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Hua HJ, Li KD, Zhu Y, Fan QH, Li H. [Neuroblastoma-like schwannoma of the lung: report of a case]. Zhonghua Bing Li Xue Za Zhi 2024; 53:492-494. [PMID: 38678334 DOI: 10.3760/cma.j.cn112151-20231016-00271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Affiliation(s)
- H J Hua
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - K D Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - Y Zhu
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - Q H Fan
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - H Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
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Li KD, Bowman MS, Yang H, Sui W, Freise C, Stoller M. Case presentation and review of renal autotransplantation for nutcracker syndrome. Urol Case Rep 2024; 54:102717. [PMID: 38617183 PMCID: PMC11015379 DOI: 10.1016/j.eucr.2024.102717] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Nutcracker Syndrome (NCS) is characterized by entrapment of the left renal vein, leading hematuria, flank pain, and proteinuria. We evaluated the efficacy of renal autotransplantation as a curative treatment for NCS through a review and case report. 55 patients from 18 studies were analyzed, with a combined 91% success rate of symptom resolution or improvement post-autotransplantation. In our case report, a 25-year-old man with severe NCS received laparoscopic nephrectomy and autotransplant, resulting in symptom resolution at 3.1 years follow up. Further research should confirm these findings and refine patient selection criteria and surgical techniques.
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Affiliation(s)
- Kevin D. Li
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Max S. Bowman
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Heiko Yang
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Sui
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Chris Freise
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Marshall Stoller
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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3
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Li KD, Venishetty N, Fernandez AM, Hakam N, Ghaffar U, Gupta S, Patel HV, Breyer BN. Fragility of overactive bladder medication clinical trials: A systematic review. Neurourol Urodyn 2024. [PMID: 38594889 DOI: 10.1002/nau.25468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Adrian M Fernandez
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Umar Ghaffar
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Shiv Gupta
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Hiren V Patel
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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4
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Fernandez AM, Li KD, Patel HV, Allen IE, Ghaffar U, Hakam N, Breyer BN. Electric Bicycle Injuries and Hospitalizations. JAMA Surg 2024:2815376. [PMID: 38381444 PMCID: PMC10882498 DOI: 10.1001/jamasurg.2023.7860] [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: 02/22/2024]
Abstract
This cross-sectional study investigates injury trends associated with electric bicycles in the US from 2017 to 2022.
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Affiliation(s)
| | - Kevin D Li
- Department of Urology, University of California, San Francisco
| | - Hiren V Patel
- Department of Urology, University of California, San Francisco
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Umar Ghaffar
- Department of Urology, University of California, San Francisco
| | - Nizar Hakam
- Department of Urology, University of California, San Francisco
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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5
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Fernandez AM, Jones CP, Patel HV, Ghaffar U, Hakam N, Li KD, Nabavizadeh B, Breyer BN. Real-World Complications of the SpaceOAR Hydrogel Spacer: A Review of the Manufacturer and User Facility Device Experience Database. Urology 2024; 183:157-162. [PMID: 37774851 DOI: 10.1016/j.urology.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To characterize adverse events related to use of the perirectal spacing agent SpaceOAR, we examined the Manufacturer and User Facility Device Experience (MAUDE) database. METHODS The MAUDE database was queried for "SpaceOAR" and "Augmenix" from June 2015 (when SpaceOAR was approved by the Food and Drug Administration) to October 2022. Reports were reviewed for adverse events (AEs), operative procedures performed because of the AE, and changes to the radiation plan. AEs were categorized using Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. RESULTS Six hundred fifty-four reports were reviewed. Eighty-four were excluded and 4 reports reviewed 2 separate cases of SpaceOAR administration. Five hundred seventy-four cases were ultimately included. Three deaths were reported (0.5% of all AEs). One point six percent of cases represented CTCAE grade 4 injuries (life-threatening consequences; urgent intervention indicated), 15.9% grade 3 (severe but not immediately life-threatening; hospitalization), 24.2% grade 2 (moderate; local/noninvasive intervention), and 57% of events were CTCAE grade 1 (mild; asymptomatic or mild symptoms). Bowel diversion occurred in 29 cases (9%). CONCLUSION Both asymptomatic (n = 311) and debilitating (n = 12) complications of SpaceOAR hydrogel use were identified. Death, gel embolization, anaphylaxis, rectal ulcerations, and infections requiring bowel or urinary diversions were among the complications reviewed. Providers should consider these potential complications before perirectal spacer administration and during patient counseling.
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Affiliation(s)
- Adrian M Fernandez
- Department of Urology, University of California San Francisco, San Francisco, CA.
