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Cortina LE, Amini A, Benson J, Huang VW, Naples JG. Hearing Loss and Sociodemographic Barriers to Health Care Access Using the All of Us Research Program. Otolaryngol Head Neck Surg 2024; 170:76-83. [PMID: 37473437 DOI: 10.1002/ohn.431] [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: 03/28/2023] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To explore how gender and low-income status independently influence general health care access in patients with hearing loss. STUDY DESIGN Cross-sectional study. SETTING National database. METHODS Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographics such as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation. RESULTS A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income. CONCLUSION This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss.
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Affiliation(s)
- Luis E Cortina
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Amini
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jalen Benson
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria W Huang
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James G Naples
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Benson J, Stewart C, Kenna M, Shearer AE. Otolaryngologic Manifestations of Trisomy 13 and Trisomy 18 in Pediatric Patients. Laryngoscope 2023; 133:1501-1506. [PMID: 37158261 PMCID: PMC10169904 DOI: 10.1002/lary.30350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The survival rate of patients with trisomy 13 and trisomy 18 has increased dramatically over the past two decades. We sought to comprehensively describe the otolaryngologic clinical characteristics and procedures required for these patients at our institution. METHODS We performed algorithmic identification of patients with a diagnosis of trisomy 13 and trisomy 18 for whom the otolaryngology service provided inpatient or outpatient care at our institution between the dates of February 1997 and March 2021. RESULTS Of the 47 patients studied, 18 patients had a diagnosis of trisomy 13, and 29 had a diagnosis of trisomy 18. Complete trisomy was present in 44% (8/18) of trisomy 13 patients and 55% (16/29) of trisomy 18 patients. 81% of patients were living at the time of the study. About 94% (44/47) of patients required consultation with another specialty in addition to Otolaryngology. Overall, the most common diagnoses among this cohort were gastroesophageal reflux disease (47%), dysphagia (40%), otitis media (38%), and obstructive sleep apnea (34%). Nearly three-quarters (74%) of patients studied required an otolaryngologic procedure. The most common surgical procedure was tonsillectomy and/or adenoidectomy. Patients with trisomy 18 were significantly more likely to have external auditory canal stenosis and obstructive sleep apnea whereas patients with trisomy 13 were more likely to have cleft lip and palate. CONCLUSIONS Patients with a diagnosis of trisomy 13 or 18 often require multidisciplinary management and the range of required care spans the breadth of otolaryngology. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1501-1506, 2023.
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Affiliation(s)
- Jalen Benson
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Candace Stewart
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Margaret Kenna
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, MA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - A. Eliot Shearer
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, MA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
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Chatterjee A, Dunleavy S, Gonzalez T, Benson J, Henault L, MacIntosh A, Goodell K, Witzburg R, Paasche-Orlow M. Health professions school applicant experiences of discrimination during interviews. Med Teach 2023; 45:532-541. [PMID: 36369780 DOI: 10.1080/0142159x.2022.2142107] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Bias pervades every aspect of healthcare including admissions, perpetuating the lack of diversity in the healthcare workforce. Admissions interviews may be a time when applicants to health profession education programs experience discrimination. METHODS Between January and June 2021 we invited US and Canadian applicants to health profession education programs to complete a survey including the Everyday Discrimination Scale, adapted to ascertain experiences of discrimination during admissions interviews. We used chi-square tests and multivariable logistic regression to determine associations between identity factors and positive responses. RESULTS Of 1115 respondents, 281 (25.2%) reported discrimination in the interview process. Individuals with lower socioeconomic status (OR: 1.78, 95% CI [1.26, 2.52], p = 0.001) and non-native English speakers (OR: 1.76, 95% CI [1.08, 2.87], p = 0.02) were significantly more likely to experience discrimination. Half of those experiencing discrimination (139, or 49.6%) did nothing in response, though 44 (15.7%) reported the incident anonymously and 10 (3.6%) reported directly to the institution where it happened. CONCLUSIONS Reports of discrimination are common among HPE applicants. Reforms at the interviewer- (e.g. avoiding questions about family planning) and institution-level (e.g. presenting institutional efforts to promote health equity) are needed to decrease the incidence and mitigate the impact of such events.
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Affiliation(s)
- Avik Chatterjee
- Section of General Internal Medicine, Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Spencer Dunleavy
- Columbia Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Lori Henault
- Section of General Internal Medicine, Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Michael Paasche-Orlow
- Section of General Internal Medicine, Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
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Lyon A, Yu Q, Hu A, Benson J, Ahmed O. Abstract No. 572 Meta-Analysis of Genicular Artery Embolization for Treatment of Osteoarthritis of the Knee. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.430] [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: 02/27/2023] Open
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Lyon A, Yu Q, Tran P, Ungchusri E, Hu A, Neale M, Benson J, Ahmed O. Abstract No. 594 Single Session Mechanical Thrombectomy of Ileofemoral Deep Vein Thrombosis with ClotTriever: Exploring its Possibilities in an Outpatient Setting. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.452] [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: 02/26/2023] Open
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6
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Roy E, Shrager J, Benson J, Trope WL, Bhandari P, Lui N, Liou D, Backhus L, Berry MF. Risk of adenocarcinoma in patients with a suspicious ground-glass opacity: a retrospective review. J Thorac Dis 2022; 14:4236-4245. [PMID: 36524073 PMCID: PMC9745528 DOI: 10.21037/jtd-22-583] [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] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/02/2022] [Indexed: 02/11/2024]
Abstract
BACKGROUND Both primary lung adenocarcinoma and benign processes can have a ground-glass opacity (GGO) appearance on imaging. This study evaluated the incidence of and risk factors for malignancy in a diverse cohort of patients who underwent resection of a GGO suspicious for lung cancer. METHODS All patients who underwent resection of a pulmonary nodule with a GGO component and suspected to be primary lung cancer at a single institution from 2001-2017 were retrospectively reviewed. Risk factors for malignancy were evaluated using multivariable logistic regression analysis that included nodule size, age, sex, and race as potential predictors. RESULTS The incidence of pulmonary adenocarcinoma in the 243 patients who met inclusion criteria was 86% (n=208). The most common pathologic findings in 35 patients with a benign pathology was granulomatous inflammation (n=14, 40%). Risk factors for adenocarcinoma in multivariable logistic regression were age [odds ratio (OR) 1.06, P=0.003], GGO size (OR 2.76, P<0.001), female sex (OR 4.47, P=0.002), and Asian race (OR 8.35, P=0.002). In this cohort, adenocarcinoma was found in 100% (44/44) of Asian females, 86% (25/29) of Asian males, 84% (98/117) of non-Asian females, and 77% (41/53) of non-Asian males. CONCLUSIONS The likelihood of adenocarcinoma in lung nodules with a ground-glass component is influenced by sex and race. Asian females with a GGO have a much higher likelihood of having adenocarcinoma than men and non-Asians. This data can be used when deciding whether to pursue nodule resection or surveillance in a patient with a GGO.
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Affiliation(s)
- Esha Roy
- Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
- Stanford University, Stanford, CA, USA
| | | | | | | | | | | | - Doug Liou
- Stanford University, Stanford, CA, USA
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7
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Bundred N, Dixon M, Acuthan R, Barrett E, Benson J, Courtney C, Skene A, Hoar F, Bhaskar P, Todd C, Macmillan D, Watterston D, Barnes N. Does the use of an Intraoperative device to assess margins reduce need for reexcison after breast conserving surgery: Multicentre Randomised Controlled Trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01358-2] [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: 11/19/2022]
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8
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Nardi V, Benson J, Saba L, Bois M, Meyer F, Lanzino G, Lilach L, Lerman A. Patients with carotid intraplaque hemorrhage have higher incidence of cerebral microbleeds. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1983] [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: 11/14/2022] Open
Abstract
Abstract
Background
Carotid intraplaque hemorrhage (IPH) is considered a strong marker of histologically defined plaque vulnerability leading to cerebrovascular ischemic events. Cerebral microbleeds (CMBs) represent hemorrhage-prone small vessel disease and they are a common finding on brain MRI in patients with cerebrovascular disease. However, the potential mechanism and the risk for CMBs are not clear. The characteristics of carotid lesions have been considered relevant in the relationship between carotid artery atherosclerosis and the presence of CMBs. The potential association between carotid IPH histologically defined and CMBs has not been investigated yet.
