1
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Harrison DJ, Qumseya A, Xue W, Arnold M, Lautz TB, Hiniker SM, Thomas SM, Venkatramani R, Weiss AR, Mascarenhas L. Adolescents and young adults with rhabdomyosarcoma: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. Pediatr Blood Cancer 2024; 71:e30847. [PMID: 38282125 DOI: 10.1002/pbc.30847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/02/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The impact of established prognostic factors on survival outcomes for childhood rhabdomyosarcoma (RMS) have not been well described in the adolescent and young adult (AYA) RMS patient population. METHODS This is a retrospective analysis of patients with newly diagnosed RMS enrolled between 1997 and 2016 on seven previously reported Children's Oncology Group (COG) clinical trials. Demographics, clinical features, treatment details, and outcome data were collected. Five-year event-free survival (EFS) and overall survival (OS) were estimated for patients diagnosed at age 15-39 years and those diagnosed under age 15 years using the Kaplan-Meier method. Log-rank test was used to compare prognostic factors for EFS and OS. Factors significant in the univariable analysis were included in a Cox proportional hazards regression model. Nonsignificant covariates were removed from the multiple regression model. RESULTS Total 2151 patients including 402 AYAs were analyzed. AYAs were more likely to present with primary tumors ≥5 cm in size, metastatic disease, alveolar histology, and have FOXO1 fusions compared to children. Five-year EFS for the AYA cohort was 44.2% versus 67% for children (p < .001), and 5-year OS was 52% for the AYA cohort versus 78% for children (p < .001). Multivariable analysis revealed tumor site, size and invasiveness, clinical group, and histology were prognostic in AYAs. CONCLUSION AYAs with RMS have a poorer prognosis compared to younger children due to multiple factors. Further research focused on AYAs to better understand RMS biology and improve treatments is critical to improve survival.
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Affiliation(s)
| | | | - Wei Xue
- University of Florida, Gainesville, Florida, USA
| | - Michael Arnold
- Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | | | | | - Rajkumar Venkatramani
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, Texas, USA
| | | | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California, USA
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2
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Azari N, Yakovlev M, Rye N, Dunsiger SR, Sundar S, Bordelon MM, Thomas SM, Thompson JD, Rosa PFS, Sonier JE. Absence of Spontaneous Magnetic Fields due to Time-Reversal Symmetry Breaking in Bulk Superconducting UTe_{2}. Phys Rev Lett 2023; 131:226504. [PMID: 38101387 DOI: 10.1103/physrevlett.131.226504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
We have investigated the low-temperature local magnetic properties in the bulk of molten salt-flux (MSF)-grown single crystals of the candidate odd-parity superconductor UTe_{2} by zero-field muon spin relaxation (μSR). In contrast to previous μSR studies of UTe_{2} single crystals grown by a chemical vapor transport method, we find no evidence of magnetic clusters or electronic moments fluctuating slow enough to cause a discernible relaxation of the zero-field μSR asymmetry spectrum. Consequently, our measurements on MSF-grown single crystals rule out the generation of spontaneous magnetic fields in the bulk that would occur near impurities or lattice defects if the superconducting state of UTe_{2} breaks time-reversal symmetry. This result suggests that UTe_{2} is characterized by a single-component superconducting order parameter.
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Affiliation(s)
- N Azari
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - M Yakovlev
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - N Rye
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - S R Dunsiger
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Centre for Molecular and Materials Science, TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - S Sundar
- Scottish Universities Physics Alliance, School of Physics and Astronomy, University of St. Andrews, St. Andrews KY16 9SS, United Kingdom
| | - M M Bordelon
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S M Thomas
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J D Thompson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - P F S Rosa
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J E Sonier
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
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Somasundaram E, Anderson PM, Smile TD, Halima A, Broughman JB, Reddy CA, Parsai S, Scott JG, Chan T, Campbell S, Angelov L, Zahler S, Trucco M, Thomas SM, Johnson S, Qi P, Magnelli A, Murphy ES. Neutrophil to lymphocyte ratio (NTLR) predicts local control and overall survival after stereotactic body radiotherapy (SBRT) in metastatic sarcoma. Sci Rep 2023; 13:19256. [PMID: 37935813 PMCID: PMC10630331 DOI: 10.1038/s41598-023-46476-3] [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: 02/10/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023] Open
Abstract
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs. local control (N = 138 lesions). Cox analyses identified factors associated with overall survival. If local control was successful, NLTR change was not significant (p = 0.30). However, NLTR significantly changed in patients with local failure (p = 0.027). The multivariable Cox model demonstrated higher NLTR before SBRT was associated with worse overall survival (p = 0.002). The optimal NTLR cut point was 5 (Youden index: 0.418). One-year overall survival in SBRT metastatic sarcoma cohort was 47.6% (CI 34.3%-66.1%). Patients with an NTLR above 5 had a one-year overall survival of 37.7% (21.4%-66.3%); patients with an NTLR below 5 had a significantly improved overall survival of 63% (43.3%-91.6%, p = 0.014). Since NTLR at the time of SBRT was significantly associated with local control success and overall survival in metastatic sarcoma treated with SBRT, future efforts to reduce tumor inhibitory microenvironment factors and improve lymphocyte recovery should be investigated.
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Affiliation(s)
| | - Peter M Anderson
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - James B Broughman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Shireen Parsai
- Department of Radiation Oncology, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Jacob G Scott
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Timothy Chan
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Shauna Campbell
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Stacey Zahler
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Matteo Trucco
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Shavaughn Johnson
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Peng Qi
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Anthony Magnelli
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA.
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4
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Gupta A, Riedel RF, Shah C, Borinstein SC, Isakoff MS, Chugh R, Rosenblum JM, Murphy ES, Campbell SR, Albert CM, Zahler S, Thomas SM, Trucco M. Consensus recommendations in the management of Ewing sarcoma from the National Ewing Sarcoma Tumor Board. Cancer 2023; 129:3363-3371. [PMID: 37403815 DOI: 10.1002/cncr.34942] [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: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023]
Abstract
Ewing sarcoma (ES) is a malignant tumor of bone and soft tissue that most often occurs in adolescents and young adults. Despite an international coordinated approach, several nuances, discrepancies, and debates remain in defining the standard of care for treating ES. In this review, the authors leverage the expertise assembled by formation of the National Ewing Sarcoma Tumor Board, a multi-institution, multidisciplinary virtual tumor board that meets monthly to discuss complicated and challenging cases of ES. This report is focused on select topics that apply to the management of patients with newly diagnosed ES. The specific topics covered include indications for bone marrow aspirate and biopsy for initial evaluation compared with fluorodeoxyglucose-positron emission tomography, the role of interval compressed chemotherapy in patients aged 18 years and older, the role of adding ifosfamide/etoposide to vincristine/doxorubicin/cyclophosphamide for patients with metastatic disease, the data on and role of high-dose chemotherapy with autologous stem cell transplantation, maintenance therapy, and whole-lung irradiation. The data referenced are often limited to subgroup analyses and/or compiled from multiple sources. Although not intended to replace the clinical judgement of treating physicians, the guidelines are intended to provide clarity and recommendations for the upfront management of patients with ES. PLAIN LANGUAGE SUMMARY: Ewing sarcoma is a malignant tumor of bone and soft tissue that most often occurs in adolescents and young adults. For this review, the authors used the experience of the National Ewing Sarcoma Tumor Board, a multi-institution, multidisciplinary virtual tumor board that meets monthly to discuss complicated and challenging cases of Ewing sarcoma. Although not intended to replace the clinical judgement of treating physicians, the guidelines will focus on the development of consensus statements for the upfront management of patients with Ewing sarcoma.
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Affiliation(s)
- Ajay Gupta
- Division of Pediatric Oncology, Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Richard F Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott C Borinstein
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Rashmi Chugh
- Department of Medicine, Division of Hematology and Oncology, Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Jeremy M Rosenblum
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Catherine M Albert
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Stacey Zahler
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Stefanie M Thomas
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Matteo Trucco
- Department of Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, Ohio, USA
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5
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Canavera KE, Bjornard KL, Cost NG, Grady A, Irving H, Kaye EC, Ketterl T, Levine J, Reinecke J, Rios J, Roth M, Sawyer K, Thomas SM, Unguru Y, Johnson LM. Disparate Access to Fertility Preservation in Youth: A Call for Advocacy to Close the Gap. J Pediatr 2023; 261:113496. [PMID: 37211206 DOI: 10.1016/j.jpeds.2023.113496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/07/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Affiliation(s)
| | - Kari L Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN; Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Nicholas G Cost
- Department of Pediatric Urology and the Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO
| | - Allison Grady
- Department of Pediatrics, Oncology Section, Medical College of Wisconsin, Milwaukee, WI; University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI
| | - Helen Irving
- Department of Oncology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Tyler Ketterl
- Department of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, WA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | | | - Julie Rios
- Department of Obstetrics, Gynecology, and Reproductive Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Sawyer
- Department of Pediatrics, Section of Palliative Care, Baylor College of Medicine, Houston, TX
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, OH
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.