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Hiren V Patel
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Umar Ghaffar
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
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Li KD, Jones CP, Hakam N, Erickson BA, Vanni AJ, Chancellor MB, Breyer BN. Haemorrhagic cystitis: a review of management strategies and emerging treatments. BJU Int 2023; 132:631-637. [PMID: 37501638 DOI: 10.1111/bju.16140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Haemorrhagic cystitis (HC) is characterised by persistent haematuria and lower urinary tract symptoms following radiotherapy or chemotherapy. Its pathogenesis is poorly understood but thought to be related to acrolein toxicity following chemotherapy or fibrosis/vascular remodelling after radiotherapy. There is no standard of care for patients with HC, although existing strategies including fulguration, hyperbaric oxygen therapy, botulinum toxin A, and other intravesical therapies have demonstrated short-term efficacy in cohort studies. Novel agents including liposomal tacrolimus are promising targets for further research. This review summarises the incidence and pathogenesis of HC as well as current evidence supporting its different management strategies.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Michael B Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oaks, MI, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Low P, Wang L, Li KD, Shibley WP, Cedars BE, Holler JT, Enriquez A, Sadeghi-Nejad H, Amend GM, Breyer BN. Thematic analysis of the psycho-sexual symptoms in patients with Peyronie's disease present on online forums. Int J Impot Res 2023; 35:533-538. [PMID: 35710605 PMCID: PMC10499595 DOI: 10.1038/s41443-022-00589-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/21/2021] [Revised: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022]
Abstract
Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea that may result in penile deformity, pain, a palpable plaque, and erectile dysfunction. In order to understand the psycho-sexual impacts of PD on patients and their partners, we selected three online forums containing the largest number of threads on PD. Threads focusing on the psycho-sexual impacts posted from January 1, 2011 to January 1, 2021 were compiled, and thematic analysis was performed on Dedoose. There were 277 unique posters, including 225 patients and 52 partners. Eighty-four categories and five themes were developed including information and social support, physical symptoms, psycho-sexual symptoms, treatment and effect, and impacts on partners and relationship. Emotional distress including depressed mood (n = 75, 33.3%) and feelings of isolation (n = 41, 18.2%) was prevalent. Partners developed sexual dysfunction including sexual dissatisfaction (n = 11, 21.2%) and dyspareunia (n = 4, 7.7%). Relationships experienced disruption (n = 14, 5.1%) or termination (n = 10, 3.6%). Posters received psychological treatment including psychotherapy (n = 20, 8.9%) and antidepressants (n = 17, 7.6%). Of these, 12 reported improvement and 11 stated no improvement. On these forums, psychological burden affecting individuals with PD and their partners is reported. Few seek help from a psychologist or therapist, and psychological distress may persist even after successful PD treatment. Further research is needed to identify strategies for effective psychological management.
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Affiliation(s)
- Patrick Low
- Department of Urology, University of California, San Francisco, CA, USA
| | - Lin Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin D Li
- Department of Urology, University of California, San Francisco, CA, USA
| | - W Patrick Shibley
- Department of Urology, University of California, San Francisco, CA, USA
| | | | - Jordan T Holler
- Department of Urology, University of California, San Francisco, CA, USA
| | - Anthony Enriquez
- Department of Urology, University of California, San Francisco, CA, USA
| | - Hossein Sadeghi-Nejad
- Department of Surgery, Division of Urology, Rutgers New Jersey Medical School and Hackensack University Medical Center, Hackensack, NJ, USA
| | - Gregory M Amend
- Department of Urology, University of California, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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Zhang ZA, Li F, Ma ZY, Li FD, Wang ZL, Li SR, Wang XJ, Li KD. Variability in chewing, ruminal fermentation, digestibility and bacterial communities between subacute ruminal acidosis-susceptible and acidosis-tolerant sheep. Animal 2023; 17:100902. [PMID: 37544054 DOI: 10.1016/j.animal.2023.100902] [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: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Sorting behaviour is a common phenomenon observed in ruminants when they are provided with a total mixed ration, which contributes to variations in the severity of subacute ruminal acidosis (SARA). Pelleted total mixed ration (PTMR) reduces sorting, but high-grain content increases acidosis risk. However, whether the variability in the severity of SARA exists in sheep fed the same high-grain PTMR is less understood. This study aimed to investigate SARA variability among individual sheep offered a high-grain PTMR, considering chewing activity, ruminal fermentation, bacterial communities and nutrient digestibility. Twenty ruminally cannulated male Hu sheep were individually housed in cages and fed a PTMR comprising 80% concentrate mix and 20% roughage. A 14-day adaptation period to the diet and facilities was provided before a 10-day sample collection period. Continuous monitoring of ruminal pH was conducted for 48 h, during which time chewing activity was also recorded. Ruminal fluid samples were collected for analysis of volatile fatty acid and microbial DNA extraction. Faecal samples were collected to measure nutrient digestibility. Based on their acidosis index, the sheep were classified into two groups: SARA-susceptible group (n = 6) and SARA-tolerant group (n = 6). The SARA-susceptible sheep exhibited a lower ruminal mean pH and minimum pH than the SARA-tolerant sheep (P < 0.05). Additionally, the SARA-susceptible group increased the acidosis index, duration and areas of pH below 5.8 and 5.6 compared to the SARA-tolerant group (P < 0.05). The SARA-susceptible group also exhibited a longer ruminating time than the SARA-tolerant group (P < 0.05). The SARA-susceptible group exhibited a tendency to increase the relative abundance of Firmicutes (P = 0.089), while simultaneously decreasing the copy number of Fibrobacter succinogenes in the rumen, as well as the digestibility of NDF and ADF compared to the SARA-tolerant group (P < 0.05). The acidosis index was found to be positively correlated with ruminating time (min/kg DM intake (DMI)) and total chewing time (min/kg DMI), but negatively correlated with the copy number of Fibrobacter succinogenes and Ruminococcus albus in the rumen. These findings indicate that there exists variability in the SARA severity among sheep when fed a high-grain PTMR, as evidenced by varied chewing activity, bacterial communities and nutrient digestibility. Ruminating time, total chewing time per kilogram of DMI as well as the copy number of Fibrobacter succinogenes and Ruminococcus albus in the rumen hold potential as indicators for assessing the severity of SARA.