Purpose
We have previously reported the prevalence of IPH in patients with non-obstructive carotid disease in patients who underwent carotid endarterectomy (CEA). In this study, we aimed to investigate whether the presence and the extent of carotid IPH are related to the existence of CMBs. We hypothesized that patients with carotid IPH would have a higher risk of CMBs.
Methods
This retrospective study enrolled 101 consecutive patients undergoing CEA with symptomatic (including ischemic stroke, TIA, and amaurosis fugax) or asymptomatic ipsilateral carotid artery disease. Carotid plaque specimens were collected at CEA from all the patients and stained with Movat Pentachrome to identify the presence and the extent (%) of IPH. Neck CTA was obtained to measure the degree of carotid stenosis. Brain MRI was pre-surgically performed and CMBs were studied using T2*-weighted gradient-recalled echo (GRE) or susceptibility-weighted imaging (SWI) sequence. The CMBs were counted and localized. Clinical and biochemical data, comorbidities, and medications were recorded. The association between carotid IPH and CMBs was examined adjusted for other risk factors.
Results
The presence of carotid IPH was in 57 (56.4%) patients. CMBs were more observed in patients with carotid IPH compared to those without IPH [19 (33.3%) vs 5 (11.4%); p=0.010]. Logistic regression analysis demonstrated an association between the extent of IPH in the carotid atheroma and the presence of CMBs [OR 1.051 (95% CI 1.012–1.090); p=0.009]. Moreover, the carotid IPH extent was associated with the number of CMBs (p=0.004). In patients with CMBs, the median degree of ipsilateral carotid stenosis was 40% (35–65%) and it was 70% (50–80%) in those without CMBs, with a significant difference between the two groups (p=0.049).
Conclusions
In patients undergoing CEA, the histologically defined presence of carotid IPH and its extent are associated with CMBs on brain MR imaging. CMBs may be a potential mechanism for cerebrovascular events in patients with carotid atherosclerotic IPH and they may be an imaging marker that can distinguish the severity of the carotid artery disease.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Mayo Clinic Foundation
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Affiliation(s)
- V Nardi
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - J Benson
- Mayo Clinic, Radiology , Rochester , United States of America
| | - L Saba
- University of Cagliari, Radiology , Cagliari , Italy
| | - M Bois
- Mayo Clinic, Laboratory Medicine and Pathology , Rochester , United States of America
| | - F Meyer
- Mayo Clinic, Neurologic Surgery , Rochester , United States of America
| | - G Lanzino
- Mayo Clinic, Neurologic Surgery , Rochester , United States of America
| | - L Lilach
- Mayo Clinic, Nephrology and Hypertension , Rochester , United States of America
| | - A Lerman
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
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9
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Nair VS, Hui ABY, Chabon JJ, Esfahani MS, Stehr H, Nabet BY, Zhou L, Chaudhuri AA, Benson J, Ayers K, Bedi H, Ramsey M, Van Wert R, Antic S, Lui N, Backhus L, Berry M, Sung AW, Massion PP, Shrager JB, Alizadeh AA, Diehn M. Genomic Profiling of Bronchoalveolar Lavage Fluid in Lung Cancer. Cancer Res 2022; 82:2838-2847. [PMID: 35748739 PMCID: PMC9379362 DOI: 10.1158/0008-5472.can-22-0554] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
Genomic profiling of bronchoalveolar lavage (BAL) samples may be useful for tumor profiling and diagnosis in the clinic. Here, we compared tumor-derived mutations detected in BAL samples from subjects with non-small cell lung cancer (NSCLC) to those detected in matched plasma samples. Cancer Personalized Profiling by Deep Sequencing (CAPP-Seq) was used to genotype DNA purified from BAL, plasma, and tumor samples from patients with NSCLC. The characteristics of cell-free DNA (cfDNA) isolated from BAL fluid were first characterized to optimize the technical approach. Somatic mutations identified in tumor were then compared with those identified in BAL and plasma, and the potential of BAL cfDNA analysis to distinguish lung cancer patients from risk-matched controls was explored. In total, 200 biofluid and tumor samples from 38 cases and 21 controls undergoing BAL for lung cancer evaluation were profiled. More tumor variants were identified in BAL cfDNA than plasma cfDNA in all stages (P < 0.001) and in stage I to II disease only. Four of 21 controls harbored low levels of cancer-associated driver mutations in BAL cfDNA [mean variant allele frequency (VAF) = 0.5%], suggesting the presence of somatic mutations in nonmalignant airway cells. Finally, using a Random Forest model with leave-one-out cross-validation, an exploratory BAL genomic classifier identified lung cancer with 69% sensitivity and 100% specificity in this cohort and detected more cancers than BAL cytology. Detecting tumor-derived mutations by targeted sequencing of BAL cfDNA is technically feasible and appears to be more sensitive than plasma profiling. Further studies are required to define optimal diagnostic applications and clinical utility. SIGNIFICANCE Hybrid-capture, targeted deep sequencing of lung cancer mutational burden in cell-free BAL fluid identifies more tumor-derived mutations with increased allele frequencies compared with plasma cell-free DNA. See related commentary by Rolfo et al., p. 2826.
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Affiliation(s)
- Viswam S. Nair
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington School of Medicine, Seattle, Washington
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Angela Bik-Yu Hui
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Jacob J. Chabon
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Mohammad S. Esfahani
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Henning Stehr
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Barzin Y. Nabet
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Li Zhou
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Aadel A. Chaudhuri
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jalen Benson
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Kelsey Ayers
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Harmeet Bedi
- Division of Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Meghan Ramsey
- Division of Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Ryan Van Wert
- Division of Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Sanja Antic
- Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Natalie Lui
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Leah Backhus
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Mark Berry
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Arthur W. Sung
- Division of Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Pierre P. Massion
- Division of Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joseph B. Shrager
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ash A. Alizadeh
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
| | - Maximilian Diehn
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
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Torres-Zegarra C, Sundararajan D, Benson J, Seagle H, Witten M, Walders-Abramson N, Simon SL, Huguelet P, Nokoff NJ, Cree-Green M. Care for Adolescents With Polycystic Ovary Syndrome: Development and Prescribing Patterns of a Multidisciplinary Clinic. J Pediatr Adolesc Gynecol 2021; 34:617-625. [PMID: 33794340 PMCID: PMC8808364 DOI: 10.1016/j.jpag.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Based on updated guidelines and expressed patient needs, we created a multidisciplinary clinic including endocrinology, gynecology/adolescent medicine, dermatology, psychology, and nutrition to provide comprehensive care to adolescent girls with polycystic ovary syndrome (PCOS). We describe the patient population presenting to this clinic, and prescribing patterns when a multidisciplinary approach is used. DESIGN Retrospective chart review. SETTING Tertiary care hospital. PARTICIPANTS Female patients, aged 11-24 years, presenting for initial assessment in a multidisciplinary PCOS clinic. INTERVENTIONS None. MAIN OUTCOME MEASURES Medical history, physical examination findings, laboratory measurements and prescribed therapies. RESULTS A total of 92 patients seen from 2014 to 2018 are described (age 15.9 years, range 11-24 years, body mass index 35.6 kg/m2, range 19.9-53.5). Metabolic syndrome features were common: 26% had a prediabetes hemoglobin A1c (>5.6%), 83% had a high-density lipoprotein (HDL) <50 mg/dL, 40% had a systolic blood pressure >120 mm Hg, and 43% had an alanine aminotransferase level of >30 U/L. Dermatologic findings included acne 93%, hirsutism 38%, acanthosis nigricans 85%, hidradenitis suppurativa 16%, and androgenic alopecia 2%. Of the patients, 33% had a diagnosis of depression or anxiety, 16% of patients had a diagnosis of obstructive sleep apnea, and an additional 59% had symptoms warranting a sleep study The most commonly prescribed medications were topical acne preparations (62%), followed by estrogen-containing hormonal therapy (56%) and metformin (40%). CONCLUSION In adolescents with PCOS and obesity, metabolic, dermatologic, and psychologic co-morbidities are common. The use of a multidisciplinary clinic model including dermatology in addition to endocrinology, gynecology, psychology, and lifestyle experts provides care for most aspects of PCOS.
