- Obesity, Morbid/ethnology
- Obesity, Morbid/genetics
- Obesity, Morbid/metabolism
- Obesity, Morbid/surgery
- Osteonectin/blood
- Osteonectin/genetics
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Young Adult
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Affiliation(s)
- S H Lee
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Geets X, Grégoire V, Lee JA. Implementation of hypoxia PET imaging in radiation therapy planning. Q J Nucl Med Mol Imaging 2013; 57:271-282. [PMID: 24045623] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Hypoxia has historically been relevant to radiation oncology as it relates to radioresistance, poor response to therapy and unfavorable patient's outcome in many solid tumors. In that regard, the recent advances in imaging, computation and radiation delivery techniques have been offering new perspectives to prescribe and deliver radiation dose in accordance with the spatial distribution of hypoxia mapped with molecular or functional imaging modalities, i.e., the so-called dose painting (DP). At first glance, the concept of dose painting appears promising and let foresee likely improvement in tumor local control at an acceptable clinical cost. However, adapting radiotherapy planning and delivery according to hypoxia imaging implicitly assumes: 1) that the imaging variable actually correlates with a local biological property associated with individual therapy outcome; 2) that the spatial distribution of the imaging parameter can be adequately converted into dose; and 3) that an irradiation device can actually deliver such a heterogeneous dose in fractionated RT treatments. In that regard, many uncertainties and difficulties remain at each step of the DP process, mainly related to the limitations of the current imaging techniques and the treatment fractionation. This paper will thus review the state of the art of DP with a specific focus on hypoxia, going from cancer biology to adaptive dose delivery. It will address the technological challenges and the clinical validation, which are both essential to translate an intuitively appealing concept into a clinically meaningful practice.
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Affiliation(s)
- X Geets
- Department of Radiation Oncology, Molecular Imaging Radiotherapy and Oncology (MIRO) Lab. Université Catholique de Louvain Cliniques Universitaires St-Luc, Brussels, Belgium -
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Chung HE, Yu J, Baek M, Lee JA, Kim MS, Kim SH, Maeng EH, Lee JK, Jeong J, Choi SJ. Toxicokinetics of zinc oxide nanoparticles in rats. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/429/1/012037] [Citation(s) in RCA: 11] [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: 11/11/2022]
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Walker MD, Rundek T, Homma S, DiTullio M, Iwata S, Lee JA, Choi J, Liu R, Zhang C, McMahon DJ, Sacco RL, Silverberg SJ. Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. Eur J Endocrinol 2012; 167:277-85. [PMID: 22660025 PMCID: PMC3668344 DOI: 10.1530/eje-12-0124] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We recently demonstrated that mild primary hyperparathyroidism (PHPT) is associated with increased carotid intima-media thickness (IMT) and stiffness, and increased aortic valve calcification. It is unclear whether parathyroidectomy (PTX) improves these abnormalities. The purpose of this study was to determine whether cardiovascular abnormalities in PHPT improve with PTX. DESIGN Forty-four patients with PHPT were studied using carotid ultrasound and transthoracic echocardiography before and after PTX. Carotid IMT, carotid plaque and stiffness, left ventricular mass index (LVMI), myocardial and valvular calcification, and diastolic function were measured before, 1- and 2-year post-PTX. RESULTS Two years after PTX, increased carotid stiffness tended to decline to the normal range (17%, P=0.056) while elevated carotid IMT did not improve. Carotid plaque number and thickness, LVMI and cardiac calcifications did not change after PTX, while some measures of diastolic function (isovolumic relaxation time (IVRT) and tissue Doppler peak early diastolic velocity) worsened within the normal range. Indices did improve in patients with cardiovascular abnormalities at baseline. Increased carotid stiffness improved by 28% (P=0.004), a decline likely to be of clinical significance. More limited improvements also occurred in elevated IMT (3%, P=0.017) and abnormal IVRT (13%, P<0.05), a measure of diastolic dysfunction. CONCLUSIONS In mild PHPT, PTX led to modest changes in some cardiovascular indices. Improvements were mainly evident in those with preexisting cardiovascular abnormalities, particularly elevated carotid stiffness. These findings are reassuring with regard to current international guidelines that do not include cardiovascular disease as a criterion for PTX.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Kleffmann W, Zink AM, Lee JA, Senderek J, Mangold E, Moog U, Rappold GA, Wohlleber E, Engels H. 5q31 Microdeletions: Definition of a Critical Region and Analysis of LRRTM2, a Candidate Gene for Intellectual Disability. Mol Syndromol 2012; 3:68-75. [PMID: 23326251 DOI: 10.1159/000341252] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2012] [Indexed: 11/19/2022] Open