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Affiliation(s)
- Z A Zhang
- State Key Laboratory of Grassland Agro-ecosystems, Key Laboratory of Grassland Livestock Industry Innovation, Ministry of Agriculture and Rural Affairs, Engineering Research Center of Grassland Industry, Ministry of Education, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - F Li
- State Key Laboratory of Grassland Agro-ecosystems, Key Laboratory of Grassland Livestock Industry Innovation, Ministry of Agriculture and Rural Affairs, Engineering Research Center of Grassland Industry, Ministry of Education, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China.
| | - Z Y Ma
- State Key Laboratory of Grassland Agro-ecosystems, Key Laboratory of Grassland Livestock Industry Innovation, Ministry of Agriculture and Rural Affairs, Engineering Research Center of Grassland Industry, Ministry of Education, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - F D Li
- State Key Laboratory of Grassland Agro-ecosystems, Key Laboratory of Grassland Livestock Industry Innovation, Ministry of Agriculture and Rural Affairs, Engineering Research Center of Grassland Industry, Ministry of Education, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Z L Wang
- State Key Laboratory of Grassland Agro-ecosystems, Key Laboratory of Grassland Livestock Industry Innovation, Ministry of Agriculture and Rural Affairs, Engineering Research Center of Grassland Industry, Ministry of Education, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - S R Li
- Animal Husbandry and Veterinary Station, Minqin 733399, China
| | - X J Wang
- Animal Husbandry and Veterinary Station, Minqin 733399, China
| | - K D Li
- Agricultural and Rural Bureau Zhongxing Town Animal Husbandry and Veterinary Station, Minqin 733399, China
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Li KD, Chu CE, Patel M, Meng MV, Morgan TM, Porten SP. Cxbladder Monitor testing to reduce cystoscopy frequency in patients with bladder cancer. Urol Oncol 2023; 41:326.e1-326.e8. [PMID: 36868882 DOI: 10.1016/j.urolonc.2023.01.009] [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: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Bladder cancer surveillance is associated with high costs and patient burden. CxMonitor (CxM), a home urine test, allows patients to skip their scheduled surveillance cystoscopy if CxM-negative indicating a low probability of cancer presence. We present outcomes from a prospective multi-institutional study of CxM to reduce surveillance frequency during the coronavirus pandemic. MATERIALS AND METHODS Eligible patients due for cystoscopy from March-June 2020 were offered CxM and skipped their scheduled cystoscopy if CxM-negative. CxM-positive patients came for immediate cystoscopy. The primary outcome was safety of CxM-based management, assessed by frequency of skipped cystoscopies and detection of cancer at immediate or next cystoscopy. Patients were surveyed on satisfaction and costs. RESULTS During the study period, 92 patients received CxM and did not differ in demographics nor history of smoking/radiation between sites. 9 of 24 (37.5%) CxM-positive patients had 1 T0, 2 Ta, 2 Tis, 2 T2, and 1 Upper tract urothelial carcinoma (UTUC) on immediate cystoscopy and subsequent evaluation. 66 CxM-negative patients skipped cystoscopy, and none had findings on follow-up cystoscopy requiring biopsy. Six of these patients did not attend follow-up, 4 elected to undergo additional CxM instead of cystoscopy, 2 stopped surveillance, and 2 died of unrelated causes. CxM-negative and positive patients did not differ in demographics, cancer history, initial tumor grade/stage, AUA risk group, or number of prior recurrences. Median satisfaction (5/5, IQR 4-5) and costs (26/33, 78.8% no out-of-pocket costs) were favorable. CONCLUSIONS CxM safely reduces frequency of surveillance cystoscopy in real-world settings and appears acceptable to patients as an at-home test.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Carissa E Chu
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Milan Patel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Maxwell V Meng
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, CA.