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Affiliation(s)
- C Torres-Zegarra
- (1)Department of Surgery, Division of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - D Sundararajan
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - J Benson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - H Seagle
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - M Witten
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - N Walders-Abramson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S L Simon
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - P Huguelet
- Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - N J Nokoff
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - M Cree-Green
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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11
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Yee LM, McGee P, Bailit JL, Wapner RJ, Varner MW, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Mallett G, Grobman W, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Moseley L, Leveno K, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Rouse D, Andrews W, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Rice M, Zhao Y, Momirova V, Palugod R, Reamer B, Larsen M, Spong C, Tolivaisa S, VanDorsten J. Differences in obstetrical care and outcomes associated with the proportion of the obstetrician's shift completed. Am J Obstet Gynecol 2021; 225:430.e1-430.e11. [PMID: 33812810 DOI: 10.1016/j.ajog.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. OBJECTIVE The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending's shift change. STUDY DESIGN This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending's shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern RESULTS: Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. CONCLUSION Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician's shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.
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Seyedsaadat S, Neuhaus A, Nicholson P, Polley E, Hilditch C, Mihal D, Krings T, Benson J, Mark I, Kallmes D, Brinjikji W, Schaafsma J. Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1104-1108. [PMID: 33926898 PMCID: PMC8191662 DOI: 10.3174/ajnr.a7096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is the leading cause of long-term disability in adults, but our ability to prognosticate from baseline imaging data is limited. The ASPECTS measures ischemic change in the middle cerebral artery territory on noncontrast CT based on 10 anatomic regions. Here, we investigated whether infarction in particular regions was associated with worse long-term outcome. MATERIALS AND METHODS We identified consecutive patients receiving mechanical thrombectomy for ICA/MCA occlusion at 2 comprehensive stroke centers. Pretreatment ASPECTS was assessed by 2 blinded reviewers. Clinical data including demographics, baseline NIHSS score, and 90-day mRS were collected. The relationship between individual ASPECTS regions and the mRS score (0-2 versus 3-6) was assessed using multivariable logistic regression. RESULTS Three hundred fifty-three patients were included (mean age, 70 years; 46% men), of whom 214 had poor outcome (mRS = 3-6). Caudate (OR = 3.26; 95% CI, 1.33-8.82), M4 region (OR = 2.94; 95% CI, 1.09-9.46), and insula (OR = 1.75; 95% CI, 1.08-2.85) infarcts were associated with significantly greater odds of poor outcome, whereas M1 region infarction reduced the odds of poor outcome (OR = 0.38; 95% CI, 0.14-0.99). This finding remained unchanged when restricted to only patients with good recanalization. No significant associations were found by laterality. Similarly, no region was predictive of neurologic improvement during the first 24 hours or of symptomatic intracerebral hemorrhage. CONCLUSIONS Our results indicate that ASPECTS regions are not equal in their contribution to functional outcome. This finding suggests that patient selection based on total ASPECTS alone might be insufficient, and infarct topography should be considered when deciding eligibility for thrombectomy.
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Affiliation(s)
- S.M. Seyedsaadat
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Radiology (S.M.S.), Mayo Clinic, Jacksonville, Florida
| | - A.A. Neuhaus
- Radcliffe Department of Medicine (A.A.N.), University of Oxford, Oxford, UK
| | - P.J. Nicholson
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - E.C. Polley
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C.A. Hilditch
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada,Department of Neuroradiology (C.A.H.), Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - D.C. Mihal
- Department of Radiology (D.C.M.), Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio
| | - T. Krings
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - J. Benson
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - I. Mark
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - D.F. Kallmes
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W. Brinjikji
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
| | - J.D. Schaafsma
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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Vidya R, Leff DR, Green M, McIntosh SA, St John E, Kirwan CC, Romics L, Cutress RI, Potter S, Carmichael A, Subramanian A, O'Connell R, Fairbrother P, Fenlon D, Benson J, Holcombe C. Innovations for the future of breast surgery. Br J Surg 2021; 108:908-916. [PMID: 34059874 DOI: 10.1093/bjs/znab147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/06/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. METHODS Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. RESULTS Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. CONCLUSION Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.
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Affiliation(s)
- R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - D R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Green
- The Walsall NHS Trust, Walsall, UK
| | - S A McIntosh
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - E St John
- Locum Consultant Oncoplastic Breast Surgeon, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - C C Kirwan
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Romics
- New Victoria Hospital Glasgow, Glasgow, UK
| | - R I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Southampton, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - A Carmichael
- University Hospital of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
| | | | - R O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Benson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,School of Medicine, Anglia Ruskin University, Chelmsford and Cambridge, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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Benson J, Bhandari P, Lui N, Berry M, Liou DZ, Shrager J, Ayers K, Backhus LM. Use of a Personalized Multimedia Education Platform Improves Preoperative Teaching for Lung Cancer Patients. Semin Thorac Cardiovasc Surg 2021; 34:363-372. [PMID: 33711462 DOI: 10.1053/j.semtcvs.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Abstract
We sought to develop and evaluate a personalized multimedia education (ME) tool for preoperative patient education to improve patient health knowledge, quality of life and satisfaction with care in thoracic surgery. The ME tool was developed and deployed in outpatient clinic during preoperative teaching for patients undergoing surgical resection for lung cancer for quality improvement. Patients were given an electronic survey prior to preoperative teaching and at initial postoperative visit to assess teaching effectiveness and care satisfaction. Sequential patients received either standard preoperative teaching or teaching using the ME tool. Pre- and postoperative survey responses were compared using independent sample paired t test and multivariable linear regression modeling for adjustment. The final ME tool was an iPad application that incorporated real-time annotations of 3-dimensional, interactive anatomic diagrams. The tool featured video tours of operations, and radiology image import for annotation by the surgeon. Forty-eight patients were included in this pilot study (standard education n = 26; ME, n = 22). ME patients had significantly higher satisfaction scores compared to SE patients with respect to length of education materials, clarity of content, supportiveness of content and willingness to recommend materials to others. There was no difference in length of clinic visit between groups. Both patient and provider input can be used to create an innovative electronic preoperative educational tool that prepares and empowers patients in shared decision-making before surgery. Improvements in health literacy and self-efficacy may be more difficult to achieve but remain important as multimedia teaching tools are further developed.