Abstract
Microdeletions including 5q31 have been reported in only few patients to date. Apart from intellectual disability/developmental delay (ID/DD) of varying degrees, which is common to all reported patients, the clinical spectrum is wide and includes short stature, failure to thrive, congenital heart defects, encephalopathies, and dysmorphic features. We report a patient with a 0.9-Mb de novo deletion in 5q31.2, the smallest microdeletion in 5q31 reported thus far. His clinical presentation includes mild DD, borderline short stature, postnatal microcephaly, and mild dysmorphic signs including microretrognathia. Together with data from 7 reported overlapping microdeletions, analysis of our patient enabled the tentative delineation of a phenotype map for 5q31 deletions. In contrast to the mild phenotype of small microdeletions affecting only 5q31.2, carriers of larger microdeletions which also include subbands 5q31.1 and/or 5q31.3 seem to be more severely affected with congenital malformations, growth anomalies, and severe encephalopathies. A 240-kb smallest region of overlap in 5q31.2 is delineated which contains only 2 genes, CTNNA1 and LRRTM2. We propose LRRTM2 as the most promising candidate gene for ID/DD due to its expression pattern, function as a key regulator of excitatory development, and interaction with Neurexin 1. However, sequence analysis of LRRTM2 in 330 patients with ID/DD revealed no relevant alterations, excluding point mutations in LRRTM2 as a frequent cause of ID/DD in patients without microdeletions.
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Affiliation(s)
- W Kleffmann
- Institute of Human Genetics, Life and Brain Center, University of Bonn, Bonn, Germany
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Thorwarth D, Beyer T, Boellaard R, de Ruysscher D, Grgic A, Lee JA, Pietrzyk U, Sattler B, Schaefer A, van Elmpt W, Vogel W, Oyen WJG, Nestle U. Integration of FDG-PET/CT into external beam radiation therapy planning: technical aspects and recommendations on methodological approaches. Nuklearmedizin 2012; 51:140-53. [PMID: 22473130 DOI: 10.3413/nukmed-0455-11-12] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/19/2012] [Indexed: 12/20/2022]
Abstract
UNLABELLED This work addresses the clinical adoption of FDG-PET/CT for image-guided radiation therapy planning (RTP). As such, important technical and methodological aspects of PET/CT-based RTP are reviewed and practical recommendations are given for routine patient management and clinical studies. First, recent developments in PET/CT hardware that are relevant to RTP are reviewed in the context of quality control and system calibration procedures that are mandatory for a reproducible adoption of PET/CT in RTP. Second, recommendations are provided on image acquisition and reconstruction to support the standardization of imaging protocols. A major prerequisite for routine RTP is a complete and secure data transfer to the actual planning system. Third, state-of-the-art tools for image fusion and co-registration are discussed briefly in the context of PET/CT imaging pre- and post-RTP. This includes a brief review of state-of-the-art image contouring algorithms relevant to PET/CT-guided RTP. Finally, practical aspects of clinical workflow and patient management, such as patient setup and requirements for staff training are emphasized. PET/CT-guided RTP mandates attention to logistical aspects, patient set-up and acquisition parameters as well as an in-depth appreciation of quality control and protocol standardization. CONCLUSION Upon fulfilling the requirements to perform PET/CT for RTP, a new dimension of molecular imaging can be added to traditional morphological imaging. As a consequence, PET/CT imaging will support improved RTP and better patient care. This document serves as a guidance on practical and clinically validated instructions that are deemed useful to the staff involved in PET/CT-guided RTP.
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Affiliation(s)
- D Thorwarth
- University Hospital for Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls University Tübingen, Germany.