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Sadighian M, Hakam N, Amend G, Shaw NM, Tahir P, Allen IE, Nabavizadeh B, Holler J, Shibley W, Li KD, Abbasi B, Bell A, Mohamad O, Breyer BN. Radiation-induced Fistulas in Patients With Prior Pelvic Radiotherapy for Prostate Cancer: A Systematic Review and Meta-analysis. Urology 2023; 176:121-126. [PMID: 36963666 DOI: 10.1016/j.urology.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To systematically aggregate and summarize existing data on fistula prevalence among patients with a history of pelvic radiotherapy for prostate cancer. MATERIALS AND METHODS We queried PubMed, Embase, and Web of Science on October 7, 2020 for peer-reviewed publications pertaining to radiation-induced fistulas in the pelvis. For meta-analysis, we used the random-effects model. We used the I2 statistic to quantify heterogeneity and the Newcastle-Ottawa Scale to assess risk of bias. RESULTS Our final meta-analysis included 6 cohort studies with a total of 7665 patients exposed to pelvic radiotherapy between 1967 and 2013. Median follow-up time was 35.5 months (IQR 33.5-57.5). Pooled prevalence of radiation-induced fistula across all 6 cohort studies was 0.2% (95% CI: 0.1-0.4, I2 = 0.000%, P < .608). In subgroup analysis, we did not detect significant heterogeneity in fistula prevalence in patients who were re-irradiated (0.3%, 95% CI: 0.1-0.4; P = .762) or patients on concurrent chemotherapy (0.4%, 95% CI: -0.3 -1.2; P = .664) compared to those receiving their first course of radiotherapy alone. No randomized controlled trials met inclusion criteria due to ambiguous and inconsistent reporting language for fistula occurrence. CONCLUSION There is limited published literature reporting fistula as an adverse event of prostate cancer radiotherapy, especially in the medium and long-term period. Patients undergoing pelvic radiotherapy for prostate cancer appear at low short-term risk for developing fistulas. Adverse event reporting in randomized controlled trials merits greater granularity where fistulas should be reported with specificity rather than aggregating into broad categories of genitourinary or gastrointestinal adverse events.
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Affiliation(s)
- Michael Sadighian
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory Amend
- Mount Sinai Health System, Mount Sinai Medical Center, New York, NY
| | - Nathan M Shaw
- Department of Urology, Georgetown University, Washington, DC
| | - Peggy Tahir
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Isabel E Allen
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | - Jordan Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - William Shibley
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Alexander Bell
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Osama Mohamad
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA
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Xu JC, Xu Y, Li KD, Wang C. [High-grade endometrial carcinoma with choriocarcinoma differentiation: report of a case]. Zhonghua Bing Li Xue Za Zhi 2022; 51:1180-1183. [PMID: 36323555 DOI: 10.3760/cma.j.cn112151-20220826-00732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- J C Xu
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Y Xu
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - K D Li
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - C Wang
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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12
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Abbasi B, Shaw NM, Lui JL, Li KD, Sudhakar A, Low P, Hakam N, Nabavizadeh B, Breyer BN. Posterior urethral stenosis: a comparative review of the guidelines. World J Urol 2022; 40:2591-2600. [PMID: 36018366 PMCID: PMC9617833 DOI: 10.1007/s00345-022-04131-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.
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Affiliation(s)
- Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington DC, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Architha Sudhakar
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
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Nabavizadeh B, Li KD, Hakam N, Shaw NM, Leapman MS, Breyer BN. Incidence of circumcision among insured adults in the United States. PLoS One 2022; 17:e0275207. [PMID: 36251658 PMCID: PMC9576047 DOI: 10.1371/journal.pone.0275207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States. Methods Using IBM MarketScan® Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes. Results We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (±12.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (Δ+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine/ritual circumcision (28.7%), phimosis + balanitis/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups. Conclusion This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | - Kevin D. Li
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan M. Shaw
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Hua HJ, Wu J, Li KD, Song GX, Li H. [Analysis of clinicopathological characteristics of gastric-type inverted hyperplastic polyps]. Zhonghua Bing Li Xue Za Zhi 2022; 51:749-751. [PMID: 35922166 DOI: 10.3760/cma.j.cn112151-20220117-00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- H J Hua
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - J Wu
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - K D Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - G X Song
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - H Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
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Park JD, Li KD, Lee J, Lee YL, Sihota H, Yang GE, Kipp M, Mower WR, Cooper RJ. Implementation and value of a student‐run volunteer clinical research program at an academic medical center. J Am Coll Emerg Physicians Open 2022; 3:e12775. [PMID: 35783458 PMCID: PMC9237120 DOI: 10.1002/emp2.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/05/2022] Open
Abstract
Clinical research output in the emergency department (ED) continues to be constrained by limitations in funding for researchers, demands of patient care on ED providers, and difficulties in obtaining high‐quality data. In response, several institutions have established programs in which student volunteers are integrated into department workflows to increase clinical research output and introduce pre‐health students to careers in medicine. One such program, the student volunteer clinical research program, presently consists of over 40 undergraduate and post‐baccalaureate student volunteers who screen, consent, and enroll patients into prospective studies in the ED of the University of California, Los Angeles (UCLA) Ronald Reagan Medical Center. The program is led by student coordinators who collaborate with departmental research staff and faculty. Our program is unique in that it is primarily run by the students themselves. Experienced student research associates facilitate recruitment through a competitive biannual application process, train new volunteers to perform on‐shift research duties, and monitor participants for compliance with both hospital and program policies. Participation in the program provides students with exposure to frontline medical research, opportunities to observe clinical medicine, and access to a variety of program‐specific resources including student‐led committees, career development resources, and mentorship from peers, alumni, and faculty. This concept piece serves as a structural model for other institutions seeking to implement volunteer clinical research or bolster existing programs through increased student‐led initiatives.
