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Prado MG, Kessler LG, Au MA, Burkhardt HA, Zigman Suchsland M, Kowalski L, Stephens KA, Yetisgen M, Walter FM, Neal RD, Lybarger K, Thompson CA, Al Achkar M, Sarma EA, Turner G, Farjah F, Thompson MJ. Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre. BMJ Open 2023; 13:e068832. [PMID: 37080616 PMCID: PMC10124310 DOI: 10.1136/bmjopen-2022-068832] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data. DESIGN Case-control study. SETTING Ambulatory care clinics at a large tertiary care academic health centre in the USA. PARTICIPANTS, OUTCOMES We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates. RESULTS Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1). CONCLUSIONS Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
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Affiliation(s)
- Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Larry G Kessler
- Health Services, University of Washington, Seattle, Washington, USA
| | - Margaret A Au
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hannah A Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | | | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- The Primary Care Unit Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Caroline A Thompson
- Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Zigman Suchsland M, Kowalski L, Burkhardt HA, Prado MG, Kessler LG, Yetisgen M, Au MA, Stephens KA, Farjah F, Schleyer AM, Walter FM, Neal RD, Lybarger K, Thompson CA, Achkar MA, Sarma EA, Turner G, Thompson M. How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States. Cancers (Basel) 2022; 14:cancers14235756. [PMID: 36497238 PMCID: PMC9740627 DOI: 10.3390/cancers14235756] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
Abstract
The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012-2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273-691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11-240), specialist consultation to diagnosis 72 days (IQR 13-456), and from diagnosis to treatment initiation 7 days (IQR 0-36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.
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Affiliation(s)
| | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hannah A. Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maria G. Prado
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Larry G. Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Maggie A. Au
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | | | - Fiona M. Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Richard D. Neal
- University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, VA 22039, USA
| | - Caroline A. Thompson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Elizabeth A. Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence:
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Kowalski L, Krusen NE. Lung Cancer Screening Policy in Alaska and Occupational Therapy. Am J Occup Ther 2021; 75:12496. [PMID: 34781340 DOI: 10.5014/ajot.2021.048231] [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: 11/17/2022] Open
Abstract
Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings. What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.
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Affiliation(s)
- Lesleigh Kowalski
- Lesleigh Kowalski, PhD, MOT, OTR/L, ATP, is Research Scientist, Department of Family Medicine, University of Washington, Seattle; . At the time of the research, Kowalski was Doctoral Student, College of Health of Professions, Pacific University, Forest Grove, OR
| | - Nancy E Krusen
- Nancy E. Krusen, PhD, MA, OTR/L, is Program Director and Associate Professor, Division of Occupational Therapy Education, University of Nebraska Medical Center, Omaha
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Kowalski L. Functional Decline as an Indicator of Ill-Health: A Retrospective Case Study of the Process Leading to Lung Cancer. J Multidiscip Healthc 2021; 14:919-927. [PMID: 33948085 PMCID: PMC8088295 DOI: 10.2147/jmdh.s295498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Lung cancer claims more lives than any cancer in the world and remains difficult to diagnosis at early stages. Detecting lung cancer is challenging due to nonspecific symptom presentation. Literature was reviewed to consider functional decline as an indicator for ill-health. This study explored the process experienced from recognition in a change of health to receiving a lung cancer diagnosis from a patient’s perspective in order to examine this phase through a biopsychosocial lens. Patients and Methods A single-case design methodology was used for this study. The method of data collection was semi-structured interviews with people diagnosed with lung cancer utilizing criterion sampling. The case study was bound by diagnostic and geographical factors to frame the single-case: participants were limited to those living in Alaska diagnosed with stage III or stage IV lung cancer. Results One (n = 1) person participated in this study. Themes consistent with lung cancer detection process from a patient’s perspective include symptom denial, symptom reductionism, and gradual impact on function. Conclusion Although the number of participants was extremely limited due to the COVID-19 pandemic at the time of recruitment, this case study suggests a decline in function present prior to being diagnosed with lung cancer. Opportunities exist within the provider and patient interface to promote earlier detection include educating medical providers to ask specific, closed-ended, non-disease related functional questions to ascertain more details and a holistic representation of patients’ health. Raising public awareness of lung cancer symptoms, such as fatigue and dyspnea, is also warranted.