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6
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Somasundaram E, Smile TD, Halima A, Broughman JB, Reddy CA, Parsai S, Scott JG, Chan T, Campbell S, Angelov L, Zahler S, Trucco M, Thomas SM, Johnson S, Qi P, Magnelli A, Anderson PM, Murphy ES. Neutrophil to Lymphocyte Ratio (NTLR) Predicts Local Control Failure and Overall Survival after Stereotactic Body Radiotherapy (SBRT) In Metastatic Sarcoma. Res Sq 2023:rs.3.rs-2570832. [PMID: 37333401 PMCID: PMC10275040 DOI: 10.21203/rs.3.rs-2570832/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: 06/20/2023]
Abstract
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs. local control (N = 138 lesions). Cox analyses identified factors associated with overall survival. If local control was successful, NLTR change was not significant (p = 0.30). However, NLTR significantly changed in patients local failure (p = 0.027). The multivariable Cox model demonstrated higher NLTR before SBRT was associated with worse overall survival (p = 0.002). The optimal NTLR cut point was 5 (Youden index: 0.418). One-year overall survival in SBRT metastatic sarcoma cohort was 47.6% (CI 34.3%-66.1%). Patients with an NTLR above 5 had a one-year overall survival of 37.7% (21.4%-66.3%); patients with an NTLR below 5 had a significantly improved overall survival of 63% (43.3%-91.6%, p = 0.014). Since NTLR at the time of SBRT was significantly associated with local control success and overall survival in metastatic sarcoma treated with SBRT, future efforts to reduce tumor inhibitory microenvironment factors and improved lymphocyte recovery should be investigated.
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7
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Iguchi Y, Man H, Thomas SM, Ronning F, Rosa PFS, Moler KA. Microscopic Imaging Homogeneous and Single Phase Superfluid Density in UTe_{2}. Phys Rev Lett 2023; 130:196003. [PMID: 37243629 DOI: 10.1103/physrevlett.130.196003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 04/04/2023] [Indexed: 05/29/2023]
Abstract
Odd-parity superconductor UTe_{2} shows spontaneous time-reversal symmetry breaking and multiple superconducting phases, which imply chiral superconductivity, but only in a subset of samples. Here we microscopically observe a homogeneous superfluid density n_{s} on the surface of UTe_{2} and an enhanced superconducting transition temperature near the edges. We also detect vortex-antivortex pairs even at zero magnetic field, indicating the existence of a hidden internal field. The temperature dependence of n_{s}, determined independent of sample geometry, does not support point nodes along the b axis for a quasi-2D Fermi surface and provides no evidence for multiple phase transitions in UTe_{2}.
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Affiliation(s)
- Yusuke Iguchi
- Geballe Laboratory for Advanced Materials, Stanford University, Stanford, California 94305, USA
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - Huiyuan Man
- Geballe Laboratory for Advanced Materials, Stanford University, Stanford, California 94305, USA
- Stanford Nano Shared Facilities, Stanford University, Stanford, California 94305, USA
| | - S M Thomas
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Filip Ronning
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - Kathryn A Moler
- Geballe Laboratory for Advanced Materials, Stanford University, Stanford, California 94305, USA
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Applied Physics, Stanford University, Stanford, California 94305, USA
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Ng DQ, Ritt-Olson A, Freyer DR, Miller KA, Thomas SM, Milam J, Chan A. Substance Use Among Young Adult Survivors of Childhood Cancer With Cognitive Impairment: An Analysis of the Project Forward Cohort. JCO Oncol Pract 2023; 19:e345-e354. [PMID: 36508698 PMCID: PMC10022886 DOI: 10.1200/op.22.00458] [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: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Young adult childhood cancer survivors (YACCSs) are often impacted by cancer-related cognitive impairment (CRCI) and psychological distress. Using the Project Forward Cohort, we evaluated the relationship between CRCI and substance use behaviors. METHODS YACCSs were surveyed between 2015 and 2018 (N = 1,106, female = 50.8%, Hispanic = 51.5%, median age = 25.5 years). Associations between CRCI and substance use (tobacco, binge drinking, marijuana, prescription drug misuse, and e-cigarette/vaporizer) were examined in multivariate logistic or log-binomial regressions, adjusting for child at diagnosis (0-14 years), years since diagnosis, sex, race/ethnicity, cancer type, and treatment intensity. Mediation analysis was performed to determine opportunities for interventions. RESULTS CRCI was reported by 144 (13.0%) survivors. The highest prevalence was observed in CNS cancers (25.4%) and leukemia (13.3%) survivors. After covariate adjustment, CRCI was associated with 2.26 times the odds of prior 30-day vaping (95% CI, 1.24 to 4.11; P = .007). Mediators with significant indirect effects in the CRCI-vaping relationship include depressive symptoms (Center for Epidemiological Studies Depression Scale) and having two or more cancer-related late effects (P < .05). CONCLUSION CRCI among YACCSs was associated with reports of vaping. Oncologists should screen for vaping behavior if CRCI is apparent. Increasing access to long-term follow-up clinics, addressing physical and mental health issues, and monitoring and educating on vaping and other substance use behaviors is recommended to improve the long-term health of YACCSs.
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Affiliation(s)
- Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Anamara Ritt-Olson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Children's Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stefanie M. Thomas
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH
| | - Joel Milam
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Epidemiology and Biostatistics, University of California Irvine, Irvine, CA
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
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9
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Benedetti DJ, Marron JM, Thomas SM, Brown AEC, Pyke-Grimm KA, Johnson LM, Unguru Y, Kodish E. The role of ethicists in pediatric hematology/oncology: Current status and future needs. Pediatr Blood Cancer 2023; 70:e30132. [PMID: 36495529 DOI: 10.1002/pbc.30132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
As pediatric hematology/oncology (PHO) becomes more complex and sub-subspecialized, dedicated PHO ethicists have emerged as sub-subspecialists focused on addressing ethical issues encountered in clinical and research practices. PHO physicians and other clinicians with advanced training in bioethics contribute to the field through ethics research, education, and ethics consultation services. Furthermore, there exists a newer generation of PHO trainees interested in bioethics. This review details the experiences of current PHO ethicists, providing a blueprint for future educational, research and service activities to strengthen the trajectory of the burgeoning sub-subspecialty of PHO ethics. Creating an American Society of Pediatric Hematology/Oncology (ASPHO) ethics Special Interest Group, enhancing clinical ethics education for pediatric hematologists/oncologists (PHOs), developing multi-institutional research collaborations, and increasing attention to ethical issues germane to nonmalignant hematology will serve the interests of the entire field of PHO, enhancing the care of PHO patients and careers of PHOs.
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Affiliation(s)
- Daniel J Benedetti
- Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Amy E Caruso Brown
- Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kimberly A Pyke-Grimm
- Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland, USA.,Johns Hopkins University Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Eric Kodish
- Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
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10
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Benedetti DJ, Marron JM, Thomas SM, Caruso Brown AE, Pyke-Grimm KA, Johnson LM, Kodish E, Unguru Y. Words Matter. J Clin Oncol 2023; 41:706-707. [PMID: 36150097 DOI: 10.1200/jco.22.01056] [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: 01/20/2023] Open
Affiliation(s)
- Daniel J Benedetti
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
| | - Jonathan M Marron
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
| | - Stefanie M Thomas
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
| | | | | | - Liza-Marie Johnson
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
| | - Eric Kodish
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
| | - Yoram Unguru
- Daniel J. Benedetti, MD, MA, Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN; Jonathan M. Marron, MD, MPH, Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, MA; Stefanie M. Thomas, MD, MS, Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic, Cleveland, OH; Amy E. Caruso Brown, MD, MSc, MSCS, Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY; Kimberly A. Pyke-Grimm, PhD, Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA; Liza-Marie Johnson, MD, MPH, MSB, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; Eric Kodish, MD, Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Case Western Reserve University, Cleveland, OH; and Yoram Unguru, MD, MS, MA, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD
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11
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Mobley EM, Thomas SM, Brailsford J, Ochoa CY, Miller K, Applebaum A, Milam J, Freyer DR. Clinical Trial Participation: A Qualitative Study of Adolescents and Younger Adults Recently Diagnosed with Cancer. J Adolesc Young Adult Oncol 2022. [PMID: 35900287 DOI: 10.1089/jayao.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Although participation of adolescents and young adults (AYAs) in cancer clinical trials (CCTs, i.e., cancer-directed treatment studies) is low, their decision-making perspectives are not well understood, especially following recent diagnosis. Methods: Semistructured interviews with younger AYAs (15-21 years old) eligible for a CCT were to be held within 60 days of beginning treatment at Children's Hospital Los Angeles, an academic pediatric hospital. Using grounded theory methods, key themes regarding CCT participation, barriers, and facilitators were identified from interview transcripts. Thematic saturation was confirmed. Results: Of nine participants, three were <18 years old, four Hispanic, six male, six diagnosed with leukemia, eight enrolled in a CCT, and eight also enrolled in ancillary studies. Four overarching themes emerged: (1) Initial Consent encompassed the first discussion of CCT with patients reflecting positive and negative effects of timing, decisional role, and the emotional impact following cancer diagnosis; (2) Informing Participation involved decision-making processes, specific knowledge, comprehension, and external influences; (3) Participant Relationships emphasized the importance of communication and relationships with providers and parents; and (4) Patient Determinants centered on motives from different perspectives, pre-conceived attitudes, and understanding of CCTs. Conclusion: Recommendations for improving CCT participation among younger AYAs include separating the diagnosis/treatment and CCT discussions, assigning AYAs a meaningful decisional role, having ongoing provider conversations, designing trials to minimize burden, and developing age-appropriate decision aids.
