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Plonowska-Hirschfeld KA, Gulati A, Stephens EM, Ochoa E, Xu MJ, Ha PK, Heaton CM, Yom SS, Chan JW, Algazi A, Kang H, Ryan WR. Treatment Modality Impact on Patient-Reported Quality of Life in Human Papilloma Virus-Associated Oropharyngeal Carcinoma. Laryngoscope 2024; 134:1687-1695. [PMID: 37767815 DOI: 10.1002/lary.31065] [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: 03/24/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To prospectively compare the impact of treatment modality on patient-reported quality of life (QOL) in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC). STUDY DESIGN Prospective cohort study. SETTING Academic medical center. METHODS One hundred one patients with American Joint Committee on Cancer (AJCC) 8th edition T1-3 N0-2 HPV + OPSCC completed the European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire and Head and Neck Module pretreatment and 3-month and 1-year posttreatment. Mean score changes were compared to published minimal clinically important differences. RESULTS Patients underwent surgery alone (SA: N = 42, 42%), surgery with adjuvant radiation (S-RT: N = 10, 10%), surgery with adjuvant chemoradiation (S-CRT: N = 8, 8%), definitive radiation (RT: N = 11, 11%), or definitive chemoradiation (CRT: N = 30, 30%). SA, S-[C]RT, and [C]RT patients all reported clinically significant difficulty with sense of taste/smell persisting at 1 year. S-[C]RT and [C]RT patients reported statistically and clinically significant worse salivary dysfunction and problems with social eating at 1 year than SA. S-[C]RT patients reported statistically and clinically significant worse fatigue and head and neck pain compared to [C]RT and SA patients at 3 months, but normalized at 1 year. S-CRT compared to S-RT had statistically and clinically worse physical and role functioning and swallowing difficulties at 3 months but this difference was resolved by 1-year posttreatment. CONCLUSION HPV + OPSCC patients after SA report the lowest posttreatment QOL impact, whereas after S-CRT report the highest symptom burden. Careful selection for definitive surgery is important given the possibility of adjuvant CRT. Patients can experience persistent sense taste and smell difficulties at 1 year with all treatment modalities. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1687-1695, 2024.
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Affiliation(s)
- Karolina A Plonowska-Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Erika M Stephens
- University of California- San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Edgar Ochoa
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mary Jue Xu
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Patrick K Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Chase M Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Jason W Chan
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Alain Algazi
- Department of Hematology and Oncology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Hyunseok Kang
- Department of Hematology and Oncology, University of California-San Francisco, San Francisco, California, U.S.A
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
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Callander JK, Souza SS, Eltawil Y, El-Sayed IH, George JR, Ha P, Ryan WR, Xu MJ, Heaton CM. Prognostic risk factors of buccal squamous cell carcinoma: A case-control study. Head Neck 2024. [PMID: 38411290 DOI: 10.1002/hed.27705] [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: 06/21/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES To describe the clinicopathologic presentation of buccal squamous cell carcinoma and identify risks factors for recurrence and overall survival. METHODS This is a retrospective case-control study of patients with oral cavity squamous cell carcinoma (OCSCC) treated at a single tertiary care center between 2010 and 2022. All patients with buccal subsite OCSCC treated during this time frame were included and paired with a randomly selected age and gender matched patient with non-buccal OCSCC. Relevant data was collected via chart review. RESULTS Seventy-seven patients with buccal SCC were matched with 77 non-buccal OCSCC controls. The median follow-up time was 27 months (IQR 14-61). Median age was 67 years (IQR 57-75) and 53% of the cohort was female. Twenty (26%) buccal SCC patients experienced a recurrence versus 19 (25%) in the controls. Age ≥65-years-old increased odds of all-cause mortality in the buccal SCC group, but not in the control group. Perineural invasion and positive margins increased odds of recurrence in the buccal group only. Overall survival and progression-free survival did not differ between the groups, despite a greater number of T2 buccal tumors and T1 non-buccal tumors. CONCLUSIONS Buccal SCC presents at a higher T stage than other oral cavity SCC subsite and may exhibit variance in the pathologic risk factors that predict poor outcomes versus non-buccal OCSCC. Despite these relatively minor differences, however, oncologic outcomes between these groups were similar.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Spenser S Souza
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Yasmin Eltawil
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Jonathan R George
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, San Francisco, California, USA
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Zeng Z, Zhou MF, Lin YJ, Bi XY, Yang L, Deng W, Jiang TT, Hu LP, Xu MJ, Zhang L, Yi W, Li MH. [A real-world study on the features of postpartum hepatitis flares in pregnant women with chronic HBV infection]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:113-118. [PMID: 38514259 DOI: 10.3760/cma.j.cn501113-20231122-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Objective: To analyze the clinical features of postpartum hepatitis flares in pregnant women with hepatitis B virus (HBV) infection. Methods: A retrospective study was conducted. Patients who met the enrollment criteria were included. Liver function and HBV virology tests were collected from pregnant women with chronic HBV infection at delivery, 6, 24, 36, and 48 weeks after delivery through the hospital information and test system. Additionally, antiviral therapy types and drug withdrawal times were collected. Statistical analysis was performed on all the resulting data. Results: A total of 533 pregnant women who met the inclusion criteria were included, with all patients aged (29.5±3.7) years old. A total of 408 cases received antiviral drugs during pregnancy to interrupt mother-to-child transmission. There was no significant difference in the levels of alanine aminotransferase (ALT, z = -1.981, P = 0.048), aspartate aminotransferase (AST, z = -3.956, P < 0.001), HBV load (z = -15.292, P < 0.001), and HBeAg (z = -4.77, P < 0.001) at delivery in patients who received medication and those who did not. All patients ALT, AST, total bilirubin, direct bilirubin, and albumin showed an upward trend within six weeks after delivery. A total of 231 cases developed hepatitis within 48 weeks after delivery. Among them, 173 cases first showed ALT abnormalities within six weeks postpartum. Conclusion: Hepatitis flare incidence peaked six weeks after delivery or six weeks after drug withdrawal in pregnant women with chronic HBV infection.
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Affiliation(s)
- Z Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing 100015, China
| | - M F Zhou
- Departmentof Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Y J Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing 100015, China
| | - X Y Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - L Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - W Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - T T Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - L P Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - M J Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - L Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - W Yi
- Departmentof Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - M H Li
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing 100015, China Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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Nzisabira J, Nuss S, Candelo E, Oumo EA, Shah KV, Kim EK, Wiedermann J, Masimbi O, Shimelash N, Xu MJ. Low-Cost Otolaryngology Simulation Models for Early-Stage Trainees: A Scoping Review. Res Sq 2023:rs.3.rs-3673832. [PMID: 38106212 PMCID: PMC10723536 DOI: 10.21203/rs.3.rs-3673832/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Importance There is a notable lack of low-cost OHNS simulation models that are relevant for early medical trainees and students. By conducting this study, we will understand the current landscape of low-cost otolaryngology-head and neck surgery simulation for early medical trainees and students. Objectives Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature. Evidence Review This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents. Findings Of the 1706 studies screened, 17 met the inclusion criteria. Most studies were conducted in HICs. Most models were low fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation. Conclusion and Relevance Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.
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Affiliation(s)
| | - Sarah Nuss
- Brown University Warren Alpert Medical School
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Okerosi S, Nkya A, Fagan J, Xu MJ. Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa. Curr Opin Otolaryngol Head Neck Surg 2023; 31:438-440. [PMID: 37820268 DOI: 10.1097/moo.0000000000000932] [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: 10/13/2023]
Abstract
PURPOSE OF REVIEW With an increased need to decentralize and train more head and neck ablative and reconstructive surgeons in sub-Saharan Africa, we assess the realities and challenges of free flap reconstruction in sub-Saharan Africa to provide context of its use as a reconstructive option. RECENT FINDINGS Head and neck free flap reconstruction has been performed by local teams as well as visiting teams in Sub Saharan Africa with good results. Free flap success rates are similar to high income regions at 89% vs. 85-100%. However, flap salvage rates are significantly lower (45% compared to 64.1% reported in high income regions). This has been attributed to resource constraints. SUMMARY With increasing efforts to increase free flap reconstructive capacity in sub-Saharan Africa, these efforts need to be in the context of available healthcare resources including infrastructure and workforce outside of the surgical team. As training of head and neck ablative and reconstructive surgeons is expanded, reconstructive training needs take the healthcare resource availability into account.
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Affiliation(s)
- Samuel Okerosi
- ENT Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Aslam Nkya
- Department of Otorhinolaryngology, Muhimibili National Hospital, Dar es Salaam, Tanzania
| | - Johan Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Selekwa M, Maina I, Yeh T, Nkya A, Ncogoza I, Nuss RC, Mushi BP, Haddadi S, Van Loon K, Mbaga E, Massawe W, Roberson DW, Dharsee N, Musimu B, Xu MJ. Tracheostomy care quality improvement in low- and middle-income countries: A scoping review. PLOS Glob Public Health 2023; 3:e0002294. [PMID: 37943736 PMCID: PMC10635432 DOI: 10.1371/journal.pgph.0002294] [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: 07/13/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Tracheostomy is a lifesaving, essential procedure performed for airway obstruction in the case of head and neck cancers, prolonged ventilator use, and for long-term pulmonary care. While successful quality improvement interventions in high-income countries such as through the Global Tracheostomy Collaborative significantly reduced length of hospital stay and decreased levels of anxiety among patients, limited literature exists regarding tracheostomy care and practices in low and middle-income countries (LMIC), where most of the world resides. Given limited literature, this scoping review aims to summarize published tracheostomy studies in LMICs and highlight areas in need of quality improvement and clinical research efforts. Based on the PRISMA guidelines, a scoping review of the literature was performed through MEDLINE/PubMed and Embase using terms related to tracheostomy, educational and quality improvement interventions, and LMICs. Publications from 2000-2022 in English were included. Eighteen publications representing 10 countries were included in the final analysis. Seven studies described baseline needs assessments, 3 development of training programs for caregivers, 6 trialed home-based or hospital-based interventions, and finally 2 articles discussed development of standardized protocols. Overall, studies highlighted the unique challenges to tracheostomy care in LMICs including language, literacy barriers, resource availability (running water and electricity in patient homes), and health system access (financial costs of travel and follow-up). There is currently limited published literature on tracheostomy quality improvement and care in LMICs. Opportunities to improve quality of care include increased efforts to measure complications and outcomes, implementing evidence-based interventions tailored to LMIC settings, and using an implementation science framework to study tracheostomy care in LMICs.