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Yoon WS, Yang DS, Lee JA, Lee S, Park YJ, Kim CY. Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies. Strahlenther Onkol 2012; 188:395-401. [PMID: 22318329 DOI: 10.1007/s00066-011-0049-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/04/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The goal of the present study was to demonstrate risk factors affecting the interfractional variation in whole pelvic irradiation. PATIENTS AND METHODS Daily image acquisitions of 101 patients with locally advanced pelvic malignancy were undertaken using a kilo-voltage orthogonal on-board imager. The baseline deviation (the shift between the initial treatment and each fraction; Value(Base)) and day-to-day variation (the shift between the previous treatment and each fraction; Value(DD)) were measured. The standard deviations (SD) along the x- (right-left), y- (cranial-caudal), and z- (anterior-posterior) axes (SD[x], SD[y], and SD[z], respectively), the 3D vector of the SD (SD[3D]), and the mean of 3D shift (mean[3D]) were calculated in each patient. Various clinical factors, lumbar pelvic balance and rotation, and the shift of 5 consecutive fractions from the initial treatment (Value(5Fx)) were investigated as risk factors. RESULTS The prone set-up showed a larger mean(Base)[3D] than in the supine position (p =0 .063). A body mass index (BMI) ≥ 30 kg/m(2) resulted in the largest mean(DD)[3D] (p = 0.078) and SD(DD)[3D] (p = 0.058). All the SD(5Fx) along the x-, y-, and z-axes had moderate linear relationships with SD(Base) and SD(DD) (p < 0.001). The SD(5Fx)[3D] also had a moderate linear relationship with the mean(Base)[3D], mean(DD)[3D], SD(Base)[3D], and SD(DD)[3D] (p < 0.001). In multivariate analysis, the SD(5Fx) had the same significant relationship with SD(Base) and SD(DD) (p < 0.001). A BMI ≥ 30 kg/m(2) was associated with the largest SD(DD)[x] (p = 0.003). CONCLUSION Close surveillance through high-quality and frequent image guidance is recommended for patients with extensive variations of the initial five consecutive fractions or obesity.
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Affiliation(s)
- W S Yoon
- Department of Radiation Oncology, Guro Hospital, Korea University College of Medicine, Korea University Medical Center, Guro-dong-gil 97, 152-703, Guro-dong, Guro-gu, Seoul, Korea
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Jung HS, Joo JD, Jeon YS, Lee JA, Kim DW, In JH, Rhee HY, Choi JW. Comparison of an Intraoperative Infusion of Dexmedetomidine or Remifentanil on Perioperative Haemodynamics, Hypnosis and Sedation, and Postoperative Pain Control. J Int Med Res 2011; 39:1890-9. [DOI: 10.1177/147323001103900533] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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] Open
Abstract
This prospective, randomized, double-blind study compared the effects of dexmedetomidine and remifentanil on haemodynamic stability, sedation and postoperative pain control in the postanaesthetic care unit (PACU). Fifty consecutive patients scheduled for total laparoscopic hysterectomy were randomly assigned to receive infusions of either dexmedetomidine (1 μg/kg) i.v. over 10 min followed by 0.2-0.7 μg/kg per h continuous i.v. infusion or remifentanil (0.8-1.2 μg/kg) i.v. over 1 min followed by 0.05-0.1 μg/kg i.v. per min, starting at the end of surgery to the time in the PACU. Modified observer's assessment of alertness scores were significantly lower in the dexmedetomidine group than in the remifentanil group at 0, 5 and 10 min after arrival in the PACU. Blood pressure and heart rate in the dexmedetomidine group were significantly lower than that recorded in the remifentanil group in the PACU. Dexmedetomidine, at the doses used in this study, had a significant advantage over remifentanil in terms of postoperative haemodynamic stability.
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Affiliation(s)
- HS Jung
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - JD Joo
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - YS Jeon
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - JA Lee
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - DW Kim
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - JH In
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - HY Rhee
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - JW Choi
- Department of Anaesthesiology and Pain Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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Baek M, Kim MK, Cho HJ, Lee JA, Yu J, Chung HE, Choi SJ. Factors influencing the cytotoxicity of zinc oxide nanoparticles: particle size and surface charge. ACTA ACUST UNITED AC 2011. [DOI: 10.1088/1742-6596/304/1/012044] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lee JA, Bae JW, Jung YH, An H, Lee ES. Abstract P6-05-01: Triple Negative Breast Cancer in Korea — Distinct Biology with Different Impact of Prognostic Factors on Survival. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-05-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with triple negative breast cancer(TNBC) are known to have poor prognosis and derive no benefit from endocrine therapy or targeted treatments. Using a database from a multicenter registry in Korea, we present the clinical features and prognosis for TNBC with other subtypes of breast cancer and clinicopathologic variables that influence the 3-year survival of the TNBC patients.