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Affiliation(s)
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Natalie Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Mark Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Joseph Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Kelsey Ayers
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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Borkar N, Provenzano E, Garreffa E, Benson J, Forouhi P, Hugh-Davies L, Wilson C, McAdam K, Russell S, Agrawal A. Does Neo-adjuvant chemotherapy response in the primary breast tumour correlate with axillary response in proven node positive ER positive HER2 negative disease? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Affiliation(s)
| | - Natalie Lui
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
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Sholtis C, Teymourtash M, Berry M, Backhus L, Bhandari P, He H, Benson J, Wang YY, Yevudza E, Lui N, Shrager J. Transcervical Thymectomy Is the Most Cost-Effective Surgical Approach in Myasthenia Gravis. Ann Thorac Surg 2020; 109:1705-1712. [DOI: 10.1016/j.athoracsur.2020.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 12/01/2022]
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Lui NS, Benson J, He H, Imielski BR, Kunder CA, Liou DZ, Backhus LM, Berry MF, Shrager JB. Sub-solid lung adenocarcinoma in Asian versus Caucasian patients: different biology but similar outcomes. J Thorac Dis 2020; 12:2161-2171. [PMID: 32642121 PMCID: PMC7330405 DOI: 10.21037/jtd.2020.04.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Asian and Caucasian patients with lung cancer have been compared in several database studies, with conflicting findings regarding survival. However, these studies did not include proportion of ground-glass opacity or mutational status in their analyses. Asian patients commonly develop sub-solid lung adenocarcinomas that harbor EGFR mutations, which have a better prognosis. We hypothesized that among patients undergoing surgery for sub-solid lung adenocarcinomas, Asian patients have better survival compared to Caucasian patients. Methods We identified Asian and Caucasian patients who underwent surgical resection for a sub-solid lung adenocarcinoma from 2002 to 2015 at our institution. Sub-solid was defined as ≥10% ground-glass opacity on preoperative CT scan or ≥10% lepidic component on surgical pathology. Time-to-event multivariable analysis was performed to determine which characteristics were associated with recurrence and survival. Results Two hundred twenty-four patients were included with median follow up 48 months. Asian patients were more likely to be never smokers (76.3% vs. 29.0%, P<0.01) and have an EGFR mutation (69.4% vs. 25.6% of those tested, P<0.01), while Caucasian patients were more likely to have a KRAS mutation (23.5% vs. 4.9% of those tested, P<0.01). There was a trend towards Asian patients having a higher proportion of ground-glass opacity (38.8% vs. 30.5%, P=0.11). Time-to-event multivariable analysis showed that higher proportion of ground-glass opacity was significantly associated with better recurrence-free survival (HR 0.76 per 20% increase, P=0.02). However, mutational status and race did not have a significant impact on recurrence-free or overall survival. Conclusions Asian and Caucasian patients with sub-solid lung adenocarcinoma have different tumor biology, but recurrence-free and overall survival after surgical resection is similar.
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Affiliation(s)
- Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jalen Benson
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Hao He
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Bartlomiej R Imielski
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.,Department of Surgery, Northwestern University, Chicago, IL, USA
| | | | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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D’Aoust JY, Sewell AM, Greco P, Benson J, Boleszczuk P, Brodsky M, Cirigliano M, Coignaud C, Fain A, Flowers R, Gour L, Hamann WT, Huszczynski G, Jesset K, Konkel P, Lacasse P, Laffey PJ, Laperriere G, Mclntyre K, Morrow A, Oggel J, Philippe LM, Purvis U, Richter ER, Thomas MD, West W, Zandstra W. Detection of Salmonella in Dry Foods Using Refrigerated Pre-Enrichment and Enrichment Broth Cultures: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.4.814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
An interlaboratory study was performed in 11 laboratories to validate the use of pre-enrichment and tetrathionate brilliant green (TBG35) and selenite cystine (SC35) enrichment cultures refrigerated 72 h at 2-5°C for greater analytical flexibility in the detection of Salmonella in dry foods. Productivities of refrigerated pre-enrichment and enrichment cultures were compared with that of the AOAC/Bacteriological Analytical Manual (BAM) procedure using 4 food types: whole egg powder, milk chocolate, animal feed, and instantized skim milk powder. Uninoculated and inoculated samples were included in each food group. There was complete agreement between the results obtained by the standard AOAC/BAM procedure and the 2 refrigeration procedures. Of 660 samples tested, the AOAC/BAM procedure identified 393 contaminated samples that were readily detected from the corresponding refrigerated pre-enrichment cultures and from the combined productivity of homologous refrigerated TBG35 and SC35 cultures. Refrigeration (72 h) of preenrichment or enrichment cultures for greater analytical flexibility and laboratory productivity in the examination of dry foods is under review for adoption by AOAC International.
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Affiliation(s)
- Jean-Yves D’Aoust
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
| | - Anne M Sewell
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
| | - Paula Greco
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
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Liao Y, Benson J, Higgins S, Drakatos P, Kaler J, O'Regan D, Tsai CC, Gnoni V, Muza R, Nesbitt A, Young A, Stokes P, Leschziner G, Rosenzweig I. Sleep architecture and comorbid sleep disorders in patients with bipolar affective disorder and recurrent depressive disorder. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.357] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Nair V, Bik-Yu Hui A, Chabon J, Esfahani M, Stehr H, Nabet B, Benson J, Chaudhuri A, Zhou L, Ayers K, Bedi H, Ramsey M, Van Wert R, Sung A, Lui N, Backhus L, Berry M, Massion P, Shrager J, Alizadeh A, Diehn M. P2.05-01 Broad Genomic Profiling of Bronchoalveolar Lavage Fluid in Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Karacosta L, Anchang B, Ignatiadis N, Kimmey S, Benson J, Shrager J, Sung A, Neal J, Wakelee H, Tibshirani R, Bendall S, Plevritis S. OA08.03 A Single-Cell Resolution Map of EMT and Drug Resistance States for Evaluating NSCLC Clinical Specimens. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mattonen SA, Davidzon GA, Benson J, Leung ANC, Vasanawala M, Horng G, Shrager JB, Napel S, Nair VS. Bone Marrow and Tumor Radiomics at 18F-FDG PET/CT: Impact on Outcome Prediction in Non-Small Cell Lung Cancer. Radiology 2019; 293:451-459. [PMID: 31526257 DOI: 10.1148/radiol.2019190357] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Primary tumor maximum standardized uptake value is a prognostic marker for non-small cell lung cancer. In the setting of malignancy, bone marrow activity from fluorine 18-fluorodeoxyglucose (FDG) PET may be informative for clinical risk stratification. Purpose To determine whether integrating FDG PET radiomic features of the primary tumor, tumor penumbra, and bone marrow identifies lung cancer disease-free survival more accurately than clinical features alone. Materials and Methods Patients were retrospectively analyzed from two distinct cohorts collected between 2008 and 2016. Each tumor, its surrounding penumbra, and bone marrow from the L3-L5 vertebral bodies was contoured on pretreatment FDG PET/CT images. There were 156 bone marrow and 512 tumor and penumbra radiomic features computed from the PET series. Randomized sparse Cox regression by least absolute shrinkage and selection operator identified features that predicted disease-free survival in the training cohort. Cox proportional hazards models were built and locked in the training cohort, then evaluated in an independent cohort for temporal validation. Results There were 227 patients analyzed; 136 for training (mean age, 69 years ± 9 [standard deviation]; 101 men) and 91 for temporal validation (mean age, 72 years ± 10; 91 men). The top clinical model included stage; adding tumor region features alone improved outcome prediction (log likelihood, -158 vs -152; P = .007). Adding bone marrow features continued to improve performance (log likelihood, -158 vs -145; P = .001). The top model integrated stage, two bone marrow texture features, one tumor with penumbra texture feature, and two penumbra texture features (concordance, 0.78; 95% confidence interval: 0.70, 0.85; P < .001). This fully integrated model was a predictor of poor outcome in the independent cohort (concordance, 0.72; 95% confidence interval: 0.64, 0.80; P < .001) and a binary score stratified patients into high and low risk of poor outcome (P < .001). Conclusion A model that includes pretreatment fluorine 18-fluorodeoxyglucose PET texture features from the primary tumor, tumor penumbra, and bone marrow predicts disease-free survival of patients with non-small cell lung cancer more accurately than clinical features alone. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Sarah A Mattonen
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Guido A Davidzon
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Jalen Benson
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Ann N C Leung
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Minal Vasanawala
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - George Horng
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Joseph B Shrager
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Sandy Napel
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
| | - Viswam S Nair
- From the Department of Radiology, James H. Clark Center (S.A.M., A.N.C.L., S.N., V.S.N.), Division of Nuclear Medicine, Department of Radiology (G.A.D.), and Division of Thoracic Surgery, Department of Cardiothoracic Surgery (J.B., J.B.S.), Stanford University, 318 Campus Dr, Room S355, Stanford, CA 94305; Palo Alto VA Health Care System, Palo Alto, Calif (M.V.); California Pacific Medical Center, San Francisco, Calif (G.H.); and Section of Pulmonary & Critical Care Medicine, Moffitt Cancer Center & Research Institute; Morsani College of Medicine, University of South Florida, Tampa, Fla (V.S.N.)