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Affiliation(s)
- Erin M Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Jennifer Brailsford
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Carol Y Ochoa
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anise Applebaum
- College of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California Irvine, Irvine, California, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Zembillas AS, Thomas SM, Rotz SJ, Buhtoiarov IN, Hanna R. Palifermin as primary mucositis prophylaxis in patients with B-cell Non-Hodgkin lymphoma: a case series. Pediatr Hematol Oncol 2022; 39:80-82. [PMID: 34003714 PMCID: PMC8711132 DOI: 10.1080/08880018.2021.1927271] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Stefanie M. Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Seth J. Rotz
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Ilia N. Buhtoiarov
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH
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13
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Somasundaram E, D Smile T, Halima A, Broughman JB, Reddy CA, Parsai S, Scott JG, Shah C, Chan T, Campbell S, Angelov L, Anderson PM, Zahler S, Trucco M, Thomas SM, Johnson S, Mesko N, Nystrom L, Shepard D, Budd GT, Qi P, Magnelli A, Murphy ES. Association between biologically effective dose and local control after stereotactic body radiotherapy for metastatic sarcoma. J Radiosurg SBRT 2022; 8:265-273. [PMID: 37416333 PMCID: PMC10322177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/28/2023] [Indexed: 07/08/2023]
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is increasingly utilized for patients with recurrent and metastatic sarcoma. SBRT affords the potential to overcome the relative radioresistance of sarcomas through delivery of a focused high biological effective dose (BED) as an alternative to invasive surgery. We report local control outcomes after metastatic sarcoma SBRT based on radiation dose and histology. Methods From our IRB-approved single-institution registry, all patients treated with SBRT for metastatic sarcoma between 2014 and 2020 were identified. Kaplan-Meier analysis was used to estimate local control and overall survival at 1 and 2 years. A receiver operating characteristic (ROC) curve was generated to determine optimal BED using an α/β ratio of 3. Local control was compared by SBRT dose using the BED cut point and evaluated by histology. Results Forty-two patients with a total of 138 lesions met inclusion criteria. Median imaging follow up was 7.73 months (range 0.5-35.0). Patients were heavily pre-treated with systemic therapy. Median SBRT prescription was 116.70 Gy BED (range 66.70-419.30). Desmoplastic small round cell tumor, Ewing sarcoma, rhabdomyosarcoma, and small round blue cell sarcomas were classified as radiosensitive (n = 63), and all other histologies were classified as radioresistant (n = 75). Local control for all lesions was 66.7% (95% CI, 56.6-78.5) at 1 year and 50.2% (95% CI, 38.2-66.1) at 2 years. Stratifying by histology, 1- and 2-year local control rates were 65.3% and 55.0%, respectively, for radiosensitive, and 68.6% and 44.5%, respectively, for radioresistant histologies (p = 0.49). The ROC cut point for BED was 95 Gy. Local control rates at 1- and 2-years were 75% and 61.6%, respectively, for lesions receiving >95 Gy BED, and 46.2% and 0%, respectively, for lesions receiving <95 Gy BED (p = 0.01). On subgroup analysis, local control by BED > 95 Gy was significant for radiosensitive histologies (p = 0.013), and trended toward significance for radioresistant histologies (p = 0.25). Conclusion There is a significant local control benefit for sarcoma SBRT when a BED > 95 Gy is used. Further investigation into the dose-response relationship is warranted to maximize the therapeutic index.
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Affiliation(s)
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - James B Broughman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Shireen Parsai
- Department of Radiation Oncology, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Jacob G Scott
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy Chan
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Shauna Campbell
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Peter M Anderson
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Stacy Zahler
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Matteo Trucco
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Shavaughn Johnson
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Nathan Mesko
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Lukas Nystrom
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Dale Shepard
- Department of Hematology and Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - George Thomas Budd
- Department of Hematology and Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Peng Qi
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Magnelli
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
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14
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Anderson PM, Thomas SM, Sartoski S, Scott JG, Sobilo K, Bewley S, Salvador LK, Salazar-Abshire M. Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating. Nutrients 2021; 13:nu13124397. [PMID: 34959948 PMCID: PMC8706251 DOI: 10.3390/nu13124397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.
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Affiliation(s)
- Peter M. Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Correspondence: or ; Tel.: +216-445-7140 or +216-308-2706
| | - Stefanie M. Thomas
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Shauna Sartoski
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jacob G. Scott
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Radiation Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kaitlin Sobilo
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sara Bewley
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Peds Nutritional Services, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Laura K. Salvador
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
| | - Maritza Salazar-Abshire
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
- Department of Nursing Education, MD Anderson Cancer Center, Houston, TX 77030, USA
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15
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Thomas SM, Lefevre JG, Baxter G, Hamilton NA. Characterization of tissue types in basal cell carcinoma images via generative modeling and concept vectors. Comput Med Imaging Graph 2021; 94:101998. [PMID: 34656812 DOI: 10.1016/j.compmedimag.2021.101998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/26/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023]
Abstract
The promise of machine learning methods to act as decision support systems for pathologists continues to grow. However, central to their successful adoption must be interpretable implementations so that people can trust and learn from them effectively. Generative modeling, most notable in the form of adversarial generative models, is a naturally interpretable technique because the quality of the model is explicit from the quality of images it generates. Such a model can be further assessed by exploring its latent space, using human-meaningful concepts by defining concept vectors. Motivated by these ideas, we apply for the first time generative methods to histological images of basal cell carcinoma (BCC). By simultaneously learning to generate and encode realistic image patches, we extract feature rich latent vectors that correspond to various tissue morphologies, namely BCC, epidermis, keratin, papillary dermis and inflammation. We show that a logistic regression model trained on these latent vectors can achieve high classification accuracies across 6 binary tasks (86-98%). Further, by projecting the latent vectors onto learned concept vectors we can generate a score for the absence or degree of presence for a given concept, providing semantically accurate "conceptual summaries" of the various tissues types within a patch. This can be extended to generate multi-dimensional heat maps for whole-image specimens, which characterizes the tissue in a similar way to a pathologist. We additionally find that accurate concept vectors can be defined using a small labeled dataset.
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Affiliation(s)
- S M Thomas
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - J G Lefevre
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - G Baxter
- MyLab Pathology, Salisbury, Australia
| | - N A Hamilton
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia.
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16
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Milam J, Freyer DR, Miller KA, Tobin J, Wojcik KY, Ramirez CN, Ritt-Olson A, Thomas SM, Baezconde-Garbanati L, Cousineau M, Modjeski D, Gupta S, Hamilton AS. Project Forward: A Population-Based Cohort Among Young Adult Survivors of Childhood Cancers. JNCI Cancer Spectr 2021; 5:pkab068. [PMID: 34585063 PMCID: PMC8462512 DOI: 10.1093/jncics/pkab068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Childhood cancer survivors (CCS) face increased risk of morbidity and are recommended to receive lifelong cancer-related follow-up care. Identifying factors associated with follow-up care can inform efforts to support the long-term health of CCS. Methods Eligible CCS (diagnosed between 1996 and 2010) identified through the Los Angeles County Cancer Surveillance Program responded to a self-report survey that assessed demographic, clinical, health-care engagement, and psychosocial risk and protective factors of recent (prior 2 years) cancer-related follow-up care. Weighted multivariable logistic regression was conducted to identify correlates of care. All statistical tests were 2-sided. Results The overall response rate was 44.9%, with an analytical sample of n = 1106 (54.2% Hispanic; mean [SD] ages at survey, diagnosis, and years since diagnosis were 26.2 [4.9], 11.6 [5.4], and 14.5 [4.4] years, respectively). Fifty-seven percent reported a recent cancer-related visit, with lower rates reported among older survivors. Having insurance, more late effects, receipt of a written treatment summary, discussing long-term care needs with treating physician, knowledge of the need for long-term care, having a regular source of care, and higher health-care self-efficacy were statistically significantly associated with greater odds of recent follow-up care, whereas older age, Hispanic or Other ethnicity (vs non-Hispanic White), and years since diagnosis were associated with lower odds of recent care (all Ps < .05). Conclusions Age and ethnic disparities are observed in receipt of follow-up care among young adult CCS. Potential intervention targets include comprehensive, ongoing patient education; provision of written treatment summaries; and culturally tailored support to ensure equitable access to and the utilization of care.
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Affiliation(s)
- Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Departments of Medicine and Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - David R Freyer
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Katherine Y Wojcik
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, WA, USA
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cousineau
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sapna Gupta
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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17
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Asaba T, Ivanov V, Thomas SM, Savrasov SY, Thompson JD, Bauer ED, Ronning F. Colossal anomalous Nernst effect in a correlated noncentrosymmetric kagome ferromagnet. Sci Adv 2021; 7:7/13/eabf1467. [PMID: 33771869 PMCID: PMC7997519 DOI: 10.1126/sciadv.abf1467] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/09/2021] [Indexed: 05/12/2023]
Abstract
The transverse voltage generated by a temperature gradient in a perpendicularly applied magnetic field, termed the Nernst effect, has promise for thermoelectric applications and for probing electronic structure. In magnetic materials, an anomalous Nernst effect (ANE) is possible in a zero magnetic field. We report a colossal ANE in the ferromagnetic metal UCo0.8Ru0.2Al, reaching 23 microvolts per kelvin. Uranium's 5f electrons provide strong electronic correlations that lead to narrow bands, a known route to producing a large thermoelectric response. In addition, uranium's strong spin-orbit coupling produces an intrinsic transverse response in this material due to the Berry curvature associated with the relativistic electronic structure. Theoretical calculations show that in UCo0.8Ru0.2Al at least 148 Weyl nodes, and two nodal lines, exist within 60 millielectron volt of the Fermi level. This work demonstrates that magnetic actinide materials can host strong Nernst and Hall responses due to their combined correlated and topological nature.