Materials and Methods: From 1993 to 2008, patients diagnosed with breast cancer who were registered to the Korean Breast Cancer Society Registry were analyzed retrospectively. A cohort of 26,767 patients were divided in four groups: luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), HER2 overexpression (ER-, PR-, HER2+), and triple negative (ER-, PR-, HER2-). Clinicopathologic features such as age, tumor size, nodal status, p53, ki-67 expression and survival were evaluated. Results: The luminal A (14437 patients, 53.9%) subtype was the largest in our study sample, as compared with luminal B (3517 patients, 13.1%), ER-/HER2+ (3227 patients, 12%), and TNBC (5586 patients, 21%) subtypes. Compared with luminal A subtype, TNBC correlated with younger age and more aggressive characteristics, such as larger size, more lymph node metastasis, and higher proliferation rate. Moreover, TNBC correlated with poor overall survival and breast cancer-specific survival. The hazard rate showed a peak at 24 months for the TNBC subtype, but after 60 months, the risk was similar to that of the luminal A subtype. Higher T, N stage and histologic grade, and lymphatic and vascular invasion showed poor prognosis in TNBC patients, but on multivariate analysis only histologic grade and ki-67 status were related to poor prognosis. Young age was related to poor prognosis in the luminal A subtype, however, age was not related to prognosis in the TNBC subtype. Of the 5586 TNBC patients, 282 patients (7.11%) expired within 3 years of diagnosis. T and N stage, and grade was significantly associated with prognosis on multivariate analysis.
Discussion: TNBC subtype is characterized by a younger age with poorer outcome. However, younger age is not related to prognosis, and mortality risk decreases to that of the luminal A subtype, which is known to have the best prognosis after a few years. The underlying biology of the TNBC subtype is important, and further studies to discover novel biomarkers to predict prognosis and target treatments for the TNBC subtype are necessary.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-05-01.
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Affiliation(s)
- JA Lee
- Korea University College of Medicine, Seoul, Korea; Korea University, Seoul, Korea; The Korean Breast Cancer Society
| | - JW Bae
- Korea University College of Medicine, Seoul, Korea; Korea University, Seoul, Korea; The Korean Breast Cancer Society
| | - Y-H Jung
- Korea University College of Medicine, Seoul, Korea; Korea University, Seoul, Korea; The Korean Breast Cancer Society
| | - H An
- Korea University College of Medicine, Seoul, Korea; Korea University, Seoul, Korea; The Korean Breast Cancer Society
| | - ES. Lee
- Korea University College of Medicine, Seoul, Korea; Korea University, Seoul, Korea; The Korean Breast Cancer Society
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Lee JA, Kim CK, Jahng GH, Hwang LK, Cho YW, Kim YJ, Lee WH, Moon SJ, Cho AR, Bahn GH. A pilot study of brain activation in children with trichotillomania during a visual-tactile symptom provocation task: a functional magnetic resonance imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1250-8. [PMID: 20637819 DOI: 10.1016/j.pnpbp.2010.06.031] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 01/25/2023]
Abstract
OBJECTIVES In order to reveal the etiology and pathophysiology of trichotillomania (TTM), it is necessary to investigate which brain regions are involved in TTM, but limited knowledge exists regarding the neurobiology of TTM and the available functional neuroimaging studies of TTM are little. The purpose of the present study was to investigate the specific brain regions involved in the pathophysiology of TTM with symptom provocation task using functional magnetic resonance imaging (fMRI) for children and adolescents with TTM. METHODS Pediatric subjects who met the DSM-IV TR criteria for TTM (n=9) and age-, sex-, handedness-, IQ matched healthy controls (HC) (n=10), ages 9 to 17 years, were recruited for two fMRI experiments; symptom provocation of Visual Only (VO) and Visual and Tactile (VT). They were scanned while viewing two alternating blocks of symptom provocation (S) and neutral (N) movies. RESULTS Random effects between-group analysis revealed significant activation in left temporal cortex(including middle and superior temporal gyrus), dorsal posterior cingulate gyrus, and putamen for the contrast S>N in TTM subjects versus HC subjects during the VO session. And TTM subjects demonstrated higher activity in the precuneus and dorsal posterior cingulate gyrus to the contrast S>N during the VT session. CONCLUSIONS This study provided an objective whole-brain-based analysis that directed researchers to areas that were abnormal in TTM. Using the symptom provocation tasks, we found significant differences in regional brain function between pediatric TTM and HC subjects. However, in the face of modest statistical power, our preliminary findings in TTM need to be replicated in a larger sample. As the functional neuroanatomic circuits involved in TTM remain largely unexplored, future functional neuroimaging studies using other various paradigms may help investigate the neuroanatomic abnormalities of TTM.