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Melton EM, Li H, Benson J, Sohn P, Huang LH, Song BL, Li BL, Chang CCY, Chang TY. Myeloid Acat1/ Soat1 KO attenuates pro-inflammatory responses in macrophages and protects against atherosclerosis in a model of advanced lesions. J Biol Chem 2019; 294:15836-15849. [PMID: 31495784 DOI: 10.1074/jbc.ra119.010564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/02/2019] [Indexed: 11/06/2022] Open
Abstract
Cholesterol esters are a key ingredient of foamy cells in atherosclerotic lesions; their formation is catalyzed by two enzymes: acyl-CoA:cholesterol acyltransferases (ACATs; also called sterol O-acyltransferases, or SOATs) ACAT1 and ACAT2. ACAT1 is present in all body cells and is the major isoenzyme in macrophages. Whether blocking ACAT1 benefits atherosclerosis has been under debate for more than a decade. Previously, our laboratory developed a myeloid-specific Acat1 knockout (KO) mouse (Acat1 -M/-M), devoid of ACAT1 only in macrophages, microglia, and neutrophils. In previous work using the ApoE KO (ApoE -/-) mouse model for early lesions, Acat1 -M/-M significantly reduced lesion macrophage content and suppressed atherosclerosis progression. In advanced lesions, cholesterol crystals become a prominent feature. Here we evaluated the effects of Acat1 -M/-M in the ApoE KO mouse model for more advanced lesions and found that mice lacking myeloid Acat1 had significantly reduced lesion cholesterol crystal contents. Acat1 -M/-M also significantly reduced lesion size and macrophage content without increasing apoptotic cell death. Cell culture studies showed that inhibiting ACAT1 in macrophages caused cells to produce less proinflammatory responses upon cholesterol loading by acetyl low-density lipoprotein. In advanced lesions, Acat1 -M/-M reduced but did not eliminate foamy cells. In advanced plaques isolated from ApoE -/- mice, immunostainings showed that both ACAT1 and ACAT2 are present. In cell culture, both enzymes are present in macrophages and smooth muscle cells and contribute to cholesterol ester biosynthesis. Overall, our results support the notion that targeting ACAT1 or targeting both ACAT1 and ACAT2 in macrophages is a novel strategy to treat advanced lesions.
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Affiliation(s)
- Elaina M Melton
- Department of Biochemistry and Cell Biology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Haibo Li
- Department of Biochemistry and Cell Biology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | | | - Paul Sohn
- Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Li-Hao Huang
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri 63130
| | - Bao-Liang Song
- College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Bo-Liang Li
- Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Catherine C Y Chang
- Department of Biochemistry and Cell Biology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Ta-Yuan Chang
- Department of Biochemistry and Cell Biology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
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25
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Kim B, Dave R, Potter S, Langlands F, Weston-Petrides G, Ashken L, Benson J, Tansley A, Doughty J. Is the current training pathway for oncoplastic breast surgeons fit for purpose? ACTA ACUST UNITED AC 2019. [DOI: 10.1308/rcsbull.2019.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We take a look at the results of a Mammary Fold members' survey to find out.
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Affiliation(s)
- B Kim
- Leeds Teaching Hospitals NHS Trust
| | - R Dave
- Manchester University NHS Foundation Trust
| | - S Potter
- Royal Liverpool and Broadgreen University Hospitals Trust
| | | | | | | | - J Benson
- Cambridge University Hospitals NHS Foundation Trust
| | - A Tansley
- Royal Liverpool and Broadgreen University Hospitals Trust
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Stott K, Benson J, Sloan S, Murphy S, Halt A. PLACE-MAKING AFTER DEATH: CONNECTIONS TO PLACE IN THE MEMORIALIZATION PRACTICES OF OLDER ADULTS AND THEIR FAMILIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2594] [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: 11/13/2022] Open
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Affiliation(s)
| | - M Teti
- University of Missouri-Columbia
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Ermer A, Segel-Karpas D, Benson J. LONELINESS TRAJECTORIES AMONG OLDER ADULT MARRIED COUPLES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1032] [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: 11/13/2022] Open
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Colwell E, Bhandari P, Benson J, He H, Lui N, Berry M, Shrager J, Backhus L. P2.15-06 Examination of Optimal Timing of Post-Surgical Surveillance for Early Stage Lung Cancer Patients and Association with Outcomes. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tita AT, Jablonski KA, Bailit JL, Grobman WA, Wapner RJ, Reddy UM, Varner MW, Thorp JM, Leveno KJ, Caritis SN, Iams JD, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Wallace M, Northen A, Grant J, Colquitt C, Mallett G, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Moseley L, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Shubert P, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Zhao Y, McGee P, Momirova V, Palugod R, Reamer B, Larsen M, Spong C, Tolivaisa S, VanDorsten J. Neonatal outcomes of elective early-term births after demonstrated fetal lung maturity. Am J Obstet Gynecol 2018; 219:296.e1-296.e8. [PMID: 29800541 DOI: 10.1016/j.ajog.2018.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 11/09/2016] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Studies of early-term birth after demonstrated fetal lung maturity show that respiratory and other outcomes are worse with early-term birth (370-386 weeks) even after demonstrated fetal lung maturity when compared with full-term birth (390-406 weeks). However, these studies included medically indicated births and are therefore potentially limited by confounding by the indication for delivery. Thus, the increase in adverse outcomes might be due to the indication for early-term birth rather than the early-term birth itself. OBJECTIVE We examined the prevalence and risks of adverse neonatal outcomes associated with early-term birth after confirmed fetal lung maturity as compared with full-term birth in the absence of indications for early delivery. STUDY DESIGN This is a secondary analysis of an observational study of births to 115,502 women in 25 hospitals in the United States from 2008 through 2011. Singleton nonanomalous births at 37-40 weeks with no identifiable indication for delivery were included; early-term births after positive fetal lung maturity testing were compared with full-term births. The primary outcome was a composite of death, ventilator for ≥2 days, continuous positive airway pressure, proven sepsis, pneumonia or meningitis, treated hypoglycemia, hyperbilirubinemia (phototherapy), and 5-minute Apgar <7. Logistic regression and propensity score matching (both 1:1 and 1:2) were used. RESULTS In all, 48,137 births met inclusion criteria; the prevalence of fetal lung maturity testing in the absence of medical or obstetric indications for early delivery was 0.52% (n = 249). There were 180 (0.37%) early-term births after confirmed pulmonary maturity and 47,957 full-term births. Women in the former group were more likely to be non-Hispanic white, smoke, have received antenatal steroids, have induction, and have a cesarean. Risks of the composite (16.1% vs 5.4%; adjusted odds ratio, 3.2; 95% confidence interval, 2.1-4.8 from logistic regression) were more frequent with elective early-term birth. Propensity scores matching confirmed the increased primary composite in elective early-term births: adjusted odds ratios, 4.3 (95% confidence interval, 1.8-10.5) for 1:1 and 3.5 (95% confidence interval, 1.8-6.5) for 1:2 matching. Among components of the primary outcome, CPAP use and hyperbilirubinemia requiring phototherapy were significantly increased. Transient tachypnea of the newborn, neonatal intensive care unit admission, and prolonged neonatal intensive care unit stay (>2 days) were also increased with early-term birth. CONCLUSION Even with confirmed pulmonary maturity, early-term birth in the absence of medical or obstetric indications is associated with worse neonatal respiratory and hepatic outcomes compared with full-term birth, suggesting relative immaturity of these organ systems in early-term births.