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Affiliation(s)
- T Asaba
- Materials Physics and Applications Division, Los Alamos National Laboratory, NM, 87545 USA.
| | - V Ivanov
- Department of Physics, University of California, Davis, CA 95616, USA
| | - S M Thomas
- Materials Physics and Applications Division, Los Alamos National Laboratory, NM, 87545 USA
| | - S Y Savrasov
- Department of Physics, University of California, Davis, CA 95616, USA
| | - J D Thompson
- Materials Physics and Applications Division, Los Alamos National Laboratory, NM, 87545 USA
| | - E D Bauer
- Materials Physics and Applications Division, Los Alamos National Laboratory, NM, 87545 USA
| | - F Ronning
- Institute for Materials Science, Los Alamos National Laboratory, NM, 87545 USA.
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18
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Quindipan C, Cotter JA, Ji J, Mitchell WG, Moke DJ, Navid F, Thomas SM, VanHirtum-Das M, Wang L, Saitta SC, Biegel JA, Hiemenz MC. Custom Pediatric Oncology Next-Generation Sequencing Panel Identifies Somatic Mosaicism in Archival Tissue and Enhances Targeted Clinical Care. Pediatr Neurol 2021; 114:55-59. [PMID: 33221597 DOI: 10.1016/j.pediatrneurol.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/06/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disorders in the PIK3CA-related overgrowth spectrum because of somatic mosaicism are associated with segmental overgrowth of the body in conjunction with vascular, skeletal, and brain malformations such as hemimegalencephaly. A pathogenic variant may only be detectable in affected tissue and not in peripheral blood or saliva samples; therefore archival tissue may be the only relevant available specimen for testing. Although this is a common approach for cancer testing, it is not typically used for constitutional genetic disorders. METHODS PIK3CA mosaicism was assessed with a custom pediatric oncology next-generation sequencing panel (OncoKids) designed to capture somatic mutations in pediatric malignancies. The panel covers a wide range of targets including PIK3CA and AKT1 hotspots. We used OncoKids on archival formalin-fixed, paraffin-embedded or frozen samples from seven patients with facial hemihypertrophy and lipomas, hemimegalencephaly, or hemihypertrophy with a lymphovascular malformation. The age of the archival tissue examined by next-generation sequencing ranged from two to 13 years (median 5 years). Every patient had clinical manifestations within the PIK3CA-related overgrowth spectrum and had a sample of an affected tissue available for testing from a prior surgical intervention. RESULTS PIK3CA mosaicism was detected in all seven patients and the mutant allele fraction was lower in the lymphovascular malformation tissues (8% to 11%) than in brain (20% to 32%) and lipomatous (16% to 23%) tissues. CONCLUSIONS Our study highlights the clinical utility of using a robust, oncology-focused next-generation sequencing assay to identify PIK3CA mosaicism in noncancer cases. It is feasible to use archival samples that are more than a decade old to obtain a molecular diagnosis, which can then be used to improve health care management.
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Affiliation(s)
- Catherine Quindipan
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.
| | - Jennifer A Cotter
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California; Department of Pathology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Jianling Ji
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California; Department of Pathology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Wendy G Mitchell
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Diana J Moke
- Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California; Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Fariba Navid
- Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California; Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Stefanie M Thomas
- Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California; Division of Hematology and Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Michele VanHirtum-Das
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Larry Wang
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California; Department of Pathology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Sulagna C Saitta
- Division of Medical Genets, Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Jaclyn A Biegel
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California; Department of Pathology, Keck School of Medicine at the University of Southern California, Los Angeles, California
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19
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Orgel E, Freyer DR, Ullrich NJ, Hardy KK, Thomas SM, Dvorak CC, Esbenshade AJ. Assessment of provider perspectives on otoprotection research for children and adolescents: A Children's Oncology Group Cancer Control and Supportive Care Committee survey. Pediatr Blood Cancer 2020; 67:e28647. [PMID: 32886425 PMCID: PMC7808411 DOI: 10.1002/pbc.28647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity for childhood cancer survivors. Understanding provider perspectives is crucial to developing otoprotection studies that are both informative and feasible. Two international trials (ACCL0431 and SIOPEL6) investigated the drug sodium thiosulfate (STS) as an otoprotectant, but definitive interpretation of the findings of these trials has been challenging. Adoption of STS has therefore been uneven, and provider perspectives on its role are unknown. PROCEDURE The Children's Oncology Group (COG) Cancer Control and Supportive Care Neurotoxicity Subcommittee therefore conducted a survey of providers at COG institutions to determine perspectives on pediatric otoprotection practices and research surrounding three major themes: (1) prevalence of routine use of STS with cisplatin-based regimens, (2) application of audiometry to cisplatin therapy, and (3) preferred modalities for otoprotection research. RESULTS Survey respondents (45%, 44/98 surveyed institutions) were of diverse institutional sizes, practice settings, and geographical locations primarily in the United States and Canada. Overall, respondents considered CIHL an important toxicity and indicated strong enthusiasm for future studies (98%, 40/41). Results indicated that while STS was the current or planned standard of care in a minority of responding institutions (36%, 16/44), most sites were receptive to its inclusion in appropriate study designs. Application of audiometry for ototoxicity monitoring varied widely across sites. For otoprotection research, systemic agents were preferred (68%, 28/41) as compared with intratympanic approaches. CONCLUSION These results suggest that pediatric otoprotection trials remain of interest to providers; the emphasis of these trials should remain on systemic and not intratympanic therapy.
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Affiliation(s)
- Etan Orgel
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nicole J. Ullrich
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | - Kristina K. Hardy
- Children’s National Hospital, Washington, DC,George Washington University School of Medicine, Cleveland, OH
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20
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Tobin JL, Thomas SM, Freyer DR, Hamilton AS, Milam JE. Estimating cancer treatment intensity from SEER cancer registry data: methods and implications for population-based registry studies of pediatric cancers. Cancer Causes Control 2020; 31:881-890. [PMID: 32757117 PMCID: PMC7537342 DOI: 10.1007/s10552-020-01328-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The Intensity of Treatment Rating (ITR) Scale condenses treatment and clinical characteristics into a single measure to study treatment effects on downstream health outcomes across cancer types. This rating was originally developed for clinicians to determine from medical charts. However, large studies are often unable to access medical charts for all study participants. We developed and tested a method of estimating treatment intensity (TI) using cancer registry and patient self-reported data. METHODS We estimated two versions of TI for a cohort of pediatric cancer survivors-one utilized information solely available from cancer registry variables (TIR) and the other included registry and self-reported information (TIS) from survey participants. In a subset of cases (n = 135) for whom the gold standard TI (TIC) was known, both TIR and TIS were compared to TIC by calculating percent agreement and weighted Cohen's kappa, overall and within cancer subtypes. RESULTS In comparison to TIC, 71% of TI scores from both methods were in agreement (k = 0.61 TIR/0.54 TIS). Among subgroups, agreement ranged from lowest (46% TIR/39% TIS) for non-defined tumors (e.g., "Tumor-other"), to highest (94% TIR/94% TIS) for acute lymphoblastic leukemia (ALL). CONCLUSIONS We developed a methodology to estimate TI for pediatric cancer research when medical chart review is not possible. High reliability was observed for ALL, the most common pediatric cancer. Additional validation is needed among a larger sample of other cancer subgroups. The ability to estimate TI from cancer registry data would assist with monitoring effects of treatment during survivorship in registry-based epidemiological studies.
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Affiliation(s)
- Jessica L Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Stefanie M Thomas
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, USA
| | - David R Freyer
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Thomas SM, Santos FB, Christensen MH, Asaba T, Ronning F, Thompson JD, Bauer ED, Fernandes RM, Fabbris G, Rosa PFS. Evidence for a pressure-induced antiferromagnetic quantum critical point in intermediate-valence UTe 2. Sci Adv 2020; 6:eabc8709. [PMID: 33055167 PMCID: PMC7556831 DOI: 10.1126/sciadv.abc8709] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/27/2020] [Indexed: 06/01/2023]
Abstract
UTe2 is a recently discovered unconventional superconductor that has attracted much interest because of its potentially spin-triplet topological superconductivity. Our ac calorimetry, electrical resistivity, and x-ray absorption study of UTe2 under applied pressure reveals key insights on the superconducting and magnetic states surrounding pressure-induced quantum criticality at P c1 = 1.3 GPa. First, our specific heat data at low pressures, combined with a phenomenological model, show that pressure alters the balance between two closely competing superconducting orders. Second, near 1.5 GPa, we detect two bulk transitions that trigger changes in the resistivity, which are consistent with antiferromagnetic order, rather than ferromagnetism. Third, the emergence of magnetism is accompanied by an increase in valence toward a U4+ (5f 2) state, which indicates that UTe2 exhibits intermediate valence at ambient pressure. Our results suggest that antiferromagnetic fluctuations may play a more substantial role on the superconducting state of UTe2 than previously thought.