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Affiliation(s)
- J A Lee
- Department of Psychiatry, Subdivision of Child & Adolescent Psychiatry, School of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoon-gu, Seoul 130-701, Republic of Korea
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Lee JA, Cockerham CC, Smith FH. The Inheritance of Gossypol Level in Gossypium I. Additive, Dominance, Epistatic, and Maternal Effects Associated with Seed Gossypol in Two Varieties of GOSSYPIUM HIRSUTUM L. Genetics 2010; 59:285-98. [PMID: 17248408 PMCID: PMC1211947 DOI: 10.1093/genetics/59.2.285] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J A Lee
- North Carolina State University, Raleigh, North Carolina 27607
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Lee JA, Press MF. HER2 testing: A health economics perspective on alternative test strategies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.606] [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: 11/20/2022] Open
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Kim Y, Yun HJ, Lee JA, Park HM, Kim SY, Cho Y. Royal jelly enhances migration of human dermal fibroblasts with decreased levels of triglycerides and cholesterol in in vitro wound healing model. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.922.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Youngae Kim
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
| | - HJ Yun
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
| | - JA Lee
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
| | - HM Park
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
| | - SY Kim
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
| | - Y Cho
- Graduate School of East‐West Medical ScienceKyung Hee UniversityGyeonggi‐doRepublic of Korea
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Lee JA, Kim MS, Koh JS, Kim MS, Kim DH, Lim JS, Kong CB, Song WS, Cho WH, Lee SY, Jeon DG. Osteosarcoma of the Flat Bone. Jpn J Clin Oncol 2009; 40:47-53. [DOI: 10.1093/jjco/hyp131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Geets X, Lee JA, Castadot P, Bol A, Grégoire V. [Potential place of FDG-PET for the GTV delineation in head and neck and lung cancers]. Cancer Radiother 2009; 13:594-9. [PMID: 19766523 DOI: 10.1016/j.canrad.2009.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
The recent progresses performed in imaging, computational and technological fields bring new opportunities to achieve high precision radiation dose delivery. However, IMRT requires a particular attention at the target delineation step to avoid inadequate dosage to TVs/OARs. In this context, the biological information provided by PET might advantageously complete CT-Scan to refine the target delineation in HNSCC and lung cancer. Integrating PET into the treatment planning however requires the use and validation of accurate and reproducible segmentation methods, which adequately integrate the PET image properties such as the blur effect and the high level of noise. In this context, we developed specific tools, i.e. edge-preserving filters for denoising and deconvolution algorithms for deblurring that allowed the detection of gradient intensity peaks. Our gradient-based method has been validated on phantom and patient materials, and proved to be more accurate than threshold-based approaches. With this tool in hand, we demonstrated that the use of FDG-PET resulted in smaller TVs than the CT-based TVs, on both pre- and per-treatment images, and significantly improved the dose distributions to the TVs/OARs. This opens avenues for dose escalation strategies that might potentially improve the tumor local control.
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Affiliation(s)
- X Geets
- Département de Radiothérapie Oncologique, Centre d'Imagerie Moléculaire et Radiothérapie Expérimentale, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgique.