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Affiliation(s)
- Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ivy Maina
- Department of Otolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tiffany Yeh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Aslam Nkya
- Department of Otolaryngology-Head & Neck Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Isaie Ncogoza
- Department of Surgery, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Roger C. Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sumaiya Haddadi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California, United States of America
| | - Elia Mbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willybroad Massawe
- Department of Otolaryngology-Head & Neck Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Otolaryngology-Head and Neck Surgery, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - David W. Roberson
- Bayhealth Medical Group, Dover, Delaware, United States of America
- Global Tracheostomy Collaborative, Raleigh, North Carolina, United States of America
| | - Nazima Dharsee
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Baraka Musimu
- Department of Otolaryngology-Head and Neck Surgery, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, United States of America
- National Clinician Scholars Program, University of California San Francisco, San Francisco, California, United States of America
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Petrucci B, Okerosi S, Patterson RH, Hobday SB, Salano V, Waterworth CJ, Brody RM, Sprow H, Alkire BC, Fagan JJ, Tamir SO, Der C, Bhutta MF, Maina IW, Pang JC, Daudu D, Mukuzi AG, Srinivasan T, Pietrobon CA, Hao SP, Nakku D, Seguya A, Din TF, Mbougo OD, Mokoh LW, Jashek-Ahmed F, Law TJ, Holt EA, Bangesh AH, Zemene Y, Ibekwe TS, Diallo OR, Alvarado J, Mulwafu WK, Fenton JE, Agius AM, Doležal P, Mudekereza ÉA, Mojica KM, Rueda RS, Xu MJ. The Global Otolaryngology-Head and Neck Surgery Workforce. JAMA Otolaryngol Head Neck Surg 2023; 149:904-911. [PMID: 37651133 PMCID: PMC10472262 DOI: 10.1001/jamaoto.2023.2339] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/25/2023] [Indexed: 09/01/2023]
Abstract
Importance A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome The OHNS workforce per capita, stratified by income and region. Results Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.
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Affiliation(s)
| | - Samuel Okerosi
- Ear Nose and Throat Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Rolvix H. Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Hobday
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Valerie Salano
- Ear Nose and Throat Department, Nyahururu County Hospital, Nyahururu, Kenya
| | - Christopher J. Waterworth
- Nossal Institute for Global Health, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Holly Sprow
- Tufts University School of Medicine, Boston, Massachusetts
| | - Blake C. Alkire
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Johannes J. Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Sharon Ovnat Tamir
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Israel
| | - Carolina Der
- Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Hospital Dr Luis Calvo Mackenna, Chile
| | | | - Ivy W. Maina
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Jonathan C. Pang
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Allan G. Mukuzi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Nairobi, Kenya
| | | | | | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Fu-Jen University, Taiwan
| | - Doreen Nakku
- Department of Otolaryngology Head and Neck Surgery, Mbarara University of Science and Technology, Uganda
| | - Amina Seguya
- Department of Otolaryngology Head and Neck Surgery, Mulago National Referral Hospital, Uganda
| | - Taseer F. Din
- Division of Pediatric Otolaryngology, Head-Neck Surgery, Department of Otolaryngology, Head-Neck Surgery, Stanford University, Stanford, California
| | | | - Lilian W. Mokoh
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Farizeh Jashek-Ahmed
- The International Center for Recurrent Head and Neck Cancer, the Royal Marsden Hospital, London, United Kingdom
| | - Tyler J. Law
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
| | - Elizabeth A. Holt
- The Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand
| | | | - Yilkal Zemene
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Titus S. Ibekwe
- University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | - Wakisa K. Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John E. Fenton
- Department of Otorhinlaryngology–Head and Neck Surgery, University of Limerick, Limerick, Ireland
| | - Adrian M. Agius
- Department of Otorhinolaryngology, University of Malta, Malta
| | - Pavel Doležal
- Department of Otorhinolaryngology and Head and Neck Surgery, Slovak Medical University, Bratislava, Slovakia
| | - Édouard Amani Mudekereza
- Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Karen M. Mojica
- Department of otolaryngology, Vivian Pellas Hospital, Managua, Nicaragua
| | - Ricardo Silva Rueda
- Servicio de Otorrinolaringología, Bogota, Hospital Militar Central, Bogata, Colombia
| | - Mary Jue Xu
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
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Ndon S, Singh A, Ha PK, Aswani J, Chan JYK, Xu MJ. Human Papillomavirus-Associated Oropharyngeal Cancer: Global Epidemiology and Public Policy Implications. Cancers (Basel) 2023; 15:4080. [PMID: 37627108 PMCID: PMC10452639 DOI: 10.3390/cancers15164080] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Global trends in human papillomavirus (HPV)-associated head and neck cancers (HNC), specifically in the oropharynx subsite, have been dynamically changing, leading to new staging and treatment paradigms. Epidemiologic studies have noted regional variations in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). While HPV vaccination remains the main preventative approach, vaccination policy in relation to gender neutrality is heterogeneous and particularly sparse in low- and middle-income countries, where the burden of global cancer cases and HPV-associated HNC are not well-characterized in certain regions. This review summarizes the existing literature on regional variations of HPV-associated OPSCC and gender-neutral vaccine policies. Based on available data, the incidence of HPV-associated OPSCC is highest in North America, Europe, and Oceania. As of 2022, 122 of 195 (63%) World Health Organization (WHO) member states had incorporated HPV vaccinations nationally; of these, 41 of 122 (34%) member states have introduced gender-neutral vaccine coverage. Future research is needed to describe continued evolving trends in HPV-associated OPSCC, understand underlying risk factors leading to regional variation in disease, and implement gender-neutral policy more broadly.
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Affiliation(s)
- Sifon Ndon
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94115, USA
| | - Amritpal Singh
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Patrick K. Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94115, USA
| | - Joyce Aswani
- Department of Surgery, University of Nairobi, Nairobi 00100, Kenya
| | - Jason Ying-Kuen Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94115, USA
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9
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Canick J, Petrucci B, Patterson R, Saunders J, Htoo Thaw M, Omosule I, Denton A, Xu MJ, Chadha S, Young G, Siafa L, Mortel O, Shamshad A, Reddy A, McCalla M, Prasad K, Yang HH, Pan DR, Shah J, Smith E, Alkire B, Ibekwe T, Waterworth C. An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans. Health Policy Plan 2023; 38:719-725. [PMID: 37130061 PMCID: PMC10274565 DOI: 10.1093/heapol/czad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023] Open
Abstract
Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.
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Affiliation(s)
- Julia Canick
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Rolvix Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - James Saunders
- Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766 , USA
| | | | - Ikeoluwa Omosule
- Department of Otorhinolaryngology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Alexa Denton
- Department of Otolaryngology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Mary Jue Xu
- Department of Otolaryngology—Head and Neck Surgery, UCSF, San Francisco , CA 94143, USA
| | - Shelly Chadha
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Gabrielle Young
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lyna Siafa
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
| | - Olivier Mortel
- Hôpital de l'Université d'état d'Haïti, Port-au-Prince, Haiti
| | - Alizeh Shamshad
- Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ashwin Reddy
- Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Monet McCalla
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, USA
| | - Kavita Prasad
- Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Debbie R Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Jaffer Shah
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Emily Smith
- Duke Global Health Institute, Durham, NC 27710, USA
- Department of Surgery, Duke University, Durham, NC 27710, USA
| | - Blake Alkire
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Titus Ibekwe
- Department of Otorhinolaryngology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Chris Waterworth
- Disability Inclusion for Health and Development, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Audiology and Speech Pathology, University of Melbourne Faculty of Medicine, Dentistry, & Health Sciences, Carlton, VIC, Australia
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10
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Srinivasan T, Cherches A, Seguya A, Salano V, Patterson RH, Xu MJ, Alkire BC, Okerosi SN, Tamir SO. Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative. Curr Opin Otolaryngol Head Neck Surg 2023; 31:194-201. [PMID: 36942853 PMCID: PMC10155687 DOI: 10.1097/moo.0000000000000885] [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: 03/23/2023]
Abstract
PURPOSE OF REVIEW To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery. RECENT FINDINGS To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions. SUMMARY Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting.
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Affiliation(s)
- Tarika Srinivasan
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Harvard Medical School, Boston, Massachusetts
| | - Alexander Cherches
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Amina Seguya
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Mulago National Referral Hospital, Kampala, Uganda
| | - Valerie Salano
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Nyahururu County Hospital, Laikipia County, Kenya
| | - Rolvix H Patterson
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mary Jue Xu
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Blake C Alkire
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical Schoo
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Samuel N Okerosi
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Kenyatta National Hospital, Nairobi, Kenya
| | - Sharon Ovnat Tamir
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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11
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Nuss S, Patterson RH, Wiedermann J, Cahill GL, Alkire B, Okerosi S, Xu MJ. Response to Letter to the Editor Regarding "Delphi Method Consensus on Priority Global Otolaryngology-Head and Neck Surgery Conditions and Procedures". Otolaryngol Head Neck Surg 2023; 168:249-250. [PMID: 36373366 DOI: 10.1177/01945998221095101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sarah Nuss
- The Global OHNS Initiative.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rolvix H Patterson
- The Global OHNS Initiative.,Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Josh Wiedermann
- The Global OHNS Initiative.,Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabrielle L Cahill
- The Global OHNS Initiative.,University of California-San Diego, La Jolla, California, USA.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake Alkire
- The Global OHNS Initiative.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Samuel Okerosi
- The Global OHNS Initiative.,Machakos Level 5 Hospital, Machakos, Kenya
| | - Mary Jue Xu
- The Global OHNS Initiative.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Okerosi S, Mokoh LW, Rubagumya F, Niyibizi BA, Nkya A, Van Loon K, Buckle G, Bent S, Ha P, Fagan JJ, Ng D, Aswani J, Xu MJ. Human Papillomavirus-Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023; 9:e2200259. [PMID: 36730877 PMCID: PMC10166441 DOI: 10.1200/go.22.00259] [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: 02/04/2023] Open
Abstract
PURPOSE The proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA. MATERIALS AND METHODS This systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies. RESULTS In this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%). CONCLUSION HPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.
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Affiliation(s)
- Samuel Okerosi
- ENT, Kenyatta National Hospital, ENT Department, Nairobi, Kenya
| | | | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda.,Rwanda Cancer Relief, Kigali, Rwanda
| | | | - Aslam Nkya
- Department of Otorhinolaryngology, Muhimibili National Hospital, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Geoffrey Buckle
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Stephen Bent
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Patrick Ha
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Dianna Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joyce Aswani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | - Mary Jue Xu
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
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13
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Suresh NV, Xu MJ, Harris J, Balar E, Barrette LX, Chorath KT, Moreira AG, Rajasekaran K. Characterizing critical predictors of an academic career following head and neck fellowship in otolaryngology. Head Neck 2022; 44:2708-2716. [PMID: 36073185 DOI: 10.1002/hed.27187] [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: 04/18/2022] [Revised: 07/04/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Historically, graduating head and neck (HN) fellows outpace available academic HN positions, resulting in a highly competitive job market. We identified factors that associate with full-time academic HN positions post-HN fellowship. METHODS Graduates of American Head and Neck Society (AHNS)-accredited fellowships from 2005 to 2017 (n = 356) were extracted from the AHNS website. RESULTS From 2015 to 2017, the supply-demand mismatch for academic HN jobs improved. Of the 57.3% (n = 204) of graduating HN fellows who entered academia, 64% (n = 130) trained at just 10 fellowship institutions, 47% (n = 94) attended OHNS residency at an NIH top 40 funded institution, and 54% (n = 111) attended OHNS residency at an AHNS-accredited institution offering HN fellowship. After multivariate regression, number of manuscripts (OR = 1.14; p = 0.01) was significantly associated with initial academic job post-fellowship. CONCLUSION The recent improvement in supply-demand mismatch for academic jobs is promising for future HN fellows interested in academia.
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Affiliation(s)
- Neeraj V Suresh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Jue Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Harris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eesha Balar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louis-Xavier Barrette
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin T Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro G Moreira
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Nuss S, Patterson RH, Cahill GL, Alkire B, Jue Xu M, Salano V, Wiedermann J, Okerosi S. Delphi Method Consensus on Priority Global Otolaryngology-Head and Neck Surgery Conditions and Procedures. Otolaryngol Head Neck Surg 2022; 167:669-677. [PMID: 35077240 DOI: 10.1177/01945998211073705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to develop an international expert consensus on priority otolaryngology-head and neck surgery conditions and procedures globally for which national health systems should be capable of caring. STUDY DESIGN The Delphi method was employed via a multiround online survey administered to attending otolaryngologists in an international research collaborative of >180 otolaryngologists in >40 countries. SETTING International online survey. METHODS In round 1, participants listed the top 15 otolaryngologic conditions and top 15 otolaryngology procedures for their World Bank regions. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as 50% of the round 2 Likert responses being ranked as "important" or "very important." Descriptive statistics were calculated for each round. RESULTS The survey was distributed to 53 experts globally, with a response rate of 38% (n = 20). Fifty percent (n = 10) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. Ten consensus surgical procedures and 10 consensus conditions were identified. CONCLUSION This study identified a list of priority otolaryngology-head and neck surgery conditions and surgical procedures for which all national health systems around the world should be capable of managing. Acute and infectious conditions with preventative and emergent procedures were highlighted. These findings can direct future research and guide international collaborations.
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Affiliation(s)
- Sarah Nuss
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rolvix H Patterson
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Gabrielle L Cahill
- The Global Otolaryngology-Head and Neck Surgery Initiative.,University of California-San Diego, La Jolla, California, USA.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake Alkire
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Mary Jue Xu
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie Salano
- The Global Otolaryngology-Head and Neck Surgery Initiative
| | - Josh Wiedermann
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel Okerosi
- The Global Otolaryngology-Head and Neck Surgery Initiative.,Machakos Level 5 Hospital, Machakos, Kenya
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15
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Lu DH, Sun GP, Ma H, Xu MJ, Gao SL, Wang DM. [Research progress of pyruvate kinase type M2 in hepatocellular carcinoma]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:117-120. [PMID: 35152683 DOI: 10.3760/cma.j.cn501113-20200708-00379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Primary hepatocellular carcinoma is one of the most common high-grade malignant tumors in the world. Its incidence ranks fifth among malignant tumors in China, and various therapeutic measures have poor curative effect. Pyruvate kinase type M2 is a key enzyme in the glycolytic pathway, and its abnormal expression in liver cancer is closely related to the proliferation, metastasis, diagnosis, treatment, prognosis, as well as drug and radiation resistance. Therefore, multi-pathway targeted regulation of pyruvate kinase type M2 use is expected to become a new direction for the treatment of primary liver cancer.
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Affiliation(s)
- D H Lu
- Department of Oncology, the 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - G P Sun
- Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei 230031, China
| | - H Ma
- Department of Oncology, the 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - M J Xu
- Department of Oncology, the 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - S L Gao
- Department of Oncology, the 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
| | - D M Wang
- Department of Oncology, the 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China
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16
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Morshed RA, Haddad AF, Raygor KP, Xu MJ, Limb CJ, Theodosopoulos PV. Microsurgical resection of an intravestibular schwannoma: a review of surgical technique and management considerations. Neurosurgical Focus: Video 2021; 5:V6. [PMID: 36285245 PMCID: PMC9550013 DOI: 10.3171/2021.7.focvid2187] [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] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Intravestibular schwannomas are rare tumors within the intralabyrinthine region and involve different management considerations compared to more common vestibular schwannomas. In this report, the authors review a case of a 52-year-old woman who presented with hearing loss and vestibular symptoms and was found to have a left intravestibular schwannoma. Given her debilitating vestibular symptoms, she underwent microsurgical resection. In this video, the authors review the relevant anatomy, surgical technique, and management considerations in these patients. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2187
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Affiliation(s)
| | | | | | - Mary Jue Xu
- Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California
| | - Charles J. Limb
- Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California
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17
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Patterson RH, Xu MJ, Okerosi S, Bhutta MF, Der C, Alkire B, Njogu R, Vendra V, Tamir SO, Fagan JJ. Letter to the Editor Response Regarding "Research Equity in Otolaryngology-Head and Neck Surgery". OTO Open 2021; 5:2473974X211041958. [PMID: 34497973 PMCID: PMC8419552 DOI: 10.1177/2473974x211041958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Xu MJ, Chang JL. Practical Salivary Ultrasound Imaging Tips and Pearls. Otolaryngol Clin North Am 2021; 54:471-487. [PMID: 34024476 DOI: 10.1016/j.otc.2021.02.008] [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: 10/21/2022]
Abstract
Ultrasound imaging is a valuable and effective clinical tool for salivary gland disorder evaluation and management. Pathologies including salivary duct stenosis, sialolithiasis, neoplasms, and autoimmune disorders have characteristic sonographic features. Maneuvers such as bimanual palpation and oral administration of sialagogues during the ultrasound examination can enhance examination findings. Ultrasound guidance is useful for targeting needle biopsies of neoplasms, ensuring appropriate intraparenchymal gland injections, and augmenting salivary duct instrumentation and intraoperative management.
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Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter Street Box 0342, San Francisco, CA 94115, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter Street Box 0342, San Francisco, CA 94115, USA.
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19
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Zhu MF, Chen LX, Gao F, Sheng DY, Xu MJ, Zhang JR, Qian WX. Correlation of STAT6 expression and gene polymorphism with chronic obstructive pulmonary disease. J BIOL REG HOMEOS AG 2021; 35:735-738. [PMID: 33792217 DOI: 10.23812/20-627-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M F Zhu
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - L X Chen
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - F Gao
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - D Y Sheng
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - M J Xu
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - J R Zhang
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
| | - W X Qian
- Department of Respiratory Diseases, The First People's Hospital of Zhangjiagang City, Soochow University, Zhangjiagang, China
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20
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Patterson RH, Xu MJ, Okerosi S, Bhutta MF, Der C, Alkire B, Njogu R, Vendra V, Tamir SO, Fagan JJ. Research Equity in Otolaryngology-Head and Neck Surgery. OTO Open 2021; 5:2473974X211024145. [PMID: 34212124 PMCID: PMC8216382 DOI: 10.1177/2473974x211024145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Equitable research collaborations benefit the quality and relevance of global otolaryngology-head and neck surgery research. However, analyses of existing global health literature have shown disproportionate representation by foreign authors. To avert this inequity and improve global otolaryngology-head and neck surgery research, we propose a framework that emphasizes local representation and capacity building in research.
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Affiliation(s)
- Rolvix Harlan Patterson
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Mary Jue Xu
- Department of Otolaryngology–Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Samuel Okerosi
- Department of Otolaryngology, Machakos Level Five Hospital, Machakos, Kenya
| | - Mahmood F. Bhutta
- University Hospitals Sussex, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Carolina Der
- School of Medicine, Clínica Alemana, Universidad del Desarrollo; Otorhinolaryngology Department, Dr Luis Calvo Mackenna Children’s Hospital, Santiago, Chile
| | - Blake Alkire
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Global Health Equity, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rose Njogu
- SH:24 Sexual and Adolescent Reproductive Health, London, UK
| | - Varun Vendra
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharon Ovnat Tamir
- Department of Otolaryngology–Head and Neck Surgery, Faculty of Health Sciences, Samson Assuta Ashdod University Hospital, Ben Gurion University, Ashdod, Israel
| | - Johannes J. Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
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21
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Wang N, Xu MJ, House AE, Strohl MP, Goldberg AN, Murr AH. Communication Chaos from Discrepancies in Personal Protective Equipment and Preoperative Guidelines. Laryngoscope 2020; 131:E746-E754. [PMID: 33128391 DOI: 10.1002/lary.29257] [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: 05/15/2020] [Revised: 09/11/2020] [Accepted: 10/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare personal protective equipment (PPE) guidelines, specifically respirator use, among international public health agencies, academic hospitals, and otolaryngology-head and neck surgery (OHNS) departments in the United States for the care of coronavirus-19 (COVID-19) patients. STUDY DESIGN Cross sectional survey. METHODS Review of publicly available public health and academic hospitals guidelines along with review of communication among otolaryngology departments. RESULTS Among 114 academic institutions affiliated with OHNS residencies, 20 (17.5%) institutions provided public access to some form of guidance on PPE and 73 (64%) provided information on screening or diagnostic testing. PPE guidelines were uniquely described based on several variables: location of care, COVID-19 status, involvement of aerosol generating or high-risk procedures, and physical distance from the patient. Six hospital guidelines were highlighted. Across these six institutions, there was agreement that N95 respirators were needed for high-risk patients undergoing high-risk procedures. Variations existed among institutions for scenarios with low-risk patients. Definitions of the low-risk patient and high-risk procedures were inconsistent among institutions. Three of the highlighted institutions had OHNS departments recommending higher level of airway protection than the institution. CONCLUSIONS OHNS departments typically had more stringent PPE guidance than their institution. Discrepancies in communicating PPE use were frequent and provide inconsistent information on how healthcare workers should protect themselves in the COVID-19 pandemic. Identification of these inconsistencies serves as an opportunity to standardize communication and develop evidence-based guidelines. LEVEL OF EVIDENCE V Laryngoscope, 131:E746-E754, 2021.
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Affiliation(s)
- Nancy Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Adrian E House
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrew N Goldberg
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrew H Murr
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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22
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Wai KC, Xu MJ, Lee RH, El-Sayed IH, George JR, Heaton CM, Knott PD, Park AM, Ryan WR, Seth R, Ha PK. Head and neck surgery during the coronavirus-19 pandemic: The University of California San Francisco experience. Head Neck 2020; 43:622-629. [PMID: 33098178 DOI: 10.1002/hed.26514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Guidelines regarding head and neck surgical care have evolved during the coronavirus-19 (COVID-19) pandemic. Data on operative management have been limited. METHODS We compared two cohorts of patients undergoing head and neck or reconstructive surgery between March 16, 2019 and April 16, 2019 (pre-COVID-19) and March 16, 2020 and April 16, 2020 (COVID-19) at an academic center. Perioperative, intraoperative, and postoperative outcomes were recorded. RESULTS There were 63 operations during COVID-19 and 84 operations during pre-COVID-19. During COVID-19, a smaller proportion of patients had benign pathology (12% vs 20%, respectively) and underwent thyroid procedures (2% vs 23%) while a greater proportion of patients underwent microvascular reconstruction±ablation (24% vs 12%,). Operative times increased, especially among patients undergoing microvascular reconstruction±ablation (687 ± 112 vs 596 ± 91 minutes, P = .04). Complication rates and length of stay were similar. CONCLUSIONS During COVID-19, perioperative outcomes were similar, operative time increased, and there were no recorded transmissions to staff or patients. Continued surgical management of head and neck cancer patients can be provided safely.
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Affiliation(s)
- Katherine C Wai
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Mary Jue Xu
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Rex H Lee
- School of Medicine, University of California, San Francisco, California, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jonathan R George
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Chase M Heaton
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - P Daniel Knott
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Andrea M Park
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - William R Ryan
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Patrick K Ha
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, USA
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23
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David AP, Xu MJ, Rosbe KW, Meyer AK, Gesthalter YB, Chan DK. Cryoprobe retrieval of an airway foreign body: A case report and literature review. Int J Pediatr Otorhinolaryngol 2019; 125:79-81. [PMID: 31271971 DOI: 10.1016/j.ijporl.2019.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
We report a case of a 7-year-old boy with clinical and radiographic evidence of foreign body (FB) aspiration with a 2-week delay in diagnosis. The retrieval of the pushpin with traditional bronchoscopic instrumentation was made difficult by granulation tissue formation. A cryoprobe through a flexible bronchoscope was used to successfully remove the FB. To our knowledge, this is the first report of interventional bronchoscopy with a cryoprobe to remove a pushpin in a child under suspension laryngoscopy and spontaneous ventilation. A high index of suspicion is crucial for identifying FBs early and minimizing granulation tissue development which complicates FB removal.
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Affiliation(s)
- Abel P David
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States.
| | - Mary Jue Xu
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Kristina W Rosbe
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Anna K Meyer
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Yaron B Gesthalter
- Division of Pulmonology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94122, United States
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
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24
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Xu MJ, Stanford-Moore G, Czechowicz JA. Association of Ebola Virus Infection With Hearing Loss in Regions Where Ebola Virus Infection Is Endemic: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2019; 145:669-675. [PMID: 31095264 DOI: 10.1001/jamaoto.2019.0710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Many survivors of Ebola virus infection describe new-onset hearing loss after infection. The prevalence, severity, and pathophysiologic features of hearing loss in this population have not been well characterized. Objective To perform a systematic review of the current literature to characterize hearing loss in survivors of Ebola virus infection. Evidence Review This study adhered to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Searches through PubMed, Embase, and Google Scholar were performed to include publications written in English from January 1, 1965, to October 1, 2018. Relevant vocabulary terms and key terms related to Ebola and hearing loss were used. Two investigators independently screened the eligible studies, extracted data, and assessed quality and risk of bias. Findings Of 127 publications reviewed, 15 met the criteria for inclusion; 3 were retrospective case-control studies (level of evidence, 3), and 12 were cross-sectional studies or case reports (level of evidence, 4). Studies included 1775 survivors of Ebola virus infection (993 female [55.9%]) and 363 uninfected controls (186 female [51.2%]) from the Democratic Republic of the Congo, Uganda, Guinea, Liberia, and Sierra Leone. The duration of follow-up ranged from 0 to 29 months (median, 5 months). Hearing loss was reported in 147 survivors of Ebola virus infection (8.3%). Among studies that compared survivors with controls, the reported odds ratios for hearing loss in survivors was 7.50 (95% CI, 3.91-14.39; range, 1.4-12.1). Including all studies, the odds ratio of hearing loss in survivors vs controls in countries where Ebola virus infection is endemic was 1.84 (95% CI, 1.10-3.08). Conclusions and Relevance Survivors of Ebola virus infection had higher rates of hearing loss than uninfected controls in regions where the infection is endemic. Further research with consistent objective methods and pure-tone audiometry may be needed to better characterize the hearing loss, understand its pathophysiologic features, and develop treatments.
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Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Gaelen Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Josephine A Czechowicz
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
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25
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Xu MJ, Plonowska KA, Gurman ZR, Humphrey AK, Ha PK, Wang SJ, El‐Sayed IH, Heaton CM, George JR, Yom SS, Algazi AP, Ryan WR. Treatment modality impact on quality of life for human papillomavirus–associated oropharynx cancer. Laryngoscope 2019; 130:E48-E56. [DOI: 10.1002/lary.27937] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/05/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | | | - Zev R. Gurman
- School of MedicineUniversity of Virginia Charlottesville Virginia
| | - Amanda K. Humphrey
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Patrick K. Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona Phoenix Arizona U.S.A
| | - Ivan H. El‐Sayed
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Chase M. Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Jonathan R. George
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Sue S. Yom
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
- Department of Radiation Oncology San Francisco California
| | - Alain P. Algazi
- Department of Medicine (Hematology/Oncology)University of California–San Francisco San Francisco California
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
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26
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Rubagumya F, Xu MJ, May L, Driscoll C, Uwizeye FR, Shyirambere C, Larrabee K, Fehr AE, Gilbert UD, Muhayimana C, Hategekimana V, Elmore S, Mpunga T, Moore M, Shulman LN, Lehmann L. Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda. J Glob Oncol 2018; 4:1-11. [PMID: 30241148 PMCID: PMC6180843 DOI: 10.1200/jgo.2017.009290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 12/20/2022] Open
Abstract
Purpose Children with acute lymphoblastic leukemia (ALL) in low-income countries have
disproportionately lower cure rates than those in high-income countries. At
Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with
ALL with the first arm of the Hunger Protocol, a graduated-intensity method
tailored for resource-limited settings. This article provides the first
published outcomes, to our knowledge, of patients with ALL treated with this
protocol. Methods This is a retrospective descriptive study of patients with ALL enrolled at
BCCOE from July 1, 2012 to June 30, 2014; data were collected through
December 31, 2015. Descriptive statistics were used to calculate patient
demographics, disease characteristics, and outcomes; event-free survival was
assessed at 2 years using the Kaplan-Meier method. Results Forty-two consecutive patients with ALL were included. At the end of the
study period, 19% (eight) were alive without evidence of relapse: three
completed treatment and five were continuing treatment. Among the remaining
patients, 71% (30) had died and 10% (four) were lost to follow-up. A total
of 83% (25) of the deaths were disease related, 3% (one) treatment-related,
and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%),
considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if
lost to follow-up is censored. Conclusion As expected, relapse was the major cause of failure with this low-intensity
regimen. However, toxicity was acceptably low, and BCCOE has decided to
advance to intensity level 2. These results reflect the necessity of a
data-driven approach and a continual improvement process to care for complex
patients in resource-constrained settings.
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Affiliation(s)
- Fidel Rubagumya
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Mary Jue Xu
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Leana May
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Caitlin Driscoll
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Frank Regis Uwizeye
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Cyprien Shyirambere
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Katherine Larrabee
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Alexandra E Fehr
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Umuhizi Denis Gilbert
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Clemence Muhayimana
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Vedaste Hategekimana
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Shekinah Elmore
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Tharcisse Mpunga
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Molly Moore
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Lawrence N Shulman
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
| | - Leslie Lehmann
- Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye, Cyprien Shyirambere, and Alexandra E. Fehr, Inshuti Mu Buzima/Partners In Health; Umuhizi Denis Gilbert, Clemence Muhayimana, Vedaste Hategekimana, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Katherine Larrabee, Geisinger Commonwealth School of Medicine, Scranton; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Shekinah Elmore, Harvard Radiation Oncology Program; Leslie Lehmann, Dana Farber Cancer Institute; Boston Children's Hospital, Boston, MA; and Molly Moore, University of Vermont, Burlington, VT
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Rodin D, Longo J, Sherertz T, Shah MM, Balagun O, Wendling N, Van Dyk J, Coleman CN, Xu MJ, Grover S. Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care. Clin Oncol (R Coll Radiol) 2016; 29:135-140. [PMID: 27955997 DOI: 10.1016/j.clon.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.
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Affiliation(s)
- D Rodin
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - J Longo
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Sherertz
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - M M Shah
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - O Balagun
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, Cornell University Medical School, New York, New York, USA
| | - N Wendling
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - J Van Dyk
- International Cancer Expert Corps (ICEC), New York, New York, USA; Departments of Oncology and Medical Biophysics, Western University, London, Ontario, Canada; Medical Physics for World Benefit (MPWB), Canada
| | - C N Coleman
- International Cancer Expert Corps (ICEC), New York, New York, USA
| | - M J Xu
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - S Grover
- International Cancer Expert Corps (ICEC), New York, New York, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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28
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Tapela NM, Mpunga T, Hedt-Gauthier B, Moore M, Mpanumusingo E, Xu MJ, Nzayisenga I, Hategekimana V, Umuhizi DG, Pace LE, Bigirimana JB, Wang J, Driscoll C, Uwizeye FR, Drobac PC, Ngoga G, Shyirambere C, Muhayimana C, Lehmann L, Shulman LN. Pursuing equity in cancer care: implementation, challenges and preliminary findings of a public cancer referral center in rural Rwanda. BMC Cancer 2016; 16:237. [PMID: 26992690 PMCID: PMC4797361 DOI: 10.1186/s12885-016-2256-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 10/25/2015] [Accepted: 03/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background Cancer services are inaccessible in many low-income countries, and few published examples describe oncology programs within the public sector. In 2011, the Rwanda Ministry of Health (RMOH) established Butaro Cancer Center of Excellence (BCCOE) to expand cancer services nationally. In hopes of informing cancer care delivery in similar settings, we describe program-level experience implementing BCCOE, patient characteristics, and challenges encountered. Methods Butaro Cancer Center of Excellence was founded on diverse partnerships that emphasize capacity building. Services available include pathology-based diagnosis, basic imaging, chemotherapy, surgery, referral for radiotherapy, palliative care and socioeconomic access supports. Retrospective review of electronic medical records (EMR) of patients enrolled between July 1, 2012 and June 30, 2014 was conducted, supplemented by manual review of paper charts and programmatic records. Results In the program’s first 2 years, 2326 patients presented for cancer-related care. Of these, 70.5 % were female, 4.3 % children, and 74.3 % on public health insurance. In the first year, 66.3 % (n = 1144) were diagnosed with cancer. Leading adult diagnoses were breast, cervical, and skin cancer. Among children, nephroblastoma, acute lymphoblastic leukemia, and Hodgkin lymphoma were predominant. As of June 30, 2013, 95 cancer patients had died. Challenges encountered include documentation gaps and staff shortages. Conclusion Butaro Cancer Center of Excellence demonstrates that complex cancer care can be delivered in the most resource-constrained settings, accessible to vulnerable patients. Key attributes that have made BCCOE possible are: meaningful North–south partnerships, innovative task- and infrastructure-shifting, RMOH leadership, and an equity-driven agenda. Going forward, we will apply our experiences and lessons learned to further strengthen BCCOE, and employ the developed EMR system as a valuable platform to assess long-term clinical outcomes and improve care.
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Affiliation(s)
- Neo M Tapela
- Botswana Ministry of Health, Gaborone, Botswana. .,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA. .,Harvard Medical School, Boston, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.
| | | | - Bethany Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Molly Moore
- University of Vermont College of Medicine, Burlington, USA
| | | | | | | | | | | | | | | | - JingJing Wang
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Peter C Drobac
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Gedeon Ngoga
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Leslie Lehmann
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA.,Boston Children's Hospital, Boston, USA
| | - Lawrence N Shulman
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
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29
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Shyirambere C, Xu MJ, Elmore SN, Fadelu T, May L, Tapela N, Umuhizi DG, Uwizeye FR, Driscoll C, Muhayimana C, Hategekimana V, Rubagumya F, Nzayisenga I, Shulman LN, Mpunga T, Lehmann LE. Treating Nephroblastoma in Rwanda: Using International Society of Pediatric Oncology Guidelines in a Novel Oncologic Care Model. J Glob Oncol 2016; 2:105-113. [PMID: 28717689 PMCID: PMC5495448 DOI: 10.1200/jgo.2015.000067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Indexed: 11/20/2022] Open
Abstract
Purpose Success in treating nephroblastoma in high-income countries has been transferred to some resource-constrained settings; multicenter studies report disease-free survival of greater than 70%. However, few reports present care models with rural-based components, care tasks shifted to internists and pediatricians, and data collection structured for monitoring and evaluation. Here, we report clinical outcomes and protocol compliance for patients with nephroblastoma evaluated at Butaro Cancer Center of Excellence in Rwanda. Patients and Methods This retrospective study reports the care of 53 patients evaluated between July 1, 2012, and June 30, 2014. Patients receiving less than half of their chemotherapy at Butaro Cancer Center of Excellence were excluded. Results Of the 53 patients included, 9.4% had stage I, 13.2% had stage II, 24.5% had stage III, 26.4% had stage IV, and 5.7% had stage V disease; the remaining 20.8% had unknown stage disease from inadequate work-up or unavailable surgical report. The incidence of neutropenia increased with treatment progression, and the greatest proportion of delays occurred during the surgical referral phase. At the end of the study period, 32.1% of patients (n = 17) remained alive after treatment; 24.5% (n = 13) remained alive while continuing treatment, including one patient with recurrent disease; 30.2% (n = 16) died; and 13.2% (n = 7) were lost to follow-up. Conclusion Our findings confirm that nephroblastoma can be effectively treated in resource-constrained settings. Using an approach in which chemotherapy is delivered at a rural-based center by nononcologists and data are used for routine evaluation, care can be delivered in safe, novel ways. Protocol modifications to mitigate chemotherapy toxicities and strong communication between the multidisciplinary team members will likely minimize delays and further improve outcomes in similar settings.
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Affiliation(s)
- Cyprien Shyirambere
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Jue Xu
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shekinah Nefreteri Elmore
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Temidayo Fadelu
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Leana May
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Neo Tapela
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Denis Gilbert Umuhizi
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Frank Regis Uwizeye
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Caitlin Driscoll
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clemence Muhayimana
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vedaste Hategekimana
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Fidel Rubagumya
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ignace Nzayisenga
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lawrence N Shulman
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tharcisse Mpunga
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
| | - Leslie E Lehmann
- , , , and , Inshuti Mu Buzima/Partners in Health Rwanda; , , , , and , Ministry of Health Rwanda, Kigali, Rwanda; , , , , and , Harvard Medical School; , , and , Brigham and Women's Hospital; and , Boston Children's Hospital; and , Dana-Farber Cancer Institute, Boston, MA; and , Icahn School of Medicine at Mount Sinai, New York, NY
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30
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Xu XB, Ma XY, Lei HH, Song HM, Ying QC, Xu MJ, Liu SB, Wang HZ. Proteomic analysis reveals the mechanisms of Mycena dendrobii promoting transplantation survival and growth of tissue culture seedlings of Dendrobium officinale. J Appl Microbiol 2015; 118:1444-55. [PMID: 25732577 DOI: 10.1111/jam.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/17/2015] [Indexed: 01/30/2023]
Abstract
AIMS Dendrobium officinale is an important traditional Chinese medicinal herb. Its seedlings generally show low survival and growth when transferred from in vitro tissue culture to a greenhouse or field environment. In this study, the effect of Mycena dendrobii on the survival and growth of D. officinale tissue culture seedlings and the mechanisms involved was explored. METHODS AND RESULTS Mycena dendrobii were applied underneath the roots of D. officinale tissue culture seedlings. The seedling survival and growth were analysed. The root proteins induced by M. dendrobii were identified using two-dimensional (2-D) electrophoresis and matrix-assisted laser desorption/ionization time-of-flight MS (MALDI-TOF-MS). Mycena dendrobii treatment significantly enhanced survival and growth of D. officinale seedlings. Forty-one proteins induced by M. dendrobii were identified. Among them, 10 were involved in defence and stress response, two were involved in the formation of root or mycorrhizae, and three were related to the biosynthesis of bioactive constituents. CONCLUSIONS These results suggest that enhancing stress tolerance and promoting new root formation induced by M. dendrobii may improve the survival and growth of D. officinale tissue culture seedlings. SIGNIFICANCE AND IMPACT OF THE STUDY This study provides a foundation for future use of M. dendrobii in the large-scale cultivation of Dendrobiums.
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Affiliation(s)
- X B Xu
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - X Y Ma
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - H H Lei
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - H M Song
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - Q C Ying
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - M J Xu
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - S B Liu
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - H Z Wang
- College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
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31
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Wei D, Huang ZH, Zhang RH, Wang CL, Xu MJ, Liu BJ, Wang GH, Xu T. Roles of p38 MAPK in the regulation of the inflammatory response to swine influenza virus-induced acute lung injury in mice. Acta Virol 2015; 58:374-9. [PMID: 25518721 DOI: 10.4149/av_2014_04_374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Swine influenza virus (SIV), one of the most important zoonotic agents, is associated with major public health concerns. The current study was conducted to investigate the role of p38 mitogen-activated protein kinase (p38 MAPK) in the regulation of the inflammatory response to acute lung injury (ALI) induced by SIV of H9N2 subtype (H9N2-SIV) in mice. For this purpose, BALB/c mice were intranasally infected with 20 LD(50) of H9N2-SIV (infected group), while non-infected mice served as control (control group). To assess the effect of p38 MAPK, its specific inhibitor SB203580 was employed followed by SIV infection (SB group). At various times after infection, mouse lungs were subjected to pathological and histological observations and detection of inflammatory cytokines tumor necrosis factor α (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10 and phosphorylated p38 MAPK. The obtained results showed obvious inflammatory responses, injury and raised levels of inflammatory cytokines and phosphorylated p38 MAPK in the lungs of virus-infected mice. In the mice inoculated with the virus alone, the level of phosphorylated p38 MAPK increased from day 2 and peaked at day 6 post infection (p.i.). However, SB203580 caused lower increases in inflammatory cytokines and phosphorylated p38 MAPK and a milder lung injury. These findings indicate that the activation of p38 MAPK upregulated the inflammatory responses to H9N2-SIV-induced ALI, increased its severity and promoted the production of inflammatory cytokines.
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32
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Abstract
Chlamydia psittaci is a zoonotic pathogen with a wide range of avian hosts and may be transmitted to humans and cause severe disease. To assess the risk of psittacosis posed by pet birds, the seroprevalence of Chlamydia psittaci antibodies in 360 Eurasian siskins (Carduelis spinus), 289 oriental skylarks (Alauda arvensis) and 36 black-tailed grosbeaks (Coccothraustes migratorius) in Gansu province, north-western China was detected by an indirect haemagglutination assay. Twenty-seven out of 289 (9.34 %) Alauda arvensis, 45 out of 360 (12.50 %) Carduelis spinus and 2 out of 36 (5.56 %) Coccothraustes migratorius were positive for Chlamydia psittaci infection at a cut-off dilution of 1 : 16. The prevalence of Chlamydia psittaci was higher in Carduelis spinus (12.5 %) than in Alauda arvensis (9.34 %) and Coccothraustes migratorius (5.56 %); however, the differences were not statistically significant (P>0.05). Statistical analysis indicated that Chlamydia psittaci seroprevalence in adult pet birds (12.4 %, 67/540) was significantly higher than that in juvenile pet birds (4.83 %, 7/145) (P<0.01). There was no statistical difference in Chlamydia psittaci seroprevalence between male (12.4 %) and female (8.27 %) birds. To our knowledge, this is the first report indicating the seroprevalence of Chlamydia psittaci exposure in pet birds in China. Our results indicate that close contact with pet birds poses the risk of zoonotic transmission of Chlamydia psittaci.
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Affiliation(s)
- W Cong
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China.,State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - S Y Huang
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - X X Zhang
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - D H Zhou
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - M J Xu
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - Q Zhao
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
| | - A D Qian
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
| | - X Q Zhu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China.,State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
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33
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Yu H, Yan QG, Wang ZB, Lu YJ, Xu MJ, Li H, Zhu XQ. MH II-DAB gene expression in grass carp Ctenopharyngodon idella (Valenciennes) after infection with the ciliate parasite, Ichthyophthirius multifiliis. J Fish Dis 2014; 37:43-50. [PMID: 24131264 DOI: 10.1111/j.1365-2761.2012.01442.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/25/2012] [Accepted: 04/30/2012] [Indexed: 06/02/2023]
Abstract
The grass carp, Ctenopharyngodon idella (Valenciennes), is one of the most extensively aquacultured freshwater fish in China. However, because of the lack of effective control measures and the high-density culture environment, considerable economic losses are caused by infection of C. idella with the parasitic ciliate, Ichthyophthirius multifiliis. The major histocompatibility (MH) DAB gene belongs to antigen-presented genes in the class II genomic region, which is associated with parasite resistance. To understand the relationship of the DAB gene with I. multifiliis infection in grass carp, the expression profiles of MH II-DAB were studied in tissues using real-time quantitative polymerase chain reaction. The results showed that expression of the MH II-DAB gene was up-regulated in head kidney after I. multifiliis infection, and the expression peak appeared earlier in the study (case) group than in the control group. The obvious up-regulation peak of MH II-DAB gene was found at days 2 and 4 in skin; at 12 h to day 4 in spleen; at 12 h and days 1 and 6 in gill; and at day 10 in blood, whereas the MH II-DAB gene was down-regulated in liver and intestines after I. multifiliis infection. These results have implications for better understanding C. idella resistance to I. multifiliis infection.
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Affiliation(s)
- H Yu
- College of Life Science, Foshan University, Foshan, China
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Cong W, Huang SY, Zhang XY, Zhou DH, Xu MJ, Zhao Q, Song HQ, Zhu XQ, Qian AD. Seroprevalence of Chlamydia psittaci infection in market-sold adult chickens, ducks and pigeons in north-western China. J Med Microbiol 2013; 62:1211-1214. [PMID: 23699067 DOI: 10.1099/jmm.0.059287-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Chlamydia psittaci, the agent of psittacosis in humans, infects a wide range of avian species. To assess the risk of psittacosis posed by domestic birds in the urban environment, the prevalence of C. psittaci antibodies in 413 chickens (Gallus domesticus; 305 caged and 108 free-range), 334 ducks (Anas spp.; 111 caged and 223 free-range) and 312 pigeons (Columba livia) in Lanzhou, north-western China, was detected using the indirect haemagglutination assay. The specific antibodies were found in sera of 55 (13.32 %) chickens, 130 (38.92 %) ducks and 97 (31.09 %) pigeons. Statistical analysis showed that the seroprevalence of C. psittaci infection in chickens was significantly lower than that in ducks and pigeons (P<0.05). The C. psittaci seroprevalence in caged and free-range chickens was 7.54 % and 29.63 %, respectively, and the difference was statistically significant (P<0.05). The C. psittaci seroprevalence in caged and free-range ducks was 26.13 % and 45.29 %, respectively (P<0.05). To our knowledge, this is the first study indicating the presence of C. psittaci infection in market-sold chickens, ducks and pigeons in north-western China. Close contact with these birds is associated with a risk of zoonotic transmission of C. psittaci. Public education should be implemented to reduce the risk of avian to human transmission of such a pathogenic agent.
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Affiliation(s)
- W Cong
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - S Y Huang
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - X Y Zhang
- Affilliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province 266071, PR China
| | - D H Zhou
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - M J Xu
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - Q Zhao
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
| | - H Q Song
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - X Q Zhu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China
| | - A D Qian
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, PR China
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Huang FW, Hodis E, Xu MJ, Kryukov G, Chin L, Garraway LA. Abstract LB-228: The identification of recurrent non-coding mutations in melanoma. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-lb-228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer genome sequencing efforts have identified many recurrent coding mutations in human cancer genes. To date, non-coding “driver” mutations within regulatory regions have rarely been observed. Here we describe the identification of two somatic mutations within the TERT core promoter that were observed in 71% of melanomas. Each mutation generated a de novo consensus ETS binding motif. Reporter assays showed that these mutations could increase transcriptional activity from the TERT promoter. We observed the same mutations in cancer cell lines from diverse tumor types with preliminary evidence of elevated frequency in bladder and hepatocellular cancer cells. Our findings suggest that somatic mutations in non-coding regulatory regions of the genome may represent important events in carcinogenesis.
Citation Format: Franklin W. Huang, Eran Hodis, Mary Jue Xu, Gregory Kryukov, Lynda Chin, Levi A. Garraway. The identification of recurrent non-coding mutations in melanoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-228. doi:10.1158/1538-7445.AM2013-LB-228
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Affiliation(s)
| | - Eran Hodis
- 1Dana-Farber Cancer Institute/Broad Institute, Boston, MA
| | - Mary Jue Xu
- 1Dana-Farber Cancer Institute/Broad Institute, Boston, MA
| | | | - Lynda Chin
- 2M.D. Anderson Cancer Center, Houston, TX
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Abstract
Systematic sequencing of human cancer genomes has identified many recurrent mutations in the protein-coding regions of genes but rarely in gene regulatory regions. Here, we describe two independent mutations within the core promoter of telomerase reverse transcriptase (TERT), the gene coding for the catalytic subunit of telomerase, which collectively occur in 50 of 70 (71%) melanomas examined. These mutations generate de novo consensus binding motifs for E-twenty-six (ETS) transcription factors, and in reporter assays, the mutations increased transcriptional activity from the TERT promoter by two- to fourfold. Examination of 150 cancer cell lines derived from diverse tumor types revealed the same mutations in 24 cases (16%), with preliminary evidence of elevated frequency in bladder and hepatocellular cancer cells. Thus, somatic mutations in regulatory regions of the genome may represent an important tumorigenic mechanism.
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37
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Zhou DH, Yuan ZG, Zhao FR, Li HL, Zhou Y, Lin RQ, Zou FC, Song HQ, Xu MJ, Zhu XQ. Modulation of mouse macrophage proteome induced by Toxoplasma gondii tachyzoites in vivo. Parasitol Res 2011; 109:1637-46. [PMID: 21584632 DOI: 10.1007/s00436-011-2435-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 04/27/2011] [Indexed: 12/21/2022]
Abstract
Toxoplasma gondii is an obligate intracellular protozoan parasite, which can invade and multiply within the macrophages of humans and most warm-blooded animals. Macrophages are important effector cells for the control and killing of intracellular T. gondii, and they may also serve as long-term host cells for the replication and survival of the parasite. In the present study, we explored the proteomic profile of macrophages of the specific pathogen-free Kunming mice at 24 h after infection with tachyzoites of the virulent T. gondii RH strain using two-dimensional gel electrophoresis combined with matrix-assisted laser desorption ionization time-of-flight (TOF)/TOF tandem mass spectrometry. Totally, 60 differentially expressed protein spots were identified. Among them, 52 spots corresponded to 38 proteins matching to proteins of the mouse, including actin, enolase, calumenin, vimentin, plastin 2, annexin A1, cathepsin S, arginase-1, arachidonate 12-lipoxygenase, and aminoacylase-1. Functional prediction using Gene Ontology database showed that these proteins were mainly involved in metabolism, structure, protein fate, and immune responses. The findings provided an insight into the interactive relationship between T. gondii and the host macrophages, and will shed new lights on the understanding of molecular mechanisms of T. gondii pathogenesis.
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Affiliation(s)
- D H Zhou
- Department of Parasitology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province 510642, People's Republic of China
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Algotar AM, Stratton MS, Xu MJ, Dalkin BL, Nagle RB, Hsu CH, Ahmann FR, Clark LC, Stratton SP. Dose-dependent effects of selenized yeast on total selenium levels in prostatic tissue of men with prostate cancer. Nutr Cancer 2011; 63:1-5. [PMID: 21128179 DOI: 10.1080/01635581.2010.516476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen MX, Ai L, Zhang RL, Xia JJ, Wang K, Chen SH, Zhang YN, Xu MJ, Li X, Zhu XQ, Chen JX. Sensitive and rapid detection of Paragonimus westermani infection in humans and animals by loop-mediated isothermal amplification (LAMP). Parasitol Res 2010; 108:1193-8. [PMID: 21107864 DOI: 10.1007/s00436-010-2162-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/10/2010] [Indexed: 12/01/2022]
Abstract
In the present study, a loop-mediated isothermal amplification (LAMP) assay was developed and validated for the detection of Paragonimus westermani adults, metacercariae, and eggs in human and animal samples. The LAMP amplification can be finished in 45 min under isothermal condition at 60°C by employing a set of four species-specific primer mixtures and the results can be checked by naked-eye visualization. No amplification products were detected with deoxyribunucleic acid (DNA) of related trematode species including Fasciola hepatica, Fasciola gigantica, Clonorchis sinensis, Opisthorchis viverrini, Schistosoma mansoni, and Schistosoma japonicum. The method was further validated by examining P. westermani DNA in intermediate hosts including freshwater crabs and crayfish, as well as in sputum and pleural fluid samples from patients of paragonimiasis. These results indicated that the LAMP assay was highly specific, sensitive, and rapid, and it was approximately 100 times more sensitive than conventional specific PCR. The LAMP assay established in this study provides a rapid and sensitive tool for the detection of P. westermani DNA in freshwater crabs, crayfish, sputum, and pleural fluid samples, which has important implications for effective control of human paragonimiasis.
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Affiliation(s)
- M X Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, People's Republic of China
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Cai XQ, Xu MJ, Wang YH, Qiu DY, Liu GX, Lin A, Tang JD, Zhang RL, Zhu XQ. Sensitive and rapid detection of Clonorchis sinensis infection in fish by loop-mediated isothermal amplification (LAMP). Parasitol Res 2010; 106:1379-83. [PMID: 20232082 DOI: 10.1007/s00436-010-1812-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [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: 02/08/2010] [Accepted: 02/19/2010] [Indexed: 01/25/2023]
Abstract
The fish-borne clonorchiasis caused by the oriental liver fluke Clonorchis sinensis is endemic in a number of countries with over 35 million people being infected globally. Rapid and accurate detection of C. sinensis in its intermediate host fish is important for the control and prevention of clonorchiasis in areas where the disease is endemic. In the present study, we established a loop-mediated isothermal amplification (LAMP) approach for the sensitive and rapid detection of C. sinensis metacercariae in fish. The specificity and sensitivity of primers designed from the C. sinensis cathepsins B3 gene were evaluated, and specific amplification products were obtained with C. sinensis, while no amplification products were detected with DNA of related trematodes, demonstrating the specificity of the assay. The LAMP assay was proved to be 100 times more sensitive than a conventional polymerase chain reaction for detection of C. sinensis. The established LAMP assay provides a useful tool for the rapid and sensitive detection of C. sinensis in fish, which has important implications for the effective control of human clonorchiasis.
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Affiliation(s)
- X Q Cai
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, Guangdong Province 510642, People's Republic of China
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41
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Abstract
1. Experiments were conducted to assess the influence of caecectomy on amino acid availability (AAA) of three feedstuffs for goose. 2. Nine caecectomised and 9 intact Yangzhou ganders, 24 weeks old, were used in these experiments. Fish meal, soybean meal and cottonseed meal were used as the sole source of protein. The endogenous amino acid (AA) losses were evaluated by a nitrogen (N)-free diet method. The influence of caecectomy on apparent amino acid availability (AAAA) in fish meal, soybean meal and cottonseed meal was assessed in experiment 1 and true amino acid availability (TAAA) of three protein diets was determined in experiment 2. 3. Results showed that, in the soybean meal and cottonseed meal, the AAAA and TAAA of most AA determined by the intact ganders were higher than in the caecectomised ganders; in the fish meal, the AAAA and TAAA of most AA determined by the intact ganders were lower than in the caecectomised ganders. 4. Results of the present study suggest that the effect of caecectomy on AAA in geese was dependent on the feedstuff assayed, and it was better to use caecectomised poultry for AAA assessment.
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Affiliation(s)
- Z Y Wang
- College of Animal Science and Technology, Yangzhou University, Yangzhou, P.R. China.
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42
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Hisakawa H, Sugiyama D, Nishijima I, Xu MJ, Wu H, Nakao K, Watanabe S, Katsuki M, Asano S, Arai K, Nakahata T, Tsuji K. Human granulocyte-macrophage colony-stimulating factor (hGM-CSF) stimulates primitive and definitive erythropoiesis in mouse embryos expressing hGM-CSF receptors but not erythropoietin receptors. Blood 2001; 98:3618-25. [PMID: 11739165 DOI: 10.1182/blood.v98.13.3618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although erythropoietin (EPO) and its receptor (EPOR) are crucial for the proliferation, survival, and terminal differentiation of erythroid progenitors, it remains to be elucidated whether EPOR-unique signaling is required for erythropoiesis. To address this issue, human granulocyte-macrophage colony-stimulating factor (hGM-CSF) receptor (hGMR)-transgenic mice and heterozygous EPOR mutant mice were crossed by in vitro fertilization. In methylcellulose clonal culture of fetal liver (FL) cells of generated hGMR-expressing EPOR(-/-) embryos at embryonic day (E) 12.5 of gestation, hGM-CSF stimulated erythroid colony formation under serum-containing and serum-free conditions. Analysis of globin expression in individual erythrocyte-containing colonies formed from E12.5 FL cells showed that hGM-CSF supports primitive and definitive erythropoiesis even in EPOR(-/-) embryos. In comparison of activities between hGM-CSF and EPO in hGMR-expressing EPOR(+/+) embryos, the 2 substances supported the formation of similar numbers of erythroid colonies in clonal culture of E12.5 FL cells; enhanced adult, but not embryonic, globin synthesis; and induced increase of GATA-1 expression and decrease of erythroid Kruppel-like factor and cMyb expression in the FL cells. On the other hand, in E8.0 yolk sac erythropoiesis, both substances had a similar effect on erythroid colony formation, but hGM-CSF induced an increase of beta-major globin expression, while EPO did not. All together, the results of the present study demonstrated that hGM-CSF can stimulate the proliferation and differentiation of primitive and definitive erythroid cells independently of EPOR signal if they express hGMR, and the activity is comparable to that of EPO in definitive, but not primitive, erythropoiesis.
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MESH Headings
- Animals
- Cell Differentiation
- Cell Division
- Cells, Cultured
- Crosses, Genetic
- DNA-Binding Proteins/genetics
- Embryo, Mammalian/metabolism
- Erythroid Precursor Cells/cytology
- Erythroid-Specific DNA-Binding Factors
- Erythropoiesis
- Erythropoietin/pharmacology
- Female
- Fertilization in Vitro
- GATA1 Transcription Factor
- Gene Expression
- Gestational Age
- Globins/biosynthesis
- Globins/genetics
- Granulocyte-Macrophage Colony-Stimulating Factor/pharmacology
- Humans
- Mice
- Mice, Inbred ICR
- Mice, Knockout
- Mice, Transgenic
- Receptors, Erythropoietin/genetics
- Receptors, Erythropoietin/physiology
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/genetics
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/physiology
- Signal Transduction
- Transcription Factors/genetics
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Affiliation(s)
- H Hisakawa
- Department of Clinical Oncology, Division of DNA Biology and Embryo Engineering, Center for Experimental Medicine, The Institute of Medical Science, The University of Tokyo, Japan
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Lopez AM, Ketchum M, Nichols H, Xu MJ, Peng YM, Dorr R, Alberts DS. A phase I trial of AUC-directed carboplatin with infusional doxorubicin and ifosfamide plus G-CSF in patients with advanced gynecologic malignancies. Cancer Chemother Pharmacol 2001; 46:411-5. [PMID: 11127946 DOI: 10.1007/s002800000154] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The effect of the addition of G-CSF to carboplatin, ifosfamide and doxorubicin (CIA) at the maximally tolerated dose (MTD) was studied in a phase I clinical trial. Nine patients with incurable solid tumors were treated: six endometrial and epithelial ovarian cancers, one colon cancer with pelvic masses and two unknown primary cancers. The carboplatin dose was calculated using the Calvert formula and administered in a standard 30-min intravenous infusion. The initial carboplatin dose was AUC 4.0 mg/ml per min. Fixed doses of ifosfamide (1.25 g/m2 per day), mesna (1.0 g/m2 per day, and doxorubicin (15 mg/m2 per day) were combined and given as a 4-day continuous intravenous infusion in an attempt to decrease nonhematologic toxicity. The dose-limiting toxicity of CIA was myelosuppression, mainly neutropenia and thrombocytopenia. Nonhematologic toxicities were hemorrhagic cystitis, weakness, fatigue, and nausea and vomiting. The MTD for CIA was established at the first dose level of carboplatin (4.0 mg/ml per min). Following this, G-CSF was added to the regimen in an unsuccessful effort to escalate the carboplatin dose. Free and total carboplatin pharmacokinetics were determined using flameless atomic absorption spectroscopy. There was one complete response and one partial response among eight evaluable patients. Both responding patients had advanced ovarian cancer. We conclude that carboplatin dose intensification beyond an AUC of 4.0 mg/ml per min is not made feasible by the addition of G-CSF to infusional doxorubicin and ifosfamide in patients with advanced gynecologic cancer.
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Affiliation(s)
- A M Lopez
- Department of Medicine, College of Medicine, University of Arizona, Tucson 85724, USA
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44
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Alberts DS, Dorr RT, Einspahr JG, Aickin M, Saboda K, Xu MJ, Peng YM, Goldman R, Foote JA, Warneke JA, Salasche S, Roe DJ, Bowden GT. Chemoprevention of human actinic keratoses by topical 2-(difluoromethyl)-dl-ornithine. Cancer Epidemiol Biomarkers Prev 2000; 9:1281-6. [PMID: 11142412] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Alpha-2-(Difluoromethyl)-dl-ornithine (DFMO), an irreversible inhibitor of ornithine decarboxylase, has been shown to suppress skin carcinogenesis in murine models after oral or topical administration. We designed a randomized, placebo-controlled study using a topical hydrophilic ointment formulation with or without 10% (w/w) DFMO. Forty-eight participants with moderate-severe actinic keratoses (AKs) on their forearms (i.e., at least 10 well-circumscribed lesions on the lateral surface) completed a 1-month run-in on placebo ointment. Before randomization, all lateral forearm AKs were circled, counted, photographed, and skin biopsies were obtained for DFMO and polyamine levels. Then participants were randomized to receive DFMO ointment on the right versus the left forearm and placebo hydrophilic ointment on the contralateral forearm twice daily for 6 months. DFMO was not detected in the blood of any subject, and there were no systemic toxicities. None of a subsample of 17 placebo forearms had measurable concentrations of DFMO, whereas 13 of the corresponding DFMO-treated forearms had high DFMO skin levels. As compared with placebo, the 6-month DFMO treatment caused a 23.5% reduction in the number of AKs (P = 0.001) as well as significant suppression of AK biopsy spermidine levels (26%; P = 0.04). Seven of the 48 (14.6%) participants experienced severe (2; 4.2%) or moderate (5; 10.4%) inflammatory reactions on their DFMO-treated arms which required dosing modification. Topical DFMO for 6 months can reduce the number of AK lesions and skin spermidine concentrations in high-risk participants and deserves additional study as a skin cancer chemopreventive agent.
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Affiliation(s)
- D S Alberts
- Arizona Cancer Center, University of Arizona, Tucson 85724, USA.
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45
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Ebihara Y, Xu MJ, Manabe A, Kikuchi A, Tanaka R, Kato S, Nakahata T, Tsuji K. Exclusive expression of G-CSF receptor on myeloid progenitors in bone marrow CD34+ cells. Br J Haematol 2000; 109:153-61. [PMID: 10848795 DOI: 10.1046/j.1365-2141.2000.01952.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although granulocyte colony-stimulating factor (G-CSF) has been reported to act on cells of neutrophilic lineage, the administration of G-CSF to induce the mobilization of various haematopoietic progenitors into the circulation. We analysed the expression of receptors for G-CSF (G-CSFR) on human bone marrow and G-CSF-mobilized peripheral blood CD34+ cells, and examined the proliferation and differentiation capabilities of sorted CD34+G-CSFR+ and CD34+G-CSFR- cells using methylcellulose clonal culture. Flow cytometric analysis showed that G-CSFR was expressed on 14.9 +/- 4.9% of bone marrow CD34+ cells, most of which were included in CD34+CD33+ and CD34+CD38+ cell fractions. In clonal cultures, CD34+G-CSFR+ cells produced only myeloid colonies, whereas CD34+G-CSFR- cells produced erythroid bursts, megakaryocyte and multilineage colonies. When incubated with the cytokine cocktail for 5 d, CD34+G-CSFR- cells generated CD34+G-CSFR+ myeloid progenitors. In G-CSF-mobilized peripheral blood, CD34+ cells contained 10.8 +/- 5.8% of G-CSFR+ cells, most of which were also myeloid progenitors, although CD34+G-CSFR- cells contained a substantial number of myeloid progenitors. These results indicated that the expression of G-CSFR on CD34+ cells is restricted to myeloid progenitors, suggesting that the specific activity of G-CSF on myelopoiesis depends on the exclusive expression of its receptor on myeloid progenitors, and that the mobilization of various haematopoietic progenitors is not a direct effect of G-CSF in humans.
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Affiliation(s)
- Y Ebihara
- Department of Clinical Oncology, The Institute of Medical Science, The University of Tokyo, Japan
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46
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Yang FC, Tsuji K, Oda A, Ebihara Y, Xu MJ, Kaneko A, Hanada S, Mitsui T, Kikuchi A, Manabe A, Watanabe S, Ikeda Y, Nakahata T. Differential effects of human granulocyte colony-stimulating factor (hG-CSF) and thrombopoietin on megakaryopoiesis and platelet function in hG-CSF receptor-transgenic mice. Blood 1999; 94:950-8. [PMID: 10419886] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Granulocyte-colony stimulating factor (G-CSF) has been found to act on the neutrophilic lineage. We recently showed that human G-CSF (hG-CSF) has effects similar to early-acting cytokines such as interleukin-3 (IL-3) in the development of multipotential hematopoietic progenitors in transgenic (Tg) mice expressing receptors (R) for hG-CSF. In the present study, we examined the effects of hG-CSF on more mature hematopoietic cells committed to megakaryocytic lineage in these Tg mice. The administration of hG-CSF to the Tg mice increased the numbers of both platelets in peripheral blood and megakaryocytes in the spleen, indicating that hG-CSF stimulates megakaryopoiesis in the Tg mice in vivo. The stimulatory effect of hG-CSF was also supported by the results of studies in vitro. hG-CSF supported megakaryocyte colony formation in a dose-dependent fashion in clonal cultures of bone marrow cells derived from the Tg mice. Direct effects of hG-CSF on megakaryocytic progenitors in the Tg mice were confirmed by culture of single-cell sorted from bone marrow cells. hG-CSF showed a stronger effect on maturation of megakaryocytes in the Tg mice than that of IL-3 alone, but weaker than that of TPO alone. In addition, hG-CSF induced phosphorylation of STAT3 but not Jak2 or STAT5, while TPO induced phosphorylation of both. In contrast to TPO, hG-CSF did not enhance ADP-induced aggregation. Thus, hG-CSF has a wide variety of functions in megakaryopoiesis of hG-CSFR-Tg mice, as compared with other megakaryopoietic cytokines, but the activity of hG-CSF in megakaryocytes and platelets does not stand up to a comparison with that of TPO. Specific signals may be required for the full maturation and activation of platelets.
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Affiliation(s)
- F C Yang
- Department of Clinical Oncology and the Department of Molecular and Developmental Biology, The Institute of Medical Science, The University of Tokyo, Japan
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Kinoshita T, Sekiguchi T, Xu MJ, Ito Y, Kamiya A, Tsuji K, Nakahata T, Miyajima A. Hepatic differentiation induced by oncostatin M attenuates fetal liver hematopoiesis. Proc Natl Acad Sci U S A 1999; 96:7265-70. [PMID: 10377403 PMCID: PMC22074 DOI: 10.1073/pnas.96.13.7265] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Embryonic liver is a transient site for definitive hematopoiesis. Along with maturation of the bone marrow and spleen, hematopoietic cells relocate from the liver to their final destinations while the liver starts organizing its own structure and develops numerous metabolic functions toward adult. Recently, it was demonstrated that the signal exerted by oncostatin M (OSM) through gp130 plays a pivotal role in the maturation process of the liver both in vitro and in vivo. However, the molecular basis underlying the termination of embryonic hematopoiesis remains unknown. In this study, we report that primary culture of fetal hepatic cells from embryonic day 14.5 murine embryos supported expansion of blood cells from Lin-Sca-1(+)c-Kit+ cells, giving rise to myeloid, lymphoid, and erythroid lineages. Of interest, promotion of hepatic development by OSM and glucocorticoid strongly suppressed in vitro hematopoiesis. Consistent with these results, hepatic culture from the embryonic day 18.5 liver no longer supported hematopoiesis. These data together with the previous observations suggest that the signals exerted by OSM and glucocorticoid induce hepatic differentiation, which in turn terminate embryonic hematopoiesis and promote relocation of hematopoietic cells.
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Affiliation(s)
- T Kinoshita
- Institute of Molecular and Cellular Bioscience, University of Tokyo, Bunkyo-ku, Tokyo 113-0032, Japan
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Wang ZM, Feng H, Liang XT, Yuan ST, Xu MJ. [New diterpenoids, isodoternifolins A and B, from Isodon ternifolius]. Yao Xue Xue Bao 1998; 31:764-9. [PMID: 9863245] [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: 02/09/2023]
Abstract
Two new diterpenoids, named isodoternifolin A and B, together with seven known compounds were isolated from the ethanol extract of dried stems and leaves of Isodon ternifolius (D. Don) Kudo. Their structures were determined as 7 beta-hydroxy-6 beta, 11 alpha, 15 beta-triacetoxy-7 alpha, 20-epoxyentkaur-16-ene (1) and 6 beta, 7 beta, 15 beta-trihydroxy-11 alpha-acetoxy-7 alpha, 20-epoxy-entkaur-16-ene (2) by chemical and spectral evidence.
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Affiliation(s)
- Z M Wang
- Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine, Beijing
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Yang FC, Watanabe S, Tsuji K, Xu MJ, Kaneko A, Ebihara Y, Nakahata T. Human granulocyte colony-stimulating factor (G-CSF) stimulates the in vitro and in vivo development but not commitment of primitive multipotential progenitors from transgenic mice expressing the human G-CSF receptor. Blood 1998; 92:4632-40. [PMID: 9845529] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) stimulates the proliferation and restricted differentiation of hematopoietic progenitors into neutrophils. To clarify the effects of G-CSF on hematopoietic progenitors, we generated transgenic (Tg) mice that had ubiquitous expression of the human G-CSF receptor (hG-CSFR). In clonal cultures of bone marrow and spleen cells obtained from these mice, hG-CSF supported the growth of myelocytic as well as megakaryocytic, mast cell, mixed, and blast cell colonies. Single-cell cultures of lineage-negative (Lin-)c-Kit+Sca-1(+) or Sca-1(-) cells obtained from the Tg mice confirmed the direct effects of hG-CSF on the proliferation and differentiation of various progenitors. hG-CSF also had stimulatory effects on the formation of blast cell colonies in cultures using 5-fluorouracil-resistant hematopoietic progenitors and clone-sorted Lin-c-Kit+Sca-1(+) primitive hematopoietic cells. These colonies contained different progenitors in proportions similar to those obtained when mouse interleukin-3 was used in place of hG-CSF. Administration of hG-CSF to Tg mice led to significant increases in spleen colony-forming and mixed/blast cell colony-forming cells in bone marrow and spleen, but did not alter the proportion of myeloid progenitors in total clonogenic cells. These results show that, when functional G-CSFR is present on the cell surface, hG-CSF stimulates the development of primitive multipotential progenitors both in vitro and in vivo, but does not induce exclusive commitment to the myeloid lineage.
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Affiliation(s)
- F C Yang
- Department of Clinical Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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50
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Weiss GR, Liu PY, Alberts DS, Peng YM, Fisher E, Xu MJ, Scudder SA, Baker LH, Moore DF, Lippman SM. 13-cis-retinoic acid or all-trans-retinoic acid plus interferon-alpha in recurrent cervical cancer: a Southwest Oncology Group phase II randomized trial. Gynecol Oncol 1998; 71:386-90. [PMID: 9887236 DOI: 10.1006/gyno.1998.5204] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Preclinical and clinical data support the study of retinoids and interferon-alpha (IFN-alpha) in advanced squamous cell carcinoma of the uterine cervix (SCC). This phase II randomized trial of the Southwest Oncology Group sought to estimate the response rate for IFN-alpha plus either 13-cis-retinoic acid (13cRA) or all-trans-retinoic acid (ATRA) in women with recurrent cervical SCC. PATIENTS AND METHODS Eligibility for this trial required bidimensionally measurable locally recurrent or metastatic squamous or adenosquamous carcinoma of the uterine cervix; SWOG performance status of </=2; no prior interferon, retinoids, or chemotherapy (except as radiation sensitization). All but two patients were previously treated with surgery, radiation therapy, or both. After randomization, patients received IFN-alpha-2A (subcutaneous injection; 3 x 10(6) units/m2/day) plus either 13cRA (1 mg/kg/day orally) or ATRA (150 mg/m2/day orally) in two equally divided doses. RESULTS Total enrollment was 63 patients, 21 in the ATRA arm, 42 in the 13cRA arm. Three patients were ineligible, 1 in the ATRA arm, 2 in the 13cRA arm. Each arm had 1 patient who received no assigned treatment and was not evaluated for response or toxicity. The ATRA/IFN-alpha response rate was 5% (1/19; 95% confidence interval = 0.1-26%), consisting of 1 partial response lasting 4 weeks. The 13cRA/IFN-alpha response rate was 8% (3/39; 95% confidence interval = 2-21%), consisting of 3 partial responses lasting 17, 22, and 24 weeks, respectively. All confirmed responses were partial. One additional unconfirmed partial response occurred in the 13cRA arm. Both regimens were generally well-tolerated and produced toxicities (principally malaise and fatigue) associated with each constituent agent's known single-agent side effects. CONCLUSION Based upon the results of this study, neither regimen can be recommended for further study in patients previously treated with radiation therapy.
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Affiliation(s)
- G R Weiss
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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