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Affiliation(s)
- Junghyuk D. Park
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - Kevin D. Li
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
- University of California San Francisco School of Medicine San Francisco California USA
| | - Jeesoo Lee
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
- Emory University School of Medicine Atlanta Georgia USA
| | - Ye Lim Lee
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - Hena Sihota
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - Grace E. Yang
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - Madison Kipp
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - William R. Mower
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
| | - Richelle J. Cooper
- Department of Emergency Medicine University of California Los Angeles Los Angeles California USA
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16
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Shaw NM, Hakam N, Lui JL, Nabavizadeh B, Li KD, Low P, Abbasi B, Breyer BN. Incidence of venous thromboembolism in benign urologic reconstructive cases. World J Urol 2022; 40:1879-1886. [PMID: 35471668 DOI: 10.1007/s00345-022-04004-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the rate of perioperative venous thromboembolism (VTE) among patients undergoing common benign urologic reconstructive cases. We hypothesize that this rate will be lower than previously described. METHODS We utilized the American College of Surgeons National Surgical Quality Improvement Project database from 2015 to 2019 to evaluate 30-day perioperative risk of VTE. Patients ≥ 18 years old undergoing benign urologic reconstructive cases were selected using Current Procedural Terminology (CPT) codes. Demographic, comorbidity, and operative variables were captured. The primary outcome was VTE within the 30-day postoperative period. RESULTS We identified 8467 patients who met inclusion criteria. The majority of patients were male (> 95%) with an average age of 65 and BMI of 29.6. There were 23 VTE events (0.27%) within the 30-day perioperative period. Fourteen (14/59) procedures had a perioperative VTE. Many of the traditional factors for VTE including operative time and obesity significantly increased risk of VTE in univariate analysis. In multivariate analysis, only BMI (OR 1.09; 95% CI 1.01-1.12) and inpatient status (OR 4.42; 95% CI 1.9-10.2) were correlated with increased perioperative VTE. CONCLUSION The rate of VTE among patients undergoing benign urologic reconstructive cases is low. Providers should continue to have high index of suspicion particularly for inpatients with high BMI in addition to other known risk factors for VTE.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Patrick Low
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA. .,Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
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17
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Lui JL, Shaw NM, Hakam N, Nabavizadeh B, Li KD, Low P, Abbasi B, Breyer BN. Foley Catheter Balloon Rupture and Risk of Free Fragment Formation. Urology 2022; 165:67-71. [DOI: 10.1016/j.urology.2022.03.018] [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] [Received: 01/05/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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18
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Holler JT, Hakam N, Nabavizadeh B, Sadighian MJ, Shibley WP, Li KD, Weiser L, Rios N, Enriquez A, Leapman MS, Amend GM, Breyer BN. Characteristics of Online Crowdfunding Campaigns for Urological Cancers in the United States. Urol Pract 2022; 9:56-63. [PMID: 37145560 DOI: 10.1097/upj.0000000000000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We examined the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S. METHODS This cross-sectional study analyzed publicly available data from GoFundMe, the largest online medical crowdfunding service, via automated web scraping. Online campaigns from 2010 to 2018 with the following primary cancer types were included: kidney, prostate, bladder and testicular. Financial outcomes were compared using Kruskal-Wallis and Wilcoxon rank-sum tests. Multivariable analyses were utilized to identify predictors of campaign financial outcomes. RESULTS Kidney cancers were the most frequent online campaign type (478), followed by prostate (379), bladder (202) and testicular (175) malignancies. Urological cancer campaign recipients frequently requested funding for medical expenses (71%) during active treatment (57%). After adjustment, testicular cancer and children's cancer campaigns generated more donations than other urological and adult cancer campaigns (p <0.05). Family and friend-authored campaigns generated more donations and average donation amounts than self-authored campaigns (p <0.05). Campaign narratives focused on disheartening circumstances received fewer donations than narratives focused on the recipient's high moral character or contributions to society (p <0.05), and unclear narratives received the smallest donation amounts (p <0.05). CONCLUSIONS Urological cancer crowdfunding in the U.S. is primarily used to finance uncovered costs associated with medical care during active treatment. Crowdfunding financial outcomes are likely related to the campaign recipient's age, malignancy type, social network and primary appeal of the narrative. Urologists should be aware of trends in medical crowdfunding in order to better understand the financial burden this patient population faces.