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Kim MS, Lee SY, Lee TR, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Jeon DG. Prognostic nomogram for predicting the 5-year probability of developing metastasis after neo-adjuvant chemotherapy and definitive surgery for AJCC stage II extremity osteosarcoma. Ann Oncol 2009; 20:955-60. [PMID: 19153123 DOI: 10.1093/annonc/mdn723] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In this retrospective study, we developed and internally validate a nomogram for predicting 5-year metastasis probability for nonmetastatic extremity osteosarcoma. PATIENTS AND METHODS We reviewed 365 osteosarcoma patients treated at our institute from 1990 to 2003. Clinicopathologic variables were recorded. Multivariate analysis using Cox proportional hazards regression was done and this Cox model was used as the basis for the nomogram. RESULTS By American Joint Committee on Cancer (AJCC) staging system, 141 patients (38.6%) were stage IIA and 224 (61.4%) were stage IIB. Multivariate Cox model identified patient age at diagnosis, tumor size, humeral location, and tumor necrosis rate after chemotherapy as correlated with metastasis-free survival. The degree of contribution of each covariate to the total point was tumor location, tumor necrosis rate, maximal tumor diameter, and age in decreasing order. The concordance index for the model was 0.78. Nomogram discrimination was superior to that of AJCC stage (concordance index 0.78 versus 0.68; P = 0.02) and histologic response grouping (concordance index 0.78 versus 0.69; P = 0.0004). CONCLUSIONS We devised a nomogram for nonmetastatic osteosarcoma that proposes improved estimates of metastasis over AJCC staging system or tumor necrosis rate. We suggest that this nomogram allows individualized risk assessments and could be used as the basis for risk-adapted therapy.
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Affiliation(s)
- M S Kim
- Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
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Carpenter WR, Weiner BJ, Richardson LC, Lee JA, Peppercorn JM, Lewis MA, Whitmire JT, Walden SP, Hinson LO. Beyond claims data: Assessing the problem of access to radiation therapy for low-income women with breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6579] [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: 11/20/2022] Open
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Lee JA, Park JE, Lee DH, Park SG, Myung PK, Park BC, Cho S. G1 to S phase transition protein 1 induces apoptosis signal-regulating kinase 1 activation by dissociating 14-3-3 from ASK1. Oncogene 2007; 27:1297-305. [PMID: 17700517 DOI: 10.1038/sj.onc.1210740] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/09/2022]
Abstract
Apoptosis signal-regulating kinase 1 (ASK1), a member of the mitogen-activated protein kinase kinase kinase family, plays a critical role in mediating apoptosis signals initiated by a variety of death stimuli such as hydrogen peroxide and tumor necrosis factor-alpha. Owing to its critical role in inducing apoptosis, the activity of ASK1 is tightly regulated by various mechanisms such as post-translational modifications and protein-protein interactions. Here we describe the identification of G(1) to S phase transition protein 1 (GSPT1), which is associated with protein translation, as a regulator of ASK1. GSPT1 interacts with ASK1 and enhances ASK1-induced apoptotic activity through the activation of caspase-3. In vitro kinase assay data show that GSPT1 enhances ASK1 autophosphorylation and its kinase activity. Cell cycle-dependent GSPT1 induction and small interfering RNA analyses show that ASK1 autophosphorylation is dependent on the expression level of endogenous GSPT1 in cells. GSPT1 inhibits the binding of ASK1 to the 14-3-3 protein, an ASK1 inhibitor, while GSPT1 has no effect on the interaction between ASK1 and TRAF2, a C-terminal-binding activator of ASK1. Thus, our results reveal a novel role of GSPT1 in the regulation of ASK1-mediated apoptosis.
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Affiliation(s)
- J A Lee
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
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Pilkington MG, Caporn SJM, Carroll JA, Cresswell N, Lee JA, Emmett BA, Bagchi R. Phosphorus supply influences heathland responses to atmospheric nitrogen deposition. Environ Pollut 2007; 148:191-200. [PMID: 17182158 DOI: 10.1016/j.envpol.2006.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 10/17/2006] [Accepted: 10/20/2006] [Indexed: 05/13/2023]
Abstract
On an upland moor dominated by pioneer Calluna vulgaris and with an understorey of mosses and lichens, experimental plots were treated with factorial combinations of nitrogen (N) at +0 and +20kg Nha(-1)yr(-1), and phosphorus (P) at +0 and +5kg Pha(-1)yr(-1). Over the 4-year duration of the experiment, the cover of the Calluna canopy increased in density over time as part of normal phenological development. Moss cover increased initially in response to N addition but then remained static; increases in cover in response to P addition became stronger over time, eventually causing reductions in the cover of the dominant Calluna canopy. Lichen cover virtually disappeared within 4 years in plots receiving +20kg Nha(-1)yr(-1) and also in separate plots receiving +10kg Nha(-1)yr(-1), but this effect was reversed by the addition of P.