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Affiliation(s)
- Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA, 98195, USA
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Elkattah R, Kowalski L. “Un-Kissing” Type II Endometriomas. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.659] [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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Abstract
Silicon microspheres produced in gas-phase by hot-wall CVD offer unique quality in terms of sphericity, surface smoothness, and size. However, the spheres produced are polydisperse in size, which typically range from 0.5 μm to 5 μm. In this work we show through experiments and calculations that thermophoretic forces arising from strong temperature gradients inside the reactor volume effectively sort the particles in size along the reactor. These temperature gradients are shown to be produced by a convective gas flow. The results prove that it is possible to select the particle size by collecting them in a particular reactor region, opening new possibilities towards the production by CVD of size-controlled high-quality silicon microspheres.
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Affiliation(s)
- M Garín
- Grup de recerca en Micro i Nanotecnologies, Departament d'Enginyeria Electrònica, Universitat Politècnica de Catalunya, c/Jordi Girona Pascual 1-3, Barcelona 08034, Spain
| | - R Fenollosa
- Instituto de Tecnología Química (CSIC - UPV), Universitat Politècnica de Valencia, Av. Tarongers s/n 46022, Valencia, Spain
| | - L Kowalski
- Grup de recerca en Micro i Nanotecnologies, Departament d'Enginyeria Electrònica, Universitat Politècnica de Catalunya, c/Jordi Girona Pascual 1-3, Barcelona 08034, Spain
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Giudice F, Rodrigues B, Lacerda T, Cartaxo R, Baptistella A, Dias M, Kowalski L, Martins V. 2814 Understanding the mechanism of extracellular vesicles release in head and neck cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johnson NW, Warnakulasuriya S, Gupta PC, Dimba E, Chindia M, Otoh EC, Sankaranarayanan R, Califano J, Kowalski L. Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Adv Dent Res 2011; 23:237-46. [PMID: 21490236 DOI: 10.1177/0022034511402082] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [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: 12/16/2023]
Abstract
The mouth and oropharynx are among the ten most common sites affected by cancer worldwide, but global incidence varies widely. Five-year survival rates exceed 50% in only the best treatment centers. Causes are predominantly lifestyle-related: Tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors. Oral cancer is a disease of the poor and dispossessed, and reducing social inequalities requires national policies co-ordinated with wider health and social initiatives - the common risk factor approach: control of the environment; safe water; adequate food; public and professional education about early signs and symptoms; early diagnosis and intervention; evidence-based treatments appropriate to available resources; and thoughtful rehabilitation and palliative care. Reductions in inequalities, both within and between countries, are more likely to accrue from the application of existing knowledge in a whole-of-society approach. Basic research aimed at determining individual predisposition and acquired genetic determinants of carcinogenesis and tumor progression, thus allowing for targeted therapies, should be pursued opportunistically.
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Affiliation(s)
- N W Johnson
- Griffith Health Institute, Griffith University, Queensland, Australia.