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Affiliation(s)
- Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, California
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, California
| | - William P Shibley
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Lucas Weiser
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Natalie Rios
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Anthony Enriquez
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California
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Li KD, Xu YY, Guo CL, Pu Q, Mei JD, Liu CW, Zhu YK, Liu LX. [Emulation pulmonary nodules localization model:a novel non-invasive localization technique in resection of pulmonary nodules]. Zhonghua Yi Xue Za Zhi 2021; 101:3966-3972. [PMID: 34955000 DOI: 10.3760/cma.j.cn112137-20211020-02321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To explore the accuracy and efficiency of a novel 3D-printed emulation localization model of small pulmonary nodules in lung surgery. Methods: From April 2020 to April 2021, a total of 66 patients were selected in the study, who underwent localization and resection of pulmonary nodules with video-assisted thoracoscopic surgery (VATS) guided by the 3D-printed emulation localization model at Department of Thoracic Surgery, West China Hospital of Sichuan University. There were 13 males and 53 females, aged from 25 to 79 (52.7±11.4) years. Of all patients, 24 (36.4%) had single pulmonary nodule, and 42 (63.6%) had synchronous multiple pulmonary nodules. The chest high-resolution CT image data were utilized for digital reconstruction and 3D printing to make a tailored life-size emulation pulmonary nodules localization model, which was used to navigate real-time intraoperative localization of nodules. Clinical data including operative parameters, localization information, resection types and pathological findings of nodules were analyzed. The pulmonary nodules that doctors planned to resect were categorized into two categories:major nodules and additional nodules, according to their presence of invasion and radiological risk factors. The accuracy of localization and resection efficiency of nodules were evaluated in accordance with the categories of the nodules respectively. Results: On the basis of preoperative evaluation, there were 71 major nodules with median maximal diameter of 0.9 (0.6-1.3) cm, and 77 additional nodules with median maximal diameter of 0.5 (0.4-0.7) cm. All patients underwent VATS surgery, 52 of them (78.8%) were treated with uniportal VATS and 14 (21.2%) with triportal VATS. Among the patients with single nodule, 18 segmentectomies and 6 wedge resections were performed; whereas among the patients with multiple nodules, 5 segmentectomies, 14 wedge resections, and 23 combined pulmonary resections (including 2 cases of lobectomy+segmentectomy, 7 cases of lobectomy+wedge resections, and 14 cases of segmentectomy+wedge resections) were achieved. The median operative time was 93 (45-240) min, and the median resection time for all nodules was 51.4 (6.7-147.0) min. All major nodules were successfully resected and visibly dissected after removal, and all additional nodules were successfully resected with 85.7%(66/77) nodules visibly dissected. The accuracy rate of localization of both types of nodules was 100%. All major nodules were malignant, and the malignancy rate of additional nodules was 21.2%(14/66). Conclusion: This novel 3D-printed emulation localization model of small pulmonary nodules proved to be a non-invasive, accurate and efficient technique. Not only that, it has a unique advantage in localization of synchronous multiple pulmonary nodules.
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Affiliation(s)
- K D Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Y Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - C L Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Q Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J D Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - C W Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y K Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L X Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Low P, Li KD, Hakam N, Bell A, Abbasi B, Lui J, Shaw NM, Breyer BN. 5-Alpha reductase inhibitor related litigation: A legal database review. Andrology 2021; 10:470-476. [PMID: 34933409 DOI: 10.1111/andr.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND 5α-reductase inhibitors are commonly prescribed medications with multiple side effects used in the treatment of male pattern hair loss and benign prostatic hyperplasia. These side effects including "post-finasteride syndrome" may result in lawsuits. OBJECTIVES To characterize lawsuits involving the adverse side effects of 5α-reductase inhibitor to better understand drivers of litigation and outcomes. METHODS Legal cases were queried from Nexis Uni using the search terms "5-alpha reductase inhibitor" as well as specific agents "finasteride," "dutasteride" in combination with "malpractice," "negligence," "damage," "loss," "side effect," and "complication." Secondary review was performed with publicly available data on "In Re: Propecia." Relevant cases were reviewed and pertinent characteristics were extracted and summarized using descriptive statistics. RESULTS Our search yielded 156 unique legal cases in the Nexis Uni database from April 2003 to May 2021. Only 18 of these cases met the inclusion criteria. Adverse events experienced by patients included medication side effects (n = 12, 66.7%), delayed cancer diagnosis (n = 3, 16.7%), and lack of symptom improvement (n = 3, 16.7%). The identity of the plaintiffs were most commonly patients themselves (n = 15, 83.3%). Defendants include pharmaceutical companies (n = 6, 33.3%), a combination of parties (n = 5, 27.8%), and physicians (n = 5, 27.8%) alone. The allegations included sexual side effects such as erectile dysfunction (n = 6, 33.3%) and decreased libido (n = 4, 22.2%). These prescriptions were made for benign prostatic hyperplasia (n = 9, 50%), male pattern hair loss (n = 7, 38.9%), and feminizing hormone therapy (n = 2, 11.1%). Several of these cases involved the same plaintiffs in related cases. No verdicts were against physicians. We noted a largely settled lawsuit involving more than 1000 plaintiffs with limited data on harms alleged and a $4.3 million settled amount. Of the total cases that resulted in a verdict, 9/18 were within the last 3 years. DISCUSSION The most common complications experienced by patients in our legal review were those involving sexual dysfunction with erectile dysfunction and decreased libido. The growing number of cases in the later years of our review suggests litigation may continue to increase in the coming future. Our review did not identify any individual cases that resulted in a monetary payout beyond a $4.3 million settlement outside of court. CONCLUSION 5α-reductase inhibitor was alleged to have sexual, mental, and physical side effects, resulting in legal litigation. Despite this, no judgment against a physician or pharmaceutical company was identified. We do note and discuss a large number of lawsuits settled out of court. Given the increase in the number of lawsuits resulting in verdicts over the last 3 years, we suspect that the frequency of litigation around 5α-reductase inhibitors will continue for the foreseeable future.