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Affiliation(s)
- M G Pilkington
- Department of Environmental and Leisure Studies, Manchester Metropolitan University, MMU Cheshire, Crewe, Cheshire, UK.
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Abstract
6633 Background: The integrity of scientific and clinical research is dependent on the avoidance of conflicts of interest (COI). Hence, the American Society of Clinical Oncology (ASCO) has implemented a COI policy pertaining to articles published in the Journal of Clinical Oncology (JCO). In this study, we examined the prevalence and nature of COI among scientific articles published in JCO. Methods: We reviewed original articles, review articles and ASCO special articles published in JCO from August 2005 to January 2006. COI was categorized into employment/leadership position, consultancy, stock ownership, honoraria, research funding, expert testimonials and other remuneration. Results: Out of a total of 514 articles reviewed, original articles, review articles and ASCO special articles comprised 88.3%, 11.1% and 0.06% respectively. Overall 34.8% of the articles reported at least 1 COI. Among articles with COI, 21.8%, 27.4% and 50.8% reported 1, 2 and 3 or more COI, respectively. Consultancy (64.8%) was the most common COI, followed by honoraria (64.2%), research funds (58.7%), employment/leadership (40.2%), stock ownership (39.7%), testimonials (11.2%) and other remuneration (10.1%). COI was reported in 58.3% of clinical trials compared to 24.6% in other articles (P = 0.001). Out of the total of 4,944 authors, 14.0% reported a COI. Among authors with COI, 47.9%, 38.2% and 13.9% reported 1, 2 and 3 or more COI, respectively. The prevalence of COI among articles originating from North America, Europe and Asia/Australia were 38.2%, 31.8% and 13.8%, respectively (P = 0.020). Conclusions: COI were widely prevalent in articles published in JCO. Clinical trials had a higher prevalence of COI compared to other scientific articles. The prevalence of COI was equally high in articles originating from North America and Europe, but much lower in articles from Asia/Australia. The majority of reported COI were unrelated to research funds. No significant financial relationships to disclose.
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Affiliation(s)
- B. George
- Gundersen Lutheran Medical Center, La Crosse, WI
| | - S. Simhan
- Gundersen Lutheran Medical Center, La Crosse, WI
| | - J. A. Lee
- Gundersen Lutheran Medical Center, La Crosse, WI
| | | | - R. S. Go
- Gundersen Lutheran Medical Center, La Crosse, WI
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Sieber D, Lee JA, Keller JK, Mathiason MA, Go RS. Extent and nature of advertising in leading hematology-oncology journals. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6634] [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: 11/20/2022] Open
Abstract
6634 Background: Advertising in most medical journals is dominated by pharmaceuticals in part due to journal policy. This is primarily a fiscal consideration. Because advertising clearly influence physicians’ prescribing pattern, an indirect conflict of interest exists and may potentially affect patient care. The objectives of this study were to evaluate the extent of advertising in leading hematology-oncology (HO) journals published in the U.S. and to compare the findings to those of multi-specialty journals. Methods: We evaluated the following high impact journals that publish original research and included all issues issued in 2006: Journal of National Cancer Institute (JNCI), Journal of Clinical Oncology (JCO), Blood, New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and Annals of Internal Medicine (AIM). Of these, only JNCI (currently not affiliated with U.S. NCI) is not owned by a medical society. The number and nature of advertising for each journal were collected. Results: There was an average of 84, 283, and 459 pages for each issue of JNCI, JCO, and Blood, respectively. Overall, HO journals allocated 20% (range, 8–32) of their pages for advertising. JCO had the most, while JNCI the least, advertising, both classified (6% vs 1% vs 1%; P = 0.001) and non-classified (26% vs 10% vs 7%; P = 0.001). Among non- classified advertising, the major categories were drugs (48.5%), journal information (14.1%), conference announcements (10.1%), research/clinical trial (7%), disease information (6.4%), continuing medical education (3.6%), and others (10.3%). Among journals, JCO had the most drug advertising (72.5%), followed by Blood (65.6%), while JNCI did not have any (0%). Compared to multi-specialty journals, HO journals had less amount of classified (3% [range, 1–6] vs 15% [range, 10–19]; P = 0.001) and non-classified (17% [range, 7–26] vs 21% [range, 18–25]; P = 0.001) advertising. Conclusions: While less than their multi-specialty counterparts, HO journals allocated a substantial proportion of their pages to advertising, the overwhelming majority of which were sponsored by pharmaceutical companies. The extent of advertising varied by journal, but was most prominent with JCO. Notably, JNCI did not have any drug advertising. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - R. S. Go