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Ferlito A, Buckley JG, Shaha AR, Silver CE, Rinaldo A, Kowalski L. The role of neck dissection in the treatment of supraglottic laryngeal cancer. Acta Otolaryngol 2001; 121:448-53. [PMID: 11508502 DOI: 10.1080/000164801300366561] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
BACKGROUND AND OBJECTIVES Indications of simultaneous bilateral radical neck dissection remains controversial. The main objectives of this analysis were to study: a) the frequency of postoperative complications, b) the patterns of metastatic lymph nodes in the surgical specimen, c) the predictive factors of neck recurrences, d) the prognostic factors related to overall survival. METHODS A retrospective review of results in 193 consecutive patients submitted to a simultaneous bilateral radical neck dissection from 1960-1990. RESULTS Postoperative complications occurred in 60.8% of the cases. The most frequent ones were: fistula, wound infection, flap dehiscence and necrosis. There were four postoperative deaths (2.7%). The lymph nodes most frequently involved were of the upper jugular and upper accessory groups. Only patients with lip and paranasal sinus tumors never presented metastatic nodes at Levels IV and V. Tumor recurrences were more common at the ipsilateral neck (13.5%) or at distant sites (12.4%). The predictive factors of neck recurrences were: age, N stage, ipsilateral metastasis at Level II, and contralateral metastasis at Levels II and IV. The overall 5-year survival rates for the two age groups, that is, younger than 40 and older than 40 years of age, were respectively, of 8.5% and 35.6% (P = 0.0296). There were no survivals among the group of patients with neck lymph nodes staged as N3 or Nx. The overall 5-year survival rates were significantly influenced by contralateral metastatic lymph nodes at any level. The results of multivariate analysis using the Cox regression technique, showed that Level II ipsilateral metastatic lymph nodes, Levels II and IV contralateral metastatic lymph nodes, and age were the independent predictors of the risk of death. CONCLUSIONS This study demonstrates that simultaneous bilateral neck dissection has a high morbidity and should be contraindicated as an elective procedure. Further studies with selective neck dissections are warranted.
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Affiliation(s)
- J Magrin
- Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A.C. Camargo, São Paulo, Brazil
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Sun R, Colin E, Ajitanand NN, Alexander JM, Barton MA, DeYoung PA, Drake KL, Elmaani A, Gelderloos CJ, Gualtieri EE, Guinet D, Hannuschke S, Jaasma JA, Kowalski L, Lacey RA, Lauret J, Norbeck E, Pak R, Peaslee GF, Stern M, Stone NT, Sundbeck SD, Westfall GD, Yang LB, Yee J. Balance of mass, momentum, and energy in splintering central collisions for 40Ar up to 115 MeV /Nucleon. Phys Rev Lett 2000; 84:43-46. [PMID: 11015830 DOI: 10.1103/physrevlett.84.43] [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] [Subscribe] [Scholar Register] [Received: 09/01/1999] [Indexed: 05/23/2023]
Abstract
For central collisions of (17-115)A MeV 40Ar+Cu, Ag, Au, an overall balance is determined for the average mass, energy, and longitudinal momentum. Light charged particles and fragments are separated into forward-focused and isotropic components in the frame of the heaviest fragment. Energy removal by the isotropic component reaches 1-2 GeV. For such high deposition energies, statistical multifragmentation models predict much more extensive nuclear disassembly than is observed.
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Affiliation(s)
- R Sun
- Department of Chemistry, State University of New York at Stony Brook, Stony Brook, New York 11794, USA
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Teixeira G, Antonangelo L, Kowalski L, Saldiva P, Ferraz A, Silva Filho G. Argyrophilic nucleolar organizer regions staining is useful in predicting recurrence-free interval in oral tongue and floor of mouth squamous cell carcinoma. Am J Surg 1996; 172:684-8. [PMID: 8988678 DOI: 10.1016/s0002-9610(96)00306-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Argyrophilic nucleolar organizer regions (AgNORs) represent a tissue marker of cell proliferative activity. The purpose of this study was to assess the prognostic value of AgNORs expression in oral squamous cell carcinoma (SCC). METHODS The AgNORs area/nucleus was studied in paraffin sections by means of digital image analysis in 43 cases of stage II oral tongue and floor of the mouth SCC. RESULTS Time free of disease was considered a dependent variable of a binary indicator of AgNORs expression (7.77 microns2/nucleus as a cut-off point). High AgNORs level was associated with a statistically significant negative effect on recurrence-free interval of disease in a Cox proportional hazards models controlled for occult lymph node metastasis, involvement of the surgical margins, thickness of the lesion, and vascular invasion. CONCLUSIONS The AgNORs area increased the capability of predicting which patients have a high risk of recurrence of cancer, and its evaluation may provide useful information for the therapeutic approach to the oral tongue and floor of the mouth SCC.