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Zhang X, Turcheniuk K, Zusmann B, Benson J, Nelson S, Luo S, Magasinski A, Yushin G. Synthesis of copper oxide nanowires and nanoporous copper via environmentally friendly transformation of bulk copper-calcium alloys. Chem Commun (Camb) 2018; 54:5446-5449. [PMID: 29745404 DOI: 10.1039/c8cc02240b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this work, we report a novel, one-step, inexpensive and environmentally friendly synthesis of Cu nanostructures by means of chemical de-alloying of bulk Cu-Ca alloys in aqueous solutions. By controlling the synthesis conditions, we tune the morphology of the nanostructured Cu from nanoporous Cu to copper oxide nanowires.
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Affiliation(s)
- X Zhang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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Menegaz BA, Cuglievan B, Benson J, Camacho P, Lamhamedi-Cherradi SE, Leung CH, Warneke CL, Huh W, Subbiah V, Benjamin RS, Patel S, Daw N, Hayes-Jordan A, Ludwig JA. Clinical Activity of Pazopanib in Patients with Advanced Desmoplastic Small Round Cell Tumor. Oncologist 2017; 23:360-366. [PMID: 29212731 PMCID: PMC5905685 DOI: 10.1634/theoncologist.2017-0408] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Desmoplastic small round cell tumor (DSRCT) is an aggressive, often fatal soft tissue sarcoma that lacks an optimal salvage regimen. We retrospectively reviewed data from 29 pretreated DSRCT patients who received pazopanib at MD Anderson Cancer Center after failure of standard chemotherapies. SUBJECTS, MATERIALS, AND METHODS Medical records of patients treated from January 2012 to December 2016 were reviewed and regression analyses were performed. Median progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and differences in survival were assessed by a log-rank test. A landmark statistical analysis was used to assess OS at a predefined 12-week time point following pazopanib initiation. RESULTS The mean age at pazopanib treatment was 27.5 years (range, 6.3-50.1 years). According to RECIST 1.1 criteria, 16 patients (55%) had stable disease, 1 patient (3%) had partial response, 1 patient (3%) had complete response, and 11 patients (38%) had progressive disease. Estimated median PFS was 5.63 months (95% confidence interval [CI]: 3.23-7.47). Median OS was 15.7 months (95% CI: 10.3-32.4). As of December 2016, 11 patients (38%) were still alive, with a median follow-up time of 16.8 (range 3.8-30.1) months. Doses between 400 and 800 mg were included. Pazopanib was well tolerated and 23 (79%) of the patients continued it until progression or death, 4 discontinued because of side effects, and 2 were still on pazopanib at the time of data analysis. CONCLUSION In the largest study conducted to date in DSRCT, pazopanib was well tolerated and clinically active in heavily pretreated patients who otherwise lack good treatment options. IMPLICATIONS FOR PRACTICE Desmoplastic small round cell tumor (DSRCT) is a rare, extremely aggressive soft tissue sarcoma subtype that most commonly occurs in adolescent and young adult males. No DSRCT-specific therapies exist, and for lack of a better treatment approach, current therapies have relied upon U.S. Food and Drug Administration-approved drugs like pazopanib that exhibit clinical activity in other sarcoma subtypes. This article describes the largest experience to date using pazopanib as salvage treatment in heavily pretreated DSRCT patients. Pazopanib was well tolerated and clinically active, surpassing predefined metrics proposed by the European Organization for Research and Treatment of Cancer indicative of "active" sarcoma drugs (5.63 months progression-free survival [PSF], with 62% of the study population achieving progression-free survival at 12 weeks).
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Affiliation(s)
- Brian A Menegaz
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jalen Benson
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pamela Camacho
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Winston Huh
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert S Benjamin
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shreyaskumar Patel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Najat Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrea Hayes-Jordan
- Divison of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph A Ludwig
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ahmed M, Jozsa F, Baker R, Rubio IT, Benson J, Douek M. Erratum to: Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients. Breast Cancer Res Treat 2017; 166:337. [PMID: 28856616 DOI: 10.1007/s10549-017-4457-4] [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: 10/19/2022]
Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - F Jozsa
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - R Baker
- Department of Statistics, School of Business, University of Salford, 612, Maxwell Building, Salford, M5 4WT, UK
| | - I T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - J Benson
- Breast Surgical Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - M Douek
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
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Britton P, Willsher P, Taylor K, Kilburn-Toppin F, Provenzano E, Forouhi P, Benson J, Agrawal A, Forman J, Wallis M. Microbubble detection and ultrasound-guided vacuum-assisted biopsy of axillary lymph nodes in patients with breast cancer. Clin Radiol 2017; 72:772-779. [DOI: 10.1016/j.crad.2017.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/18/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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Dumitru D, Benson J, Wishart G, Provenzano E. Abstract P1-11-03: Rates of ipsilateral breast tumor recurrence (IBTR) following breast concerving surgery (BCS) and hypofractionated radiotherapy for ductal carcinoma in situ (DCIS). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-11-03] [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: The risk of IBTR following BCS for DCIS is dependent on both tumor and treatment-related factors including surgical margin width and adjuvant therapies. Management strategies should be risk stratified to avoid over/under-treatment with radiotherapy and endocrine therapy. De-escalation of treatments with safe omission of adjuvant therapies may demand a minimum margin of surgical clearance for non-high grade and selected high grade lesions.
Methods: A retrospective analysis was undertaken to examine rates of IBTR among patients undergoing BCS for core biopsy-proven DCIS between 1999 and 2010 when a minimum margin width of 5mm prevailed. The local institutional database identified 1260 DCIS cases with or without an invasive component among whom 323 had pure DCIS diagnosed mainly on screening (>90%). A total of 176 patients were treated with BCS alone (27.5%) or combined with breast radiotherapy [15 fractions of 2.67Gy to total dose of 40Gy without boost]. No patients received any form of hormonal therapy (tamoxifen/aromatase inhibitor). Ten patients died from non-breast cancer causes prior to development of IBTR leaving 167 unilateral and 1 bilateral patient (i.e. 168 cases) for analysis with high (72%), intermediate (17.8%) and low (9%) grade DCIS (or ungradeable).
Results: At a median follow up of 126 months (range 46 – 180) a total of 14 patients have developed IBTR as a first event (8.33%). Approximately half of these were non-invasive (n= 8) and half invasive (n=6). Half of DCIS recurrences (4/8) occurred in the first 12 months following surgery and all recurrent DCIS cases were manifest by 3 years compared with a steady recurrence of invasive disease up to 10 years of follow up. One case of invasive disease died from subsequent distant metastases with visceral deposits. There was no significant difference in rates of recurrence with (9/121) or without (5/46) irradiation (p=0.534). Among the 14 recurrent cases, 12 had conformal radial margins of 5mm whilst 2 cases had single minimum margins of 3mm and 2mm (accepted without re-excision due to advanced age, co-morbidity or lesion at edge of breast tissue). Characterization of molecular profiles (ER, HER2, Ki-67) for recurrent cases is ongoing.
Conclusion: These rates of local control with a target margin of 5mm and selective hypofractionated breast radiotherapy are consistent with published IBTR rates of approximately 1% per annum for DCIS patients treated with BCS and radiotherapy. Routine inclusion of hormonal therapy may be unnecessary for many patients receiving adjuvant radiotherapy with comparable 10 year recurrence rates of 7 - 8% reported in the International Breast Intervention Study (IBIS)-II.""Background: The risk of IBTR following BCS for DCIS is dependent on both tumor and treatment-related factors including surgical margin width and adjuvant therapies. Management strategies should be risk stratified to avoid over/under-treatment with radiotherapy and endocrine therapy. De-escalation of treatments with safe omission of adjuvant therapies may demand a minimum margin of surgical clearance for non-high grade and selected high grade lesions.