- Gundersen Lutheran, La Crosse, WI
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Foster IB, Lee JA, Tye FL. The effect of heat treatments on the semiconductor properties of a commercially electrodeposited manganese dioxide. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/jctb.5020221007] [Citation(s) in RCA: 24] [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] [Indexed: 11/08/2022]
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Rhee DJ, Kong DS, Park K, Lee JA. Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2006; 148:839-43; discussion 843. [PMID: 16804640 DOI: 10.1007/s00701-006-0847-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 10/26/2005] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) for hemifacial spasm (HFS) provides a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course and final results. METHODS From January, 1998 to April, 2004, 410 patients underwent microvascular decompression for hemifacial spasm at our Institute. During this time, 21 patients (5.4%) developed delayed facial weakness; eighteen of them were given steroid medication and they were followed up in the out-patient clinic. FINDINGS Twenty-one patients developed DFP after microvascular decompression an incidence of 5.4%. There were seventeen women (81.0%) among the 21 patients with DFP who were included in this study. In twenty of them, the symptoms of HFS improved completely after the operation, but the spasm remained with one of them. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7 weeks (range: 25 days-17 weeks); 20 patients improved to complete recovery and 1 patient remained with minimal weakness, as Grade II on the HB scale, at the follow-up examination. CONCLUSION Our findings demonstrated that the incidence of DFP was not so low as has been reported the literature, and it did not have any striking predisposing factors. Even though the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment. The etiology of DFP and its association with herpes infection should be further clarified.
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Affiliation(s)
- D J Rhee
- Deparment of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee JA, Mathiason MA, Czeczok CA, Keller JK, Go RS. Cancer clinical trial accrual patterns among community cancer centers in the United States. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6041] [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: 11/20/2022] Open
Abstract
6041 Background: Most cancer patients are diagnosed and treated in the community but clinical trial accrual rate is low. Published data on trial accrual from community-based cancer centers throughout the U.S. are limited. The Association of Community Cancer Centers (ACCC) is a national multidisciplinary education and advocacy organization that maintains a membership caring for over 60% of all patients with cancer in the U.S. In order to determine the clinical trial accrual patterns in the community across various geographic regions in the U.S., we performed a retrospective study utilizing the data from ACCC membership maintained at their web site. Methods: Data available from the most recent year (2003–2005) were obtained from 621 centers throughout the U.S., representing 49 states (no data for WY) and the DC. We investigated the number of patients (new and old) accrued into trials per year relative to the number of new analytical patients seen in the same year, a value we termed accrual ratio (AR). In addition, we studied the effects of geographic location, size of the cancer program, number of affiliations with National Cancer Institute sponsored cancer cooperative groups, and the number of medical/support/data management staffs on trial accrual. Results: A total of 670,215 new patients were seen across the ACCC membership with 43,743 patients accrued into trials for a median AR of 6.5% (range, 0.3–16.9). The top and bottom 5 accruing states were VT, MD, SD, LA, ID and KS, ND, VA, NH, AR, respectively. Regionally, the AR for Midwest, Middle Atlantic, West, South, Southwest, and New England were as follows: 7.4%, 7.0%, 6.2%, 6.0%, 5.7%, and 5.4% (p < 0.001). One hundred (16.1%) centers representing 11.8% of all new patients were not affiliated with any of the cooperative groups. This group had the lowest AR (3.1%). AR increased when centers were affiliated with more cooperative groups (p < 0.001) or cared for more new patients (p < 0.001). The number of medical, support, and data management staffs did not influence accrual. Conclusions: Overall, clinical trial accrual in the U.S. community cancer centers is low. Accrual patterns differed significantly among various geographic locations. Better access to trials is needed in order to improve participation of cancer patients. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - R. S. Go
- Gundersen Lutheran, La Crosse, WI
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