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Affiliation(s)
- G Teixeira
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo, Brazil
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Magda MT, Bauge E, Elmaani A, Braunstein T, Gelderloos CJ, Ajitanand NN, Alexander JM, Ethvignot T, Bier P, Kowalski L, Désequelles P, Elhage H, Giorni A, Kox S, Lleres A, Merchez F, Morand C, Stassi P, Benrachi JB, Chambon B, Cheynis B, Drain D, Pastor C. Fusionlike reactions of 40Ar up to 1.36 GeV: Prethermalization and postthermalization particles and fragments. Phys Rev C Nucl Phys 1996; 53:R1473-R1477. [PMID: 9971177 DOI: 10.1103/physrevc.53.r1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Gelderloos CJ, Alexander JM, Ajitanand NN, Bauge E, Elmaani A, Ethvignot T, Kowalski L, Lacey RA, Brandan ME, Giorni A, Heuer D, Kox S, Lleres A, Menchaca-Rocha A, Merchez F, Rebreyend D, Viano JB, Chambon B, Cheynis B, Drain D, Pastor C. Time relationships between direct particle emission and fragmentation: A probe for nuclear expansion prior to fragment freeze-out. Phys Rev Lett 1995; 75:3082-3085. [PMID: 10059490 DOI: 10.1103/physrevlett.75.3082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Alexander JM, Elmaani A, Kowalski L, Ajitanand NN, Gelderloos CJ. Alternatives for understanding qualitative features that dominate particle-particle correlations in heavy-ion reactions of. Phys Rev C Nucl Phys 1993; 48:2874-2880. [PMID: 9969164 DOI: 10.1103/physrevc.48.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Ethvignot T, Ajitanand NN, Alexander JM, Bauge E, Elmaani A, Kowalski L, Lopez M, Magda MT, Désesquelles P, Elhage H, Giorni A, Heuer D, Kox S, Lleres A, Merchez F, Morand C, Rebreyend D, Stassi P, Viano JB, Benrachi F, Chambon B, Cheynis B, Drain D, Pastor C. Evolution of fragment-fragment correlations in reactions of 197Au and 107,109Ag with 40Ar from 7A to 34A MeV. Phys Rev C Nucl Phys 1992; 46:637-646. [PMID: 9968160 DOI: 10.1103/physrevc.46.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Kowalski L, Falqui L, Lacy PE, Scharp DW. Production of marked prolongation of survival of canine islet xenografts in mice by antilymphocyte sera and L3T4 antibody. Transplantation 1991; 52:1094-7. [PMID: 1750074 DOI: 10.1097/00007890-199112000-00033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- L Kowalski
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri
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Miller PD, Neal BJ, McIntyre DO, Yanover MJ, Anger MS, Kowalski L. Effect of cyclical therapy with phosphorus and etidronate on axial bone mineral density in postmenopausal osteoporotic women. Osteoporos Int 1991; 1:171-6. [PMID: 1790405 DOI: 10.1007/bf01625449] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Forty seven women with postmenopausal osteoporosis and at least one but no more than four vertebral compression fractures received sequential and cyclical therapy with phosphorus and etidronate (p/etid). During the same 2-year period of observation, three other groups of patients received either sodium fluoride (n = 12), estrogen replacement therapy (n = 12), or vitamin D and calcium (Ca++) alone (n = 15). Axial bone mineral density (BMD) was measured by means of dual-photon absorptiometry. Lateral thoracic and lumbar spine radiographs were taken to assess fractures. Bone mineral density increased from baseline during p/etid therapy: Mean 15.7 +/- 1.6% (SD) (P less than 0.001). During the same time, the patients in the sodium fluoride group showed a comparable increase in their BMD from baseline: mean 15.7 +/- 1.1% (P less than 0.001). During the first year of therapy, patients in the estrogen replacement group had an increase in their BMD from baseline: mean: 4.6% +/- 1.1% (P less than 0.05). No change in BMD was seen in the control group that received vitamin D and Ca++ alone. No patient who received p/etid, sodium fluoride, or estrogen replacement therapy had any new vertebral compression fractures or height loss, whereas in the control group that received vitamin D and Ca++ alone 6 out of 15 had height loss and at least one new vertebral fracture (P less than 0.01). p/etid therapy increases BMD in women with postmenopausal osteoporosis comparable to sodium fluoride but without side effects or toxicity and stabilizes vertebral compression fractures.