Methods: A retrospective analysis was undertaken to examine rates of IBTR among patients undergoing BCS for core biopsy-proven DCIS between 1999 and 2010 when a minimum margin width of 5mm prevailed. The local institutional database identified 1260 DCIS cases with or without an invasive component among whom 323 had pure DCIS diagnosed mainly on screening (>90%). A total of 176 patients were treated with BCS alone (27.5%) or combined with breast radiotherapy [15 fractions of 2.67Gy to total dose of 40Gy without boost]. No patients received any form of hormonal therapy (tamoxifen/aromatase inhibitor). Ten patients died from non-breast cancer causes prior to development of IBTR leaving 167 unilateral and 1 bilateral patient (i.e. 168 cases) for analysis with high (72%), intermediate (17.8%) and low (9%) grade DCIS (or ungradeable).
Results: At a median follow up of 126 months (range 46 – 180) a total of 14 patients have developed IBTR as a first event (8.33%). Approximately half of these were non-invasive (n= 8) and half invasive (n=6). Half of DCIS recurrences (4/8) occurred in the first 12 months following surgery and all recurrent DCIS cases were manifest by 3 years compared with a steady recurrence of invasive disease up to 10 years of follow up. One case of invasive disease died from subsequent distant metastases with visceral deposits. There was no significant difference in rates of recurrence with (9/121) or without (5/46) irradiation (p=0.534). Among the 14 recurrent cases, 12 had conformal radial margins of 5mm whilst 2 cases had single minimum margins of 3mm and 2mm (accepted without re-excision due to advanced age, co-morbidity or lesion at edge of breast tissue). Characterization of molecular profiles (ER, HER2, Ki-67) for recurrent cases is ongoing.
Conclusion: These rates of local control with a target margin of 5mm and selective hypofractionated breast radiotherapy are consistent with published IBTR rates of approximately 1% per annum for DCIS patients treated with BCS and radiotherapy. Routine inclusion of hormonal therapy may be unnecessary for many patients receiving adjuvant radiotherapy with comparable 10 year recurrence rates of 7 - 8% reported in the International Breast Intervention Study (IBIS)-II.
Citation Format: Dumitru D, Benson J, Wishart G, Provenzano E. Rates of ipsilateral breast tumor recurrence (IBTR) following breast concerving surgery (BCS) and hypofractionated radiotherapy for ductal carcinoma in situ (DCIS) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-11-03.
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Affiliation(s)
- D Dumitru
- Addenbrooke's Hospital; Cambridge Breast Unit, Cambridge, Cambridgeshire, United Kingdom; Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
| | - J Benson
- Addenbrooke's Hospital; Cambridge Breast Unit, Cambridge, Cambridgeshire, United Kingdom; Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
| | - G Wishart
- Addenbrooke's Hospital; Cambridge Breast Unit, Cambridge, Cambridgeshire, United Kingdom; Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
| | - E Provenzano
- Addenbrooke's Hospital; Cambridge Breast Unit, Cambridge, Cambridgeshire, United Kingdom; Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
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Macklin P, Benson J. New open source simulation tools for 3-D multicellular systems biology. Cryobiology 2016. [DOI: 10.1016/j.cryobiol.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Benson J, Anderson D, Kearsley A. Investigating assumptions in single cell cryobiological modeling. Cryobiology 2016. [DOI: 10.1016/j.cryobiol.2016.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Benson J. Cell based modeling and optimization of ovarian follicle cryopreservation. Cryobiology 2016. [DOI: 10.1016/j.cryobiol.2016.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hickey C, Spillane D, Benson J, Levis J, Fanning LJ, Cryan B, Prentice MB. Hepatitis E Virus (HEV) Infection in Ireland. Ir Med J 2016; 109:451. [PMID: 28124851] [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: 06/06/2023]
Abstract
Hepatitis E virus (HEV) is a single stranded RNA virus causing infection worldwide. In developing countries HEV genotypes 1 and 2 spread faeco-orally via water. Recently, infections with HEV have been detected in Europe and North America in patients with no travel history. These are food-borne HEV genotypes 3 and 4, a pig-associated zoonosis. Most infections are asymptomatic but morbidity and chronic infection may occur with prior liver disease or immunosuppression. International seroprevalence rates vary and with improved diagnostics have increased. To determine the current prevalence in this region we studied anonymised serum samples submitted in 2015 for routine testing. We detected anti-HEV IgG in 16/198 (8%) individuals, highest rate in 40-59 year olds (43.8%). This is higher than reported for the same region in 1995 (0.4%) using a previous generation assay. This study provides evidence of HEV circulation in Ireland and reinforces the need for ongoing surveillance.
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Affiliation(s)
- C Hickey
- Department of Microbiology, Cork University Hospital, Cork
| | - D Spillane
- Department of Microbiology, Cork University Hospital, Cork
| | - J Benson
- Department of Microbiology, Cork University Hospital, Cork
| | - J Levis
- Department of Medicine, University College Cork
| | - L J Fanning
- Department of Medicine, University College Cork
| | - B Cryan
- Department of Microbiology, Cork University Hospital, Cork
| | - M B Prentice
- Department of Microbiology, Cork University Hospital, Cork
- Departments of Pathology and Microbiology, University College Cork
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McKinney A, Benson J, Nascene D, Eisengart J, Salmela M, Loes D, Zhang L, Patel K, Raymond G, Miller W. Childhood Cerebral Adrenoleukodystrophy: MR Perfusion Measurements and Their Use in Predicting Clinical Outcome after Hematopoietic Stem Cell Transplantation. AJNR Am J Neuroradiol 2016; 37:1713-20. [PMID: 27079370 PMCID: PMC5018408 DOI: 10.3174/ajnr.a4773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/08/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE MR perfusion has shown abnormalities of affected WM in cerebral X-linked adrenoleukodystrophy, but serial data is needed to explore the import of such findings after hematopoietic stem cell transplantation. Our aim was to prospectively measure MR perfusion parameters in patients with cerebral adrenoleukodystrophy pre- and post-hematopoietic stem cell transplantation, and to correlate those measurements with clinical outcome. MATERIALS AND METHODS Ten patients with cerebral adrenoleukodystrophy prospectively underwent DSC-MR perfusion imaging at <45 days pre- (baseline), 30-60 days post-, and 1 year post-hematopoietic stem cell transplantation. MR perfusion measurements in the 10 patients and 8 controls were obtained from the parieto-occipital WM, splenium of the corpus callosum, leading enhancing edge, and normal-appearing frontal white matter. MR imaging severity scores and clinical neurologic function and neurocognitive scores were also obtained. MR perfusion values were analyzed in the patients with cerebral adrenoleukodystrophy at each time point and compared with those in controls. Correlations were calculated between the pre-hematopoietic stem cell transplantation MR perfusion values and 1-year clinical scores, with P value adjustment for multiple comparisons. RESULTS At baseline in patients with cerebral adrenoleukodystrophy, both relative CBV and relative CBF within the splenium of the corpus callosum and parieto-occipital WM significantly differed from those in controls (P = .005-.031) and remained so 1 year post-hematopoietic stem cell transplantation (P = .003-.005). Meanwhile, no MR perfusion parameter within the leading enhancing edge differed significantly from that in controls at baseline or at 1 year (P = .074-.999) or significantly changed by 1 year post-hematopoietic stem cell transplantation (P = .142-.887). Baseline Loes scores correlated with 1-year clinical neurologic function (r = 0.813, P < .0001), while splenium of the corpus callosum relative CBV also significantly correlated with 1-year neurologic function scale and the neurocognitive full-scale intelligence quotient and performance intelligence quotient scores (r = -0.730-0.815, P = .007-.038). CONCLUSIONS Leading enhancing edge measurements likely remain normal post-hematopoietic stem cell transplantation in cerebral adrenoleukodystrophy, suggesting local disease stabilization. Meanwhile, parieto-occipital WM and splenium of the corpus callosum relative CBV and relative CBF values worsened; this change signified irreversible injury. Baseline splenium of the corpus callosum relative CBV may predict clinical outcomes following hematopoietic stem cell transplantation.