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Affiliation(s)
- Patrick Low
- Department of Urology, University of California, San Francisco, California, USA
| | - Kevin D Li
- Department of Urology, University of California, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California, San Francisco, California, USA
| | - Alexander Bell
- Department of Urology, University of California, San Francisco, California, USA
| | - Behzad Abbasi
- Department of Urology, University of California, San Francisco, California, USA
| | - Jason Lui
- Department of Urology, University of California, San Francisco, California, USA.,Department of Urology, University of Massachusetts School of Medicine, Massachusetts, USA
| | - Nathan M Shaw
- Department of Urology, University of California, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California, San Francisco, California, USA
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Li KD, Hakam N, Low P, Lui J, Sadighian MJ, Nabavizadeh B, Shaw NM, Breyer BN. A Legal Database Review of Circumcision Related Litigation in the United States. Urology 2021; 160:94-101. [PMID: 34788667 DOI: 10.1016/j.urology.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To characterize circumcision-related litigation in the United States (US) and factors predictive of lawsuit outcome. Circumcision is a common urologic procedure with medical and ethical nuances. METHODS We reviewed the Nexis Uni legal database for state and federal cases using the term "circumcision" in combination with "medical malpractice" or "negligence" or "medical error" or "complication" or "malpractice" or "tort". Litigation primarily related to circumcision from 1939 to 2021 were reviewed for medical and legal details. RESULTS We identified 77 unique cases. Most cases were processed in state (87%) or appellate (59%) court systems with negligent surgical performance as the most common lawsuit reason (49%). Of reported specialties, urology was the highest proportion represented among named physicians (29%) and most patients were minors at time of circumcision (64%) and lawsuit (59%). Common complications included aesthetic dissatisfaction (20%), pain (19%), impaired sexual function (17%) and surgical trauma/injury (16%). Most verdicts favored physicians (59%), but when against physicians, the median indemnity was $175,000. Lawsuits due to negligent informed consent were significantly more likely to result in verdict favoring the physician compared to those due to negligent surgical performance. CONCLUSIONS Circumcision-related litigation in the US is rare and trial verdicts favor physicians, particularly in federal court cases or when parties allege negligent informed consent. Cases that favored plaintiffs successfully alleged negligent surgical technique. We recommend physicians performing circumcisions receive proper training, clearly communicate potential complications, and ensure appropriate indications for adult patients to reduce malpractice risk.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jason Lui
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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22
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Hua HJ, Yang QY, Li KD, Li H. [Clinicopathological characteristics of esophageal submucosal gland duct adenoma]. Zhonghua Bing Li Xue Za Zhi 2021; 50:1266-1268. [PMID: 34719167 DOI: 10.3760/cma.j.cn112151-20210330-00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- H J Hua
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - Q Y Yang
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - K D Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - H Li
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
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Li KD, Hakam N, Sadighian MJ, Holler JT, Nabavizadeh B, Amend GM, Fang R, Meeks W, Makarov D, Breyer BN. Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census. Urology 2021; 156:117-123. [PMID: 34331999 DOI: 10.1016/j.urology.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/17/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Raymond Fang
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - William Meeks
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - Danil Makarov
- Population Health and Health Policy, New York University School of Medicine Veterans Affairs New York Harbor Healthcare System-Brooklyn, Brooklyn, NY
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Nabavizadeh B, Namiri NK, Hakam N, Li KD, Amend GM, Breyer BN. Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019. Urology 2021; 152:84-90. [PMID: 33775786 DOI: 10.1016/j.urology.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children. METHODS We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates. RESULTS During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r2 = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October. CONCLUSION Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.
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Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nikan K Namiri
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
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Li KD, Saigal CS, Tandel MD, Kwan L, Inkelas M, Alden DL, Frencher SK, Gollapudi K, Blumberg J, Nabhani J, Bergman J. Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System. Med Decis Making 2021; 41:120-132. [PMID: 33435816 DOI: 10.1177/0272989x20982533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. METHODS We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. RESULTS Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients' records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. CONCLUSIONS Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,University of California San Francisco, School of Medicine, San Francisco, CA, USA
| | - Christopher S Saigal
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Megha D Tandel
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Moira Inkelas
- University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Dana L Alden
- University of Hawai'i at Manoa Shidler College of Business, Marketing, Honolulu, HI, USA
| | - Stanley K Frencher
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Kiran Gollapudi
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Jeremy Blumberg
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Jamal Nabhani
- Los Angeles County Department of Health Services, Los Angeles, CA, USA.,USC Keck School of Medicine, Department of Urology, Los Angeles, CA, USA
| | - Jonathan Bergman
- Department of Urology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.,Los Angeles County Department of Health Services, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Hua HJ, Li KD, Fang HS, Li H, Zhu Y, Li X, Song GX, Liu C, Zhang ZH, Fan QH. [Clinicopathological observation of adamantinoma of long bone]. Zhonghua Bing Li Xue Za Zhi 2019; 48:522-526. [PMID: 31288306 DOI: 10.3760/cma.j.issn.0529-5807.2019.07.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathological features and differential diagnosis of adamantinoma of long bone. Methods: Seven cases of adamantinoma on long bone were selected at Jiangsu Province People's Hospital from June 2012 to May 2018. Clinicopathologic details, immunohistochemical and molecular analysis were performed,and the relevant literature reviewed. Results: There were 6 males and 1 female patients,age ranging from 21 to 60 years (mean 38 years). Six cases were on the right side and one case was on the left; in five cases the tumors arose from tibia, one from patella and one from humerus. Microscopically,tumour cells were mainly composed of spindle cells arranged in bundles or braids,with irregular epithelial island. Immunohistochemically,the epithelial island expressed high molecular weight cytokeratin but not CK8/18. Both epithelial and spindle components expressed vimentin. One case that was microscopically similar to intraosseous synovial sarcoma did not show SYT gene rearrangement. Clinical follow-up was available for five patients: one patient had axillary metastases seven months after operation, one patient had recurrence 34 months after surgery, 3 patients were uneventful with follow up duration from half a month to 32 months. Conclusion: Adamantinoma occurring in long bones is very rare. The correct diagnosis requires adequate sample selection, careful morphologic observation, immunohistochemistry and molecular genetics.