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Affiliation(s)
- P D Miller
- Western Nephrology and Metabolic Bone Disease Group, P.C. Lakewood, Colorado
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Ethvignot T, Elmaani A, Ajitanand NN, Alexander JM, Bauge E, Bier P, Kowalski L, Magda MT, Désesquelles P, Elhage H, Giorni A, Heuer D, Kox S, Lleres A, Merchez F, Morand C, Rebreyend D, Stassi P, Viano JB, Benrachi S, Chambon B, Cheynis B, Drain D, Pastor C, Fourier J. Tracking the dissipation of energy and angular momentum in central collisions between Ag and 40Ar of 7, 17, 27, and 34 MeV/nucleon. Phys Rev C Nucl Phys 1991; 43:R2035-R2039. [PMID: 9967305 DOI: 10.1103/physrevc.43.r2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
A consecutive series of 28 patients treated by conservation surgery of the larynx for radiation-failure, recurrent rT1 and T2 (postradiotherapy staging) glottic squamous cell carcinoma treated at Memorial Sloan-Kettering Cancer Center from 1966 to 1983 is reviewed. The majority of patients were men with the age ranging from 46 to 76 years. The disease-free interval ranged from 0 to 113 months (median, 8.5 months). The stage at presentation was rT1 in 25 patients and rT2 in 3 patients. Surgery consisted of cordectomy (7 patients), hemilaryngectomy (18), and extended hemilaryngectomy (3). There was no operative mortality. Local recurrence developed in 8 patients (28.5%), cervical metastasis in 2, and distant metastasis in 1. Only 3 patients were salvaged by further treatment. The rate of local control was influenced by positive surgical margins. Overall, voice preservation was achieved in 75% of patients. The ultimate local control was 82.1% during a follow-up period that ranged from 1.3 to 16.7 years (median, 6.3 years). The actuarial survival at 5 and 10 years was 73% and 71% following conservation surgery of the larynx.
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Affiliation(s)
- J P Shah
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Lacey R, Ajitanand NN, Alexander JM, Peaslee GF, Vaz LC, Kaplan M, Kildir M, Moses DJ, Parker WE, Logan D, Zisman MS, DeYoung P, Kowalski L. Large-angle correlations between 4He and 1,2,3H or 4He in the reactions 247 and 337 MeV 40Ar+natAg: Unexpected properties of the nuclear stratosphere. Phys Rev C Nucl Phys 1988; 37:2561-2577. [PMID: 9954733 DOI: 10.1103/physrevc.37.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Lacey R, Ajitanand NN, Alexander JM, Peaslee GF, Vaz LC, Kaplan M, Kildir M, Moses DJ, Parker WE, Logan D, Zisman MS, DeYoung P, Kowalski L. Mechanisms for light charged particle emission in the reactions 247 and 337 MeV 40Ar+natAg. Phys Rev C Nucl Phys 1988; 37:2540-2560. [PMID: 9954732 DOI: 10.1103/physrevc.37.2540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Fluss MJ, Miller JM, D'Auria JM, Dudey N, Foreman BM, Kowalski L, Reedy RC. Investigation of the Bohr-Independence Hypothesis for Nuclear Reactions in the Continuum:α+Co59,p+Ni62andα+Fe56,p+Cl59. ACTA ACUST UNITED AC 1969. [DOI: 10.1103/physrev.187.1449] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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