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Affiliation(s)
- A.M. McKinney
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - J. Benson
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - D.R. Nascene
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - J. Eisengart
- Pediatrics (J.E., G.R.), Division of Clinical Behavioral Neuroscience, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - M.B. Salmela
- From the Departments of Radiology (A.M.M., J.B., D.R.N., M.B.S.)
| | - D.J. Loes
- Suburban Radiologic Consultants (D.J.L.), Minneapolis, Minnesota
| | - L. Zhang
- Clinical and Translational Science Institute (L.Z.), University of Minnesota, Minneapolis, Minnesota
| | - K. Patel
- Radiology Associates of the Fox Valley (K.P.), Neenah, Wisconsin
| | - G.V. Raymond
- Pediatrics (J.E., G.R.), Division of Clinical Behavioral Neuroscience, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - W.P. Miller
- Department of Pediatrics (W.P.M.), Pediatric Blood and Marrow Transplantation Division, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota
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Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Varner M, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Leveno K, Moseley L, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Rouse D, Andrews W, Mallett G, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Zhao Y, McGee P, Momirova V, Palugod R, Reamer B, Larsen M, Williams T, Spangler T, Lozitska A, Spong C, Tolivaisa S, VanDorsten J. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215:103.e1-103.e14. [PMID: 26772790 DOI: 10.1016/j.ajog.2016.01.004] [Citation(s) in RCA: 290] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/28/2015] [Accepted: 01/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. OBJECTIVE We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. STUDY DESIGN This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. RESULTS In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. CONCLUSION Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.
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Monaghan K, Tai T, Benson J, Linggi B, Oon S, Ng M, Hoi A, Morand E, Wilson N. OP0041 JNJ-473 Potently and Specifically Depletes PDCS In SLE Patient Blood In Vitro and Ablates TLR9-Induced Interferon Alpha Responses. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1285] [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: 11/03/2022]
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Cesaroni M, Jordan J, Schreiter J, Chevrier M, Shao WH, Hilliard B, Cohen P, Caricchio R, Benson J. THU0388 Combining RNA-SEQ and Machine Learning to Classify an Sle-Specific Gene Signature and in Vitro Responses to IFN-I Pathway Inhibition. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ewing G, Ngwenya N, Farquhar M, Benson J, Gilligan D, Seymour J, Bailey S. HOW DO PATIENTS SHARE NEWS OF A CANCER DIAGNOSIS WITH FAMILY/FRIENDS; NEW UNDERSTANDINGS OF THE PROCESS AFTER BAD NEWS HAS BEEN BROKEN. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.32] [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: 11/04/2022]
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Penfold C, Ewing G, Gilligan D, Mahadeva R, Booth S, Benson J, Burkin J, Howson S, Lovick R, Todd C, Farquhar M. WHAT DO INFORMAL CARERS WANT TO LEARN ABOUT BREATHLESSNESS IN ADVANCED DISEASE AND HOW DO THEY WANT TO LEARN IT? BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bailit JL, Grobman W, Zhao Y, Wapner RJ, Reddy UM, Varner MW, Leveno KJ, Caritis SN, Iams JD, Tita AT, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, VanDorsten JP, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Mallett G, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Thorp J, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Moseley L, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Shubert P, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Rice M, McGee P, Momirova V, Palugod R, Reamer B, Larsen M, Williams T, Spong C, Tolivaisa S. Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol 2015; 212:103.e1-7. [PMID: 24983681 DOI: 10.1016/j.ajog.2014.06.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/27/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated. STUDY DESIGN Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a 3-year period. A low-risk subset of nulliparous women with vertex nonanomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for nonmedically indicated induction within each week were compared with women who did not undergo nonmedically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use, and insurance status. RESULTS We found 31,169 women who met our criteria. Neonatal complications were either less frequent with nonmedically indicated induction or no different between groups. Nonmedically indicated induction was associated with less frequent peripartum infections (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16-0.98) at 38 weeks of gestation and less frequent third- and fourth-degree lacerations (OR, 0.60; 95% CI, 0.42-0.86) and less frequent peripartum infections (OR, 0.66; 95% CI, 0.49-0.90) at 39 weeks of gestation. Nonmedically indicated induction was associated with a longer admission-to-delivery time by approximately 3-4 hours and increased odds of cesarean delivery at 38 (OR, 1.50; 95% CI, 1.08-2.08) and 40 weeks (OR, 1.30; 95% CI, 1.15-1.46) of gestation. CONCLUSION At 39 weeks of gestation, nonmedically indicated induction is associated with lower maternal and neonatal morbidity than women who are expectantly treated.
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Kohn J, Unger Z, Benson J, Marks J. Trends and variation in LARC use among Planned Parenthood affiliates. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.113] [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: 11/28/2022]
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Ewing G, Ngwenya N, Farquhar M, Gilligan D, Bailey S, Benson J, Seymour J. SHARING BAD NEWS: DEVELOPMENT OF AN INTERVENTION TO SUPPORT PATIENTS WITH LUNG CANCER SHARE NEWS OF THEIR CANCER DIAGNOSIS WITH FAMILY MEMBERS AND FRIENDS. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.29] [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: 11/04/2022]
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Ngwenya N, Farquhar M, Benson J, Gilligan D, Bailey S, Seymour J, Ewing G. 102 Sharing Bad News: Understanding the communication processes of a lung cancer diagnosis. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Valdez-Morales E, Guerrero-Alba R, Ochoa-Cortes F, Benson J, Spreadbury I, Hurlbut D, Miranda-Morales M, Lomax AE, Vanner S. Release of endogenous opioids during a chronic IBD model suppresses the excitability of colonic DRG neurons. Neurogastroenterol Motil 2013; 25:39-46.e4. [PMID: 22963585 DOI: 10.1111/nmo.12008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 02/06/2023]
Abstract
BACKGROUND Endogenous opioids are implicated in pain-regulation in chronic inflammatory bowel disease (IBD). We sought to examine whether endogenous opioids suppress the excitability of colonic nociceptive dorsal root ganglia (DRG) neurons during chronic IBD, and if so, whether modulation of underlying voltage-gated K(+) currents was involved. METHODS The effects of chronic dextran sulfate sodium (DSS) colitis on afferent signaling in mice was studied using patch clamp recordings. Colonic DRG neurons were identified using Fast Blue retrograde labeling and recordings obtained from small DRG neurons (<40 pF). KEY RESULTS In current-clamp recordings, the rheobase of neurons was increased 47% (P < 0.01) and action potential discharge at twice rheobase decreased 23% (P < 0.05) following incubation in colonic supernatants from chronic DSS mice. β-endorphin increased 14-fold, and tissue opioid immunoreactivity and expression in CD4+ cells observed by flow cytometry increased in chronic DSS colons. Incubation of naïve neurons in the μ-opioid receptor agonist D-Ala(2), N- MePhe(4), Gly-ol (DAMGO) (10 nM) partially recapitulated the effects of supernatants from DSS mice on rheobase. Supernatant effects were blocked by the μ-opioid receptor antagonist naloxone. In voltage clamp, chronic DSS supernatants and DAMGO increased I(A) K(+) currents. CONCLUSIONS & INFERENCES The release of endogenous opioids during chronic inflammation in mice suppresses the excitability of nociceptive DRG neurons. Targeting immune cells may provide a novel means of modulating IBD pain.
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Affiliation(s)
- E Valdez-Morales
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, ON, Canada
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