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Affiliation(s)
- S M Thomas
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA.
| | - F B Santos
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
- Escola de Engenharia de Lorena, Universidade de Sao Paulo (EEL-USP), Materials Engineering Department (Demar), Lorena, Sao Paolo, Brazil
| | - M H Christensen
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455, USA
| | - T Asaba
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - F Ronning
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - J D Thompson
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - E D Bauer
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - R M Fernandes
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455, USA
| | - G Fabbris
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, USA
| | - P F S Rosa
- Los Alamos National Laboratory, Los Alamos, NM 87545, USA
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Rotz SJ, Wei W, Thomas SM, Hanna R. Distance to treatment center is associated with survival in children and young adults with acute lymphoblastic leukemia. Cancer 2020; 126:5319-5327. [PMID: 32910494 DOI: 10.1002/cncr.33175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/01/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Socioeconomic and demographic categories such as income, race, insurance status, and treatment center type are associated with outcomes in acute leukemia. This study was aimed at determining whether the distance to treatment center affects overall survival for children and young adults with acute leukemia. METHODS The National Cancer Database was queried for patients 39 years old or younger who were diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). A backward elimination procedure was used to select final multivariate Cox models. RESULTS In total, 12,301 patients with AML and 22,683 patients with ALL were analyzed. The ALL model included distance to treatment center, Charlson-Deyo score, age, race, insurance status, and community income level. US census definitions of urban and rural were not statistically significant, and no interaction was significant for included variables. Compared with distances > 50 miles, all other distances were associated with improved survival (hazard ratio [HR] for ≤10 miles, 0.91; P = .04; HR for >10 to ≤20 miles, 0.86; P = .004; HR for >20 to ≤50 miles, 0.87; P = .005). The final model for AML included the same variables as the ALL model except for distance to treatment center, which was not statistically significant. CONCLUSIONS For children and young adults with ALL, distances > 50 miles are associated with inferior overall survival; however, no difference is seen for AML. Although it is unknown whether differences in survival for patients with ALL based on distance are driven by relapse or treatment-related mortality, increased attention to adherence, supportive care, and logistics for patients traveling long distances is warranted. LAY SUMMARY For children and young adults with acute lymphoblastic leukemia, living more than 50 miles from the treatment center is associated with worse outcomes.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wei Wei
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rabi Hanna
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
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23
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Kushwaha SK, Chan MK, Park J, Thomas SM, Bauer ED, Thompson JD, Ronning F, Rosa PFS, Harrison N. Magnetic field-tuned Fermi liquid in a Kondo insulator. Nat Commun 2019; 10:5487. [PMID: 31792205 PMCID: PMC6889157 DOI: 10.1038/s41467-019-13421-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/02/2019] [Indexed: 11/08/2022] Open
Abstract
Kondo insulators are expected to transform into metals under a sufficiently strong magnetic field. The closure of the insulating gap stems from the coupling of a magnetic field to the electron spin, yet the required strength of the magnetic field-typically of order 100 T-means that very little is known about this insulator-metal transition. Here we show that Ce[Formula: see text]Bi[Formula: see text]Pd[Formula: see text], owing to its fortuitously small gap, provides an ideal Kondo insulator for this investigation. A metallic Fermi liquid state is established above a critical magnetic field of only [Formula: see text] 11 T. A peak in the strength of electronic correlations near [Formula: see text], which is evident in transport and susceptibility measurements, suggests that Ce[Formula: see text]Bi[Formula: see text]Pd[Formula: see text] may exhibit quantum criticality analogous to that reported in Kondo insulators under pressure. Metamagnetism and the breakdown of the Kondo coupling are also discussed.
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Affiliation(s)
- Satya K Kushwaha
- MPA-MAGLAB, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Mun K Chan
- MPA-MAGLAB, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Joonbum Park
- MPA-MAGLAB, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - S M Thomas
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Eric D Bauer
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - J D Thompson
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - F Ronning
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Priscila F S Rosa
- MPA-CMMS, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Neil Harrison
- MPA-MAGLAB, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA.
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Squillaro AI, Zhou S, Thomas SM, Kim ES. A 10-Month-Old Infant Presenting With Signs of Precocious Puberty Secondary to a Sclerosing Stromal Tumor of the Ovary in the Absence of Hormonal Elevation. Pediatr Dev Pathol 2019; 22:375-379. [PMID: 30577720 DOI: 10.1177/1093526618819605] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Precocious puberty in an infant is an alarming and infrequent finding, making the differential diagnosis difficult for practitioners. Precocious puberty secondary to a sclerosing stromal tumor (SST) of the ovary is rare. We present a case of a child that began precocious puberty at 3 months of age including development of breast buds, pubic hair, growth spurt, and menarche 5 days prior to presenting to pediatric endocrinology at 10 months. She underwent right salpingo-oophorectomy which demonstrated a soft tissue mass occupying almost the entire ovary with a tan-pink fleshy cut surface. Histological examination confirmed a variant of SST. This case represents an extremely young onset of precocious puberty secondary to a variant of SST without hormonal elevation.
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Affiliation(s)
- Anthony I Squillaro
- 1 Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shengmei Zhou
- 2 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Stefanie M Thomas
- 3 Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,4 Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Eugene S Kim
- 1 Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.,5 Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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25
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Thomas SM, Ding X, Ronning F, Zapf V, Thompson JD, Fisk Z, Xia J, Rosa PFS. Quantum Oscillations in Flux-Grown SmB_{6} with Embedded Aluminum. Phys Rev Lett 2019; 122:166401. [PMID: 31075018 DOI: 10.1103/physrevlett.122.166401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/14/2018] [Indexed: 06/09/2023]
Abstract
SmB_{6} is a candidate topological Kondo insulator that displays surface conduction at low temperatures. Here, we perform torque magnetization measurements as a means to detect de Haas-van Alphen (dHvA) oscillations in SmB_{6} crystals grown by aluminum flux. We find that dHvA oscillations occur in single crystals containing embedded aluminum, originating from the flux used to synthesize SmB_{6}. Measurements on a sample with multiple, unconnected aluminum inclusions show that aluminum crystallizes in a preferred orientation within the SmB_{6} cubic lattice. The presence of aluminum is confirmed through bulk susceptibility measurements, but does not show a signature in transport measurements. We discuss the ramifications of our results.
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Affiliation(s)
- S M Thomas
- Department of Physics and Astronomy, University of California, Irvine, California 92967, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Xiaxin Ding
- National High Magnetic Field Laboratory, Los Alamos, New Mexico 87545, USA
| | - F Ronning
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - V Zapf
- National High Magnetic Field Laboratory, Los Alamos, New Mexico 87545, USA
| | - J D Thompson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Z Fisk
- Department of Physics and Astronomy, University of California, Irvine, California 92967, USA
| | - J Xia
- Department of Physics and Astronomy, University of California, Irvine, California 92967, USA
| | - P F S Rosa
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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26
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Rosa PFS, Thomas SM, Balakirev FF, Bauer ED, Fernandes RM, Thompson JD, Ronning F, Jaime M. Enhanced Hybridization Sets the Stage for Electronic Nematicity in CeRhIn_{5}. Phys Rev Lett 2019; 122:016402. [PMID: 31012717 DOI: 10.1103/physrevlett.122.016402] [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] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/26/2018] [Indexed: 06/09/2023]
Abstract
High magnetic fields induce a pronounced in-plane electronic anisotropy in the tetragonal antiferromagnetic metal CeRhIn_{5} at H^{*}≳30 T for fields ≃20° off the c axis. Here we investigate the response of the underlying crystal lattice in magnetic fields to 45 T via high-resolution dilatometry. At low fields, a finite magnetic field component in the tetragonal ab plane explicitly breaks the tetragonal (C_{4}) symmetry of the lattice revealing a finite nematic susceptibility. A modest a-axis expansion at H^{*} hence marks the crossover to a fluctuating nematic phase with large nematic susceptibility. Magnetostriction quantum oscillations confirm a Fermi surface change at H^{*} with the emergence of new orbits. By analyzing the field-induced change in the crystal-field ground state, we conclude that the in-plane Ce 4f hybridization is enhanced at H^{*}, in agreement with the in-plane lattice expansion. We argue that the nematic behavior observed in this prototypical heavy-fermion material is of electronic origin, and is driven by the hybridization between 4f and conduction electrons which carries the f-electron anisotropy to the Fermi surface.
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Affiliation(s)
- P F S Rosa
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S M Thomas
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - F F Balakirev
- National High Magnetic Field Laboratory, Los Alamos, New Mexico 87545, USA
| | - E D Bauer
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R M Fernandes
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J D Thompson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - F Ronning
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Jaime
- National High Magnetic Field Laboratory, Los Alamos, New Mexico 87545, USA
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27
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Aber A, Tong TS, Chilcott J, Thokala P, Maheswaran R, Thomas SM, Nawaz S, Walters S, Michaels J. Sex differences in national rates of repair of emergency abdominal aortic aneurysm. Br J Surg 2018; 106:82-89. [PMID: 30395361 DOI: 10.1002/bjs.11006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. METHODS Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. RESULTS In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in-hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co-morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in-hospital mortality rate after emergency repair of an intact AAA was also higher among women. CONCLUSION Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co-morbidities, the differences persist after case-mix adjustment.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - T S Tong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Maheswaran
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S M Thomas
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Thomas SM, Malvar J, Tran H, Shows J, Freyer DR. A prospective comparison of cancer clinical trial availability and enrollment among adolescents/young adults treated at an adult cancer hospital or affiliated children's hospital. Cancer 2018; 124:4064-4071. [PMID: 30291804 PMCID: PMC6234084 DOI: 10.1002/cncr.31727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/31/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low cancer clinical trial (CCT) enrollment may contribute to survival disparities affecting adolescents and young adults (AYAs) (ages 15-39 years). The objective of this study was to evaluate whether differences in CCT availability related to treatment site could explain the low CCT enrollment. METHODS This prospective, observational cohort study was conducted at an academic children's hospital and its affiliated but geographically separated adult cancer hospital within a National Cancer Institute-designated Comprehensive Cancer Center. For consecutive, newly diagnosed AYA patients, it was determined whether an appropriate CCT existed nationally, was available at the treatment site, and was used for enrollment. Proportions of AYAs in these categories were compared between sites using the chi-square test. RESULTS One hundred fifty-two consecutive AYA patients were included from the children's hospital (n = 68; ages 15-20 years) and the adult cancer hospital (n = 84; ages 18-39 years). Although there was no difference in CCT existence for individual AYA patients by site (children's hospital [36 of 68 patients; 52.9%] vs adult cancer hospital [45 of 84 patients; 53.6%]; P = .938), CCT availability was significantly lower at the adult cancer hospital (14 of 84 patients [16.7%] vs 30 of 68 [44.1%] at the children's hospital; P < .001). The proportion of AYAs enrolled was low at both sites (8 of 68 patients [11.8%] vs 6 of 84 patients [7.1%], respectively; P = .327). Fewer existing CCTs were available at the adult cancer hospital (4 of 27 patients [14.8%] vs 8 of 14 patients [57.1%], respectively), and those were directed toward solid tumors and new agents. CONCLUSIONS Efforts to improve low CCT enrollment among AYAs should be differentiated by treatment site. In the adult setting, these efforts should be aimed at improving CCT availability by overcoming site-level barriers to opening existing CCTs.
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Affiliation(s)
- Stefanie M. Thomas
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Henry Tran
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jared Shows
- Department of Pathology, Long Beach Memorial/Miller Children’s Hospital, Long Beach, California
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Medicine and the USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Thomas SM, Malvar J, Tran H, Shows J, Freyer DR. A prospective, observational cohort study comparing cancer clinical trial availability and enrollment between early adolescents/young adults and children. Cancer 2018; 124:983-990. [PMID: 29149450 PMCID: PMC5821554 DOI: 10.1002/cncr.31127] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 09/01/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor enrollment of adolescents and young adults (AYAs) (ages 15-39 years) onto cancer clinical trials (CCTs) may contribute to inferior survival gains compared with children. In this study, the authors assessed whether differences in CCT availability would explain lower CCT enrollment for early AYAs (eAYAs) (ages 15-21 years). METHODS This prospective, observational cohort study was conducted at a single academic children's hospital. For consecutive patients who were newly diagnosed with cancer over a 13-month period, it was determined whether an appropriate CCT existed nationally or was available locally and whether enrollment on that CCT occurred. The proportions of eAYAs versus children in each category were compared using the chi-square test. The impact of age and other factors on enrollment status was assessed using logistic regression analysis. RESULTS Among 216 patients, 58 were eAYAs, and 158 were children. There was no difference in the proportion of eAYAs versus children who had an existing CCT (28 of 58 eAYAs [48.3%] vs 85 of 158 children [53.8%]; P = .47) or an available CCT (23 of 58 eAYAs [39.7%] vs 75 of 158 children [47.5%]; P = .31). However, significantly fewer eAYAs were enrolled when a CCT was available (7 of 23 eAYAs [30.4%] vs 50 of 75 children [67.7%]; P = .002). In multivariable analysis, eAYAs were significantly less likely than children to be enrolled in an available CCT (adjusted odds ratio, 0.22; 95% confidence interval, 0.08-0.62). CONCLUSIONS Equal proportions of children and eAYAs had CCTs available, but significantly fewer eAYAs were enrolled. These findings suggest that, for eAYAs, factors other than CCT availability are important enrollment barriers and should be addressed. Cancer 2018;124:983-90. © 2017 American Cancer Society.
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Affiliation(s)
- Stefanie M. Thomas
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Henry Tran
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jared Shows
- Department of Pathology, Long Beach Memorial/Miller Children’s Hospital, Long Beach, California
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Medicine and the USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Oyekunle TO, Thomas SM, Greenup RA, Hyslop T, Blackwell K. Abstract P6-10-01: Incidence and mortality among breast cancer patients < 40 years old: U.S. trends from 1992-2014. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-10-01] [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
Introduction:
Breast cancer (BC) is the most commonly diagnosed cancer among women in the United States, but less than 5% of women develop BC before age 40. We sought to determine the trend over time in incidence and survival rates, and pathologic features of Non-Hispanic White (W), Non-Hispanic Black (B) and Hispanic (HIS) women (<40 years) with invasive breast cancer.
Methods:
Women <40 years old diagnosed with invasive BC were identified from the SEER 13 registry. Patients were stratified by year of diagnosis (1992-2014), race/ethnicity (W, B, and HIS) and pathologic features (stage, grade, ER and PR status). Age-adjusted incidence rates and 5- and 10-year disease-specific survival (DSS) rates were calculated. Incidence rate ratios (IRRs) were estimated by race/ethnicity group and pathologic features to express relative risk of BC incidence. Temporal trends of incidence rates (1992-2014), 5- (1992-2009) and 10-year (1992-2004) DSS rates were assessed as average annual percentage change (AAPC) using a joinpoint model. Survival estimates were calculated using the Kaplan-Meier method and Log-rank tests were used to test for differences in DSS among the race/ethnicity groups.
Results:
A total of 28,686 patients were included in this analysis: 64.1% W, 16.6% B, and 19.3% HIS. Overall, young B women had a higher incidence and worse survival than W women. Tumors with poor prognostic features (stage IV, grade III, ER- and PR-) were more common than those with better prognosis (stage 1, grade 1, ER+ and PR+, respectively) among young B women compared to W and HIS women. Young B women had worse 5- and 10-year DSS compared to their W and HIS counterparts (all p<0.001).
Young W women experienced a 0.8% per year increase in the incidence of invasive BC; incidence rates were stable in B and HIS women. B women had a slightly higher AAPC than W women for 5- and 10-year DSS rates. The incidence of advanced stage tumors (stage 4) and PR- tumors has been rising slightly faster in B than W women.
Trends of incidence and mortality rates by race/ethnicity and pathologic features. WBHISIRR (95% CI)Overall vs HIS1.38 (1.34-1.42)1.74 (1.69-1.81)referenceStage 4 vs 10.13 (0.12-0.14)0.41 (0.36-0.46)0.26(0.23-0.30)Grade 3 vs 17.43 (7.02-7.89)13.82 (11.99-16.00)10.40 (9.22-11.76)ER- vs +0.55 (0.53-0.56)0.83 (0.78-0.88)0.64 (0.60-0.66)PR- vs +0.71 (0.69-0.73)1.13 (1.06-1.20)0.85 (0.80-0.91)DSS 5-yr86.7 (86.1-87.2)72.9 (71.5-74.3)80.6 (79.4-81.8)10-yr78.0 (77.3-78.7)63.2 (61.5-64.8)71.4 (69.9-72.9)AAPCOverall0.8*0.20.2Stage 44.3*4.4*3.0*Grade 31.4*1.11.0*ER--0.4-0.50.2PR-1.1*1.2*1.9*DSS 5-yr0.6*0.8*0.8*10-yr0.9*1.0*1.1**AAPC is statistically different from zero (p<0.05).
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Conclusion:
The incidence of higher stage and PR- tumors is increasing at a faster rate in young black women when compared to whites. Although the incidence of BC is increasing over time for young white women and not young black women, disparities still exist in overall incidence. Similarly, although DSS is increasing at higher rates for black and Hispanic women compared to whites, large survival disparities still exist. Improvements have been made over time, but more work needs to be done to determine which factors are associated with these disparities and how to close the gap in survival.
Citation Format: Oyekunle TO, Thomas SM, Greenup RA, Hyslop T, Blackwell K. Incidence and mortality among breast cancer patients < 40 years old: U.S. trends from 1992-2014 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-01.
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Affiliation(s)
- TO Oyekunle
- Duke Cancer Institute, Durham,, NC; Duke University Medical Center, Durham,, NC
| | - SM Thomas
- Duke Cancer Institute, Durham,, NC; Duke University Medical Center, Durham,, NC
| | - RA Greenup
- Duke Cancer Institute, Durham,, NC; Duke University Medical Center, Durham,, NC
| | - T Hyslop
- Duke Cancer Institute, Durham,, NC; Duke University Medical Center, Durham,, NC
| | - K Blackwell
- Duke Cancer Institute, Durham,, NC; Duke University Medical Center, Durham,, NC
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Moke DJ, Thomas SM, Hiemenz MC, Nael A, Wang K, Shillingford N, Biegel JA, Mascarenhas L. Three synchronous malignancies in a patient with DICER1 syndrome. Eur J Cancer 2018; 93:140-143. [PMID: 29395683 DOI: 10.1016/j.ejca.2017.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/21/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Diana J Moke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Matthew C Hiemenz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ali Nael
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kasper Wang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nick Shillingford
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leo Mascarenhas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Miller KA, Ramirez CN, Wojcik KY, Ritt-Olson A, Baezconde-Garbanati L, Thomas SM, Freyer DR, Hamilton AS, Milam JE. Prevalence and correlates of health information-seeking among Hispanic and non-Hispanic childhood cancer survivors. Support Care Cancer 2017; 26:1305-1313. [PMID: 29124416 DOI: 10.1007/s00520-017-3956-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Childhood cancer survivors (CCS) report high unmet information needs. This study examined the prevalence of cancer-related information-seeking among CCS and investigated associations between information-seeking behavior and positive health outcomes such as follow-up care. METHODS Participants (n = 193) were young adult CCS diagnosed with cancer in Los Angeles County, 54% of Hispanic ethnicity, with a mean age of 19.87, in remission, and at least 2 years from completion of treatment. CCS were asked where they accessed health information related to their cancer with response options categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess variables associated with each information domain, including sociodemographics, post-traumatic growth (i.e., reporting positive changes since cancer diagnosis), health care engagement, level of education, and health insurance status. RESULTS Hospital resources were the most commonly accessed information domain (65.3%), and CCS of Hispanic ethnicity (vs. non-Hispanic) were more likely to access this source. Seeking information from other cancer survivors was positively associated with follow-up care and post-traumatic growth. Hispanic CCS were marginally less likely to seek information from other survivors and family than non-Hispanics. CONCLUSIONS While CCS obtain information from a variety of sources, hospital resources are an important site for access, particularly for individuals of Hispanic ethnicity. Information sharing between survivors may promote positive health care engagement; however, Hispanic CCS may be less likely to utilize this resource and may face barriers in information sharing with other cancer survivors.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA. .,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Katherine Y Wojcik
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Stefanie M Thomas
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David R Freyer
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto Street, Los Angeles, CA, 90032, USA
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Harris SM, Shah P, Mulnier H, Healey A, Thomas SM, Amiel SA, Hopkins D. Factors influencing attendance at structured education for Type 1 diabetes in south London. Diabet Med 2017; 34:828-833. [PMID: 28196291 DOI: 10.1111/dme.13333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
AIM To investigate the factors influencing uptake of structured education for people with Type 1 diabetes in our local population in order to understand why such uptake is low. METHODS We conducted a cross-sectional database study of adults with Type 1 diabetes in two south London boroughs, analysed according to Dose Adjustment For Normal Eating (DAFNE) attendance or non-attendance. Demographics, glycaemic control and service use, with subset analysis by ethnicity, were compared using univariate analysis. An exploratory regression model was used to identify influencing factors. RESULTS The analysis showed that 73% of adults had not attended the DAFNE programme. For non-attenders vs attenders, male gender (59 vs 48%; P = 0.002), older age (39 vs 35 years; P < 0.001), non-white ethnicity (30 vs 20%; P = 0.001) and coming from an area of social deprivation (index of multiple deprivation score 31 vs 28; P < 0.001) were associated with non-attendance. The difference in gender (88% men vs 70% women; P < 0.001) and age (43 vs 34 years) persisted in the non-white group. Regression analysis showed that higher baseline HbA1c level (odds ratio 1.96; P = 0.004), younger age (odds ratio 0.98; P = 0.001) and lower social deprivation (odds ratio 0.52; P = 0.001) was associated with attendance. CONCLUSION Socio-economic status and factors perceived as indicating greater severity of disease (HbA1c ) influence attendance at DAFNE. More work is necessary to understand the demography of non-attenders to aid future service design and alternative engagement strategies for these groups.
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Affiliation(s)
- S M Harris
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
- Health Innovation Network, London, UK
| | - P Shah
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - H Mulnier
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - A Healey
- King's Health Economics and Centre for Implementation Science at Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S M Thomas
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - S A Amiel
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
- Diabetes Research Group, King's College London, London, UK
| | - D Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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Ahmadzia HK, Lockhart EL, Thomas SM, Welsby IJ, Hoffman MR, James AH, Murtha AP, Swamy GK, Grotegut CA. Using antifibrinolytics in the peripartum period - concern for a hypercoagulable effect? J Neonatal Perinatal Med 2017; 10:1-7. [PMID: 28304315 DOI: 10.3233/npm-16139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Although antifibrinolytic agents are used to prevent and treat hemorrhage, there are concerns about a potential increased risk for peripartum venous thromboembolism. We sought to determine the impact of tranexamic acid and ɛ-aminocaproic acid on in vitro clotting properties in pregnancy. METHODS Blood samples were obtained from healthy pregnant, obese, and preeclamptic pregnant women (n = 10 in each group) prior to delivery as well as from healthy non-pregnant controls (n = 10). Maximum clot firmness (MCF) and clotting time (CT) were measured using rotation thromboelastometry in the presence of tranexamic acid (3, 30, or 300 μg/mL) or ɛ-aminocaproic acid (30, 300, or 3000 μg/mL). ANOVA and regression analyses were performed. RESULTS Mean whole blood MCF was significantly higher in healthy pregnant vs. non-pregnant women (66.5 vs. 57.5 mm, p < 0.001). Among healthy pregnant women, there was no significant difference between mean MCF (whole blood alone, and with increasing tranexamic acid doses = 66.5, 66.1, 66.4, 66.3 mm, respectively; p = 0.25) or mean CT (409, 412, 420, 424 sec; p = 0.30) after addition of tranexamic acid. Similar results were found using ɛ-aminocaproic acid. Preeclamptic women had a higher mean MCF after the addition of ɛ-aminocaproic acid and tranexamic acid (p = 0.05 and p = 0.04, respectively) compared to whole blood alone. CONCLUSIONS Pregnancy is a hypercoagulable state, as reflected by an increased MCF compared to non-pregnant women. Addition of antifibrinolytic therapy in vitro does not appear to increase MCF or CT for non-pregnant, pregnant, and obese women. Whether antifibrinolytics are safe in preeclampsia may require further study.
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Affiliation(s)
- H K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - E L Lockhart
- Department of Pathology, Division of Pathology Clinical Services, Duke University, Durham, NC, USA
| | - S M Thomas
- Department of Biostatistics, Duke University, Durham, NC, USA
| | - I J Welsby
- Department of Anesthesiology, Division of Cardiac Anesthesiology, Duke University, Durham, NC, USA
| | - M R Hoffman
- Department of Pathology, Division of General Pathology, Duke University Durham, NC, USA
| | - A H James
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - A P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - G K Swamy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
| | - C A Grotegut
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC, USA
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Thomas SM, Moke D, Lopez R, Hanna R, Kabbany MN, Alkhouri N. Liver Transplantation for Hepatocellular Carcinoma in Young Adults: A United Network for Organ Sharing Study. J Adolesc Young Adult Oncol 2016; 6:286-293. [PMID: 27996360 DOI: 10.1089/jayao.2016.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Orthotopic liver transplantation (OLT) is curative for hepatocellular carcinoma (HCC). HCC is typically a disease of older adults (OAs); therefore, characteristics and outcomes of OLT for young adults (YAs) (ages 18-40) are not described. The objective of this study was to assess the characteristics and outcomes of YAs with HCC receiving OLT and compare these to OAs (ages >40 years). METHODS YAs with HCC who had OLT from the United Network for Organ Sharing (UNOS) database were included in this study. As a comparison group, OAs with HCC were matched 4:1 to the YA group. Descriptive statistics of demographics, comorbidities, and outcomes were generated. Kaplan-Meier product limit estimates were used to assess patient and graft survival. Conditional logistic regression and Cox proportional hazards frailty models were used to compare the groups. RESULTS A total of 464 YAs received OLT for HCC. The most common underlying liver diseases were hepatitis C virus (21.3%), hepatitis B virus (HBV, 15.5%), and autoimmune/cholestatic disease (12.3%). An increased number of YAs received OLT for HCC after implementation of model for end-stage liver disease scoring. One thousand two hundred eighty OAs served as the comparison group. Post-transplant 5-year survival was 73.1% in YAs with a retransplantation rate of 7.8%. In OAs, survival and retransplantation rates were lower (68.6% p = 0.093; 4.3% p = 0.001). CONCLUSION Four hundred sixty-four YAs with HCC received OLT in the UNOS database. Compared to the older population, survival and retransplantation rates were higher. HBV, which is vaccine preventable, is a frequent contributor to HCC in YAs.
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Affiliation(s)
- Stefanie M Thomas
- 1 Children's Center for Cancer and Blood Disease , Children's Hospital Los Angeles, Los Angeles, California
- 2 Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Pediatrics, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Diana Moke
- 1 Children's Center for Cancer and Blood Disease , Children's Hospital Los Angeles, Los Angeles, California
| | - Rocio Lopez
- 3 Department of Quantitative Health Sciences, Cleveland Clinic , Cleveland, Ohio
| | - Rabi Hanna
- 4 Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's , Cleveland, Ohio
| | - Mohammad Nasser Kabbany
- 5 Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic , Cleveland, Ohio
| | - Naim Alkhouri
- 5 Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic , Cleveland, Ohio
- 6 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio
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Gregory CR, Proctor VK, Thomas SM, Ravi K. Spontaneous haemorrhage from a left gastric artery aneurysm as a cause of acute abdominal pain. Ann R Coll Surg Engl 2016; 99:e49-e51. [PMID: 27659358 DOI: 10.1308/rcsann.2016.0306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Visceral artery aneurysms are rare, with a reported incidence of less than 2% in the general population. 1,2 Aneurysms of the left gastric artery are particularly uncommon, accounting for 4% of all visceral aneurysms. 3,4 Although the majority are discovered incidentally and can be managed conservatively, prompt treatment of those ruptured or at risk of rupture is crucial to reduce the associated morbidity. Increasing awareness of visceral artery aneurysms as a cause of spontaneous intraperitoneal haemorrhage will improve early recognition and impact on survival. We present a rare case of spontaneous rupture of a left gastric artery aneurysm.
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Affiliation(s)
- C R Gregory
- Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust , Calow, Chesterfield, , Derbyshire, UK
| | - V K Proctor
- Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust , Calow, Chesterfield, , Derbyshire, UK
| | - S M Thomas
- Sheffield Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , South Yorkshire, UK
| | - K Ravi
- Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust , Calow, Chesterfield, , Derbyshire, UK
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Ahmadzia HK, Thomas SM, Murtha AP, Heine RP, Brancazio LR. Obstetric hemorrhage survey: Attitudes and practices of maternal-fetal medicine fellows. J Neonatal Perinatal Med 2016; 9:133-137. [PMID: 27197937 DOI: 10.3233/npm-16915119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate experiences related to obstetric hemorrhage and suspected abnormal placentation among first year maternal-fetal medicine fellows. STUDY DESIGN A cross-sectional anonymous survey was administered at the Society for Maternal-Fetal Medicine fellow retreat in March 2013. Fellows were asked about management strategies that reflected both their individual and institutional practices. RESULTS There was a 56% response rate (55/98). In cases of postpartum hemorrhage due to uterine atony, there was variable use of the uterine tamponade device. The median incremental time for balloon deflation was every 5 hours (IQR = 2-12). Compared to the east coast, fellows from the west coast performed more hysterectomies (mean±SD; 2.9±2.4 vs. 1.2±1.2, p = 0.004). During a peripartum hysterectomy, 29% of fellows used a handheld cautery device such as Ligasure® or Gyrus®. Fifty-six percent responded that their institution never recommend planned delayed hysterectomies for abnormal placental implantation. CONCLUSION There is wide variation in practice among first year maternal-fetal medicine fellows in management of peripartum hysterectomy and postpartum hemorrhage.
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Affiliation(s)
- H K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - S M Thomas
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - A P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - R P Heine
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - L R Brancazio
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
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Larson SR, Atif SM, Gibbings SL, Thomas SM, Prabagar MG, Danhorn T, Leach SM, Henson PM, Jakubzick CV. Ly6C(+) monocyte efferocytosis and cross-presentation of cell-associated antigens. Cell Death Differ 2016; 23:997-1003. [PMID: 26990659 PMCID: PMC4987733 DOI: 10.1038/cdd.2016.24] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 01/05/2023] Open
Abstract
Recently it was shown that circulating Ly6C+ monocytes traffic from tissue to the draining lymph nodes (LNs) with minimal alteration in their overall phenotype. Furthermore, in the steady state, Ly6C+ monocytes are as abundant as classical dendritic cells (DCs) within the draining LNs, and even more abundant during inflammation. However, little is known about the functional roles of constitutively trafficking Ly6C+ monocytes. In this study we investigated whether Ly6C+ monocytes can efferocytose (acquire dying cells) and cross-present cell-associated antigen, a functional property particularly attributed to Batf3+ DCs. We demonstrated that Ly6C+ monocytes intrinsically efferocytose and cross-present cell-associated antigen to CD8+ T cells. In addition, efferocytosis was enhanced upon direct activation of the Ly6C+ monocytes through its corresponding TLRs, TLR4 and TLR7. However, only ligation of TLR7, and not TLR4, enhanced cross-presentation by Ly6C+ monocytes. Overall, this study outlines two functional roles, among others, that Ly6C+ monocytes have during an adaptive immune response.
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Affiliation(s)
- S R Larson
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.,Department of Immunology and Microbiology, CU Anschutz Medical Campus, Aurora, CO, USA
| | - S M Atif
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - S L Gibbings
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - S M Thomas
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - M G Prabagar
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - T Danhorn
- Integrated Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - S M Leach
- Integrated Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - P M Henson
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.,Department of Immunology and Microbiology, CU Anschutz Medical Campus, Aurora, CO, USA
| | - C V Jakubzick
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.,Department of Immunology and Microbiology, CU Anschutz Medical Campus, Aurora, CO, USA
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Parsel SM, Grandis JR, Thomas SM. Nucleic acid targeting: towards personalized therapy for head and neck cancer. Oncogene 2015; 35:3217-26. [PMID: 26592450 PMCID: PMC4877278 DOI: 10.1038/onc.2015.424] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Received: 05/15/2015] [Revised: 09/29/2015] [Accepted: 10/05/2015] [Indexed: 12/13/2022]
Abstract
In light of a detailed characterization of genetic aberrations in cancer, nucleic acid targeting represents an attractive therapeutic approach with significant translational potential. Head and neck squamous cell carcinoma (HNSCC) is a leading cause of cancer deaths worldwide with stagnant 5-year survival rates. Advances in conventional treatment have done little to improve survival and combined chemoradiation is associated with significant adverse effects. Recent reports have characterized the genetic alterations in HNSCC and demonstrated that mutations confer resistance to conventional and molecular targeted therapies. The ability to use specific nucleic acid sequences to inhibit cancer-associated genes including non-druggable targets facilitates personalized medicine approaches with less adverse effects. Additionally, advances in drug delivery mechanisms have increased the transfection efficiency aiding in greater therapeutic responses. Given these advances, the stage has been set to translate the information garnered from genomic studies into personalized treatment strategies. Genes involved in the tumor protein 53 (TP53) and epidermal growth factor receptor (EGFR) pathways have been extensively investigated and many promising preclinical studies have shown tumor inhibition through genetic modulation. We, and others, have demonstrated that targeting oncogene expression with gene therapy approaches is feasible in patients. Other methods such as RNA interference have proven to be effective and are potential candidates for clinical studies. This review summarizes the major advances in sequence-specific gene modulation in the preclinical setting and in clinical trials in head and neck cancer patients.
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Affiliation(s)
- S M Parsel
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA
| | - J R Grandis
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - S M Thomas
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
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Thomas SM, Ford PJ, Weise KL, Worley S, Kodish E. Not just little adults: a review of 102 paediatric ethics consultations. Acta Paediatr 2015; 104:529-34. [PMID: 25611088 DOI: 10.1111/apa.12940] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 09/12/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
AIM The American Academy of Pediatrics statement on institutional ethics committees highlights the importance of paediatric ethics consultation. However, little has been published on actual experience with ethics consultation in paediatrics. The objective of this study was to review and describe topics covered by a large retrospective sample of clinical ethics consultations in paediatric medicine. METHODS We reviewed ethics consultations involving patients of <18 years of age from January 2005 to July 2013 at one institution. Descriptive statistics of the patient population, the reason for the ethics consultation and the consultant's perceived contribution to the case were generated. Subgroups of patients were compared based on demographic and clinical characteristics using Wilcoxon's rank sum tests, chi-square tests and logistic regression models. RESULTS Most of the 102 eligible consultations originated from intensive care units and were requested by attending physicians. The most frequent topic leading to consultation was end-of-life issues. Both younger age and male sex were associated with consults for end-of-life issues (p < 0.001 and p = 0.010). CONCLUSION This analysis provides important information describing the type of consults requested in paediatric medicine, which is necessary given the movement towards professionalising clinical ethics consultation. Further empirical research is needed on ethics consultation in paediatrics.
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Affiliation(s)
- Stefanie M. Thomas
- Department of Pediatric Hematology/Oncology and Blood and Marrow Transplantation; Cleveland Clinic Children's; Cleveland OH USA
| | - Paul J. Ford
- Center for Ethics, Humanities and Spiritual Care; Cleveland Clinic Foundation; Cleveland OH USA
| | - Kathryn L. Weise
- Center for Ethics, Humanities and Spiritual Care; Cleveland Clinic Foundation; Cleveland OH USA
| | - Sarah Worley
- Department of Quantitative Health Sciences; Cleveland Clinic Foundation; Cleveland OH USA
| | - Eric Kodish
- Center for Ethics, Humanities and Spiritual Care; Cleveland Clinic Foundation; Cleveland OH USA
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Becker N, Krüger A, Kuhn C, Plenge-Bönig A, Thomas SM, Schmidt-Chanasit J, Tannich E. [Mosquitoes as vectors for exotic pathogens in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:531-40. [PMID: 24781910 DOI: 10.1007/s00103-013-1918-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/25/2022]
Abstract
As a result of intensified globalization of international trade and of substantial travel activities, mosquito-borne exotic pathogens are becoming an increasing threat for Europe. In Germany some 50 different mosquito species are known, several of which have vector competence for pathogens. During the last few years a number of zoonotic arboviruses that are pathogenic for humans have been isolated from mosquitoes in Germany including Usutu, Sindbis and Batai viruses. In addition, filarial worms, such as Dirofilaria repens have been repeatedly detected in mosquitoes from the federal state of Brandenburg. Other pathogens