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Affiliation(s)
- H J Hua
- Department of Pathology, Jiangsu Province People's Hospital(First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
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Li KD. [Evaluation of radioimmunotherapy in the multimodality treatment of hepatocellular carcinoma (HCC)]. Zhonghua Zhong Liu Za Zhi 1992; 14:430-2. [PMID: 1338985] [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: 12/26/2022]
Abstract
The evaluation of radioimmunotherapy using 131I-anti HCC isoferritin IgG antibody in the multimodality treatment of HCC was reported. Forty three patients with surgically verified unresectable HCC have been treated by radioimmunotherapy as a part of multimodality treatment during 1985-1990. The short-term responses and prolong survival were compared with that in control group of 39 patients with HCC receiving conventional multimodality treatment. The rates of tumor shrinkage, AFP level decline and second resection in radioimmunotherapy group were 67.4% (29/43), 69.6% (16/23) and 30.2% (13/43) respectively, significantly higher than those in control group 23.1% (15/39), 40.0% (8/20) and 10.3% (4/39) respectively. The 1, 3, 5-year survival rates were 61.5%, 40.4% and 35.5% in radioimmunotherapy group, however, in control group were 51.3%, 20.1% and 15.5%, respectively. The results suggested that radioimmunotherapy is one of modalities of choice, particularly for the treatment of unresectable HCC in the multimodality treatment regimen.
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Affiliation(s)
- K D Li
- Liver Cancer Institute, Shanghai Medical University
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Li KD, Sheridan JA, Bloom DM. Picosecond pulse generation in Nd:BEL with a high-frequency acousto-optic mode locker. Opt Lett 1991; 16:1505-1507. [PMID: 19777015 DOI: 10.1364/ol.16.001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
By using a high-frequency acousto-optic mode locker, 7.5-ps FWHM pulses were obtained from a diode-pumped Nd:BEL laser. After the pulses were compressed with a fiber-grating compressor, l.0-ps FWHM pulse durations were achieved.
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Godil AA, Li KD, Bloom DM. Pulsed FM mode locking of a Nd:BEL laser. Opt Lett 1991; 16:1243-1245. [PMID: 19776932 DOI: 10.1364/ol.16.001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A novel but simple and practical mode locker was built and demonstrated for a diode-pumped Nd:BEL laser. Fast electrical pulses from a comb generator drive a LiNbO(3) crystal, which produces pulsed electro-optic phase modulation in the laser cavity. Stable mode-locked pulses of 7.5-ps duration were obtained at a repetition rate of 250 MHz.
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Keller U, Li KD, Khuri-Yakub BT, Bloom DM, Weingarten KJ, Gerstenberger DC. High-frequency acousto-optic mode locker for picosecond pulse generation. Opt Lett 1990; 15:45-47. [PMID: 19759706 DOI: 10.1364/ol.15.000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We modeled, designed, and built a 500-MHz acousto-optic mode locker with a diffraction efficiency of 28% per 1 W drive power. The transducer is zinc oxide sputtered onto a sapphire substrate. A new figure of merit is defined for the mode-locker design, which indicates that sapphire is a good substrate material. Pulse widths of less than 10 psec with an average power of 150 mW were achieved from a 500-MHz pulse-rate, diode-pumped, cw mode-locked Nd:YLF laser using a pump power of 700 mW.
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Abstract
We discuss our design, construction, and characterization of thin-film Gires-Tournois interferometers for cubic-phase correction of ultrashort (<10-fsec) laser pulses. We include in the theory of the group delay of Gires-Tournois interferometers the dispersion of the thin-film layer, an important effect in the broadband limit. We characterize and use specific broadband, high-efficiency, low-dispersion substrates for this application.
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Knox WH, Pearson NM, Li KD, Hirlimann CA. Interferometric measurements of femtosecond group delay in optical components. Opt Lett 1988; 13:574. [PMID: 19745968 DOI: 10.1364/ol.13.000574] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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