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Mayol del Valle M, Morales B, Philbrick B, Adeagbo S, Goyal S, Newman S, Frontera NL, Nduom E, Olson J, Neill S, Hoang K. Intramedullary Spinal Cord Tumors: Whole-Genome Sequencing to Assist Management and Prognosis. Cancers (Basel) 2024; 16:404. [PMID: 38254893 PMCID: PMC10814932 DOI: 10.3390/cancers16020404] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Intramedullary spinal cord tumors (IMSCTs) harbor unique genetic mutations which may play a role in prognostication and management. To this end, we present the largest cohort of IMSCTs with genetic characterization in the literature from our multi-site institutional registry. A total of 93 IMSCT patient records were reviewed from the years 1999 to 2020. Out of these, 61 complied with all inclusion criteria, 14 of these patients had undergone genetic studies with 8 undergoing whole-genomic sequencing. Univariate analyses were used to assess any factors associated with progression-free survival (PFS) using the Cox proportional hazards model. Firth's penalized likelihood approach was used to account for the low event rates. Fisher's exact test was performed to compare whole-genome analyses and specific gene mutations with progression. PFS (months) was given as a hazard ratio. Only the absence of copy neutral loss of heterozygosity (LOH) was shown to be significant (0.05, p = 0.008). Additionally, higher risk of recurrence/progression was associated with LOH (p = 0.0179). Our results suggest LOH as a genetic predictor of shorter progression-free survival, particularly within ependymoma and glioblastoma tumor types. Further genomic research with larger multi-institutional datasets should focus on these mutations as possible prognostic factors.
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Affiliation(s)
- Miguel Mayol del Valle
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Bryan Morales
- Department of Neuropathology, Emory University Hospital, 1364 Clifton Road, NE Room H-184, Atlanta, GA 30322, USA; (B.M.); (S.N.)
| | - Brandon Philbrick
- Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA (S.A.)
| | - Segun Adeagbo
- Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA (S.A.)
| | - Subir Goyal
- Biostatistics Shared Resource Department, Winship Cancer Institute, Emory University, 1365-C Clifton Road, NE, Atlanta, GA 30322, USA;
| | - Sarah Newman
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Natasha L. Frontera
- School of Medicine, University of Puerto Rico Medical Sciences Campus, P.O. Box 365067, San Juan 00936-5067, Puerto Rico;
| | - Edjah Nduom
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Jeffrey Olson
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
| | - Stewart Neill
- Department of Neuropathology, Emory University Hospital, 1364 Clifton Road, NE Room H-184, Atlanta, GA 30322, USA; (B.M.); (S.N.)
| | - Kimberly Hoang
- Department of Neurosurgery, Emory University Hospital, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, USA; (S.N.); (E.N.); (J.O.); (K.H.)
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Henry TL, Freeman CD, Sheth A, Jenkins L, Olakunle OE, Adeagbo S, Sanchez-Medina MC, Alcegueire K, Rodríguez J. Making an Impact with E.M.P.A.C.T. Engage, Mentor Prepare, Advocate, Cultivate, and Teach: An Innovative Pilot Mentoring Program Evaluation for Students Underrepresented in Medicine. Adv Med Educ Pract 2023; 14:803-813. [PMID: 37496711 PMCID: PMC10368113 DOI: 10.2147/amep.s400547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
Purpose Medicine has yet to increase the representation of historically excluded persons in medicine to reflect the general population. The lack of support and guidance in the medical training of these individuals is a significant contributor to this disparity. The Engage, Mentor, Prepare, Advocate for, Cultivate, and Teach (EMPACT) Mentoring program was created to address this problem by providing support for learners who are historically underrepresented in medicine (URiM) as they progress through medical school. Methods The EMPACT Pilot Program was formed and conducted during the 2019-2020 academic year. A total of 19 EMPACT mentorship groups were created, each consisting of two mentors and four medical student mentees. Additionally, four professional development workshops were held along with a final Wrap-up and Awards event. Pre and post pilot program surveys along with surveys after each workshop and focus groups were conducted with a random selection of program participants. Results When compared to data from before and after the implementation of the EMPACT program, there were statistically significant differences (p < 0.05) in EMPACT mentees reporting they agree or strongly agree they felt ready to handle their clinical rotations (28% to 65%), felt the need to have an advocate (85% to 47%), possessed insight on day-to-day activities of an attending (26% to 56%) and felt a sense of community (79% to 94%). Mentors revealed an increase in their awareness of the concepts of microaggressions and imposter phenomenon. Finally, both groups felt an increase in their support system and sense of community at the school of medicine. Conclusion Despite COVID-19 limitations, the EMPACT program met its goals. We effectively supported URiM medical students through mentorship, networking, and community.
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Affiliation(s)
- Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Christian D Freeman
- University of California San Francisco, Department of Obstetrics and Gynecology, San Francisco, CA, USA
| | - Anisha Sheth
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Lauren Jenkins
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Oreoluwa E Olakunle
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Segun Adeagbo
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Josué Rodríguez
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Graciaa S, Adeagbo S, Fong G, Rollins M, McElfresh P, Zerra PE, Bennett C, Josephson CD, Briones M, Fasano RM, Chonat S. Clinical features and neurological outcomes in pediatric immune-mediated thrombotic thrombocytopenic purpura: A report from a large pediatric hematology center. Pediatr Blood Cancer 2022; 69:e29992. [PMID: 36151977 DOI: 10.1002/pbc.29992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/23/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and severely reduced or absent ADAMTS13 (A disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) activity, with varying degrees of organ dysfunction. As TTP is rare in pediatrics, most of the medical and scientific literature has largely reported on adult patients. As a result, limited data exist regarding the clinical features, comorbidities, treatment response, and long-term outcomes in pediatric patients with immune-mediated TTP. METHODS A single-center retrospective cohort study was conducted of all children and adolescents presenting to Children's Healthcare of Atlanta, Atlanta, Georgia, between the years 2001 and 2021 with immune-mediated TTP (iTTP). Clinical features, treatments, and outcomes, including long-term neurocognitive function, were analyzed. RESULTS Eighteen individuals were identified, six of whom had a total of 10 relapses, amounting to 28 episodes overall. Thirty-eight percent of the patients experienced exacerbations but, ultimately, 85% achieved a clinical response and clinical remission. Only one in-hospital death occurred (mortality rate 5.5%). Seventy-three percent of analyzed patients demonstrated long-term neurocognitive abnormalities, including cognitive delay, learning difficulties, and severe depression. CONCLUSIONS Children and adolescents recovering from iTTP are at high risk for neurocognitive deficits from initial and possibly ongoing microvascular disease. Due to risk for long-term neurological deficits, we recommend neuropsychological testing in addition to monitoring of other organ functions in all children with TTP, as well as long-term surveillance of ADAMTS13 activity during remission to detect and promptly treat early relapse.
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Affiliation(s)
- Sara Graciaa
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Segun Adeagbo
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Grace Fong
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Margo Rollins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Patricia McElfresh
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Patricia E Zerra
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carolyn Bennett
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cassandra D Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Briones
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Saad H, Bray DP, McMahon JT, Philbrick BD, Dawoud RA, Douglas JM, Adeagbo S, Yarmoska SK, Agam M, Chow J, Pradilla G, Olson JJ, Alawieh A, Hoang K. Permanent Cerebrospinal Fluid Diversion in Adults With Posterior Fossa Tumors: Incidence and Predictors. Neurosurgery 2021; 89:987-996. [PMID: 34561703 DOI: 10.1093/neuros/nyab341] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Posterior fossa tumors (PFTs) can cause hydrocephalus. Hydrocephalus can persist despite resection of PFTs in a subset of patients requiring permanent cerebrospinal fluid (CSF) diversion. Characteristics of this patient subset are not well defined. OBJECTIVE To define preoperative and postoperative variables that predict the need for postoperative CSF diversion in adult patients with PFTs. METHODS We surveyed the CNS (Central Nervous System) Tumor Outcomes Registry at Emory (CTORE) for patients who underwent PFT resection at 3 tertiary-care centers between 2006 and 2019. Demographic, radiographic, perioperative, and dispositional data were analyzed using univariate and multivariate models. RESULTS We included 617 patients undergoing PFT resection for intra-axial (57%) or extra-axial (43%) lesions. Gross total resection was achieved in 62% of resections. Approximately 13% of patients required permanent CSF diversion/shunting. Only 31.5% of patients who required pre- or intraop external ventricular drain (EVD) placement needed permanent CSF diversion. On logistic regression, size, transependymal flow, use of perioperative EVD, postoperative intraventricular hemorrhage (IVH), and surgical complications were predictors of permanent CSF diversion. Preoperative tumor size was only independent predictor of postoperative shunting in patients with subtotal resection. In patients with intra-axial tumors, transependymal flow (P = .014), postoperative IVH (P = .001), surgical complications (P = .013), and extent of resection (P = .03) predicted need for shunting. In extra-axial tumors, surgical complications were the major predictor (P = .022). CONCLUSION Our study demonstrates that presence of preoperative hydrocephalus in patients with PFT does not necessarily entail the need for permanent CSF diversion. We report the major predictive factors for needing permanent CSF diversion.
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Affiliation(s)
- Hassan Saad
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - David P Bray
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | | | - Reem A Dawoud
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Segun Adeagbo
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Matthew Agam
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jocelyn Chow
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kimberly Hoang
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
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Affiliation(s)
- B L Slaughenhoupt
- Department of Surgery, University of Louisville School of Medicine, KY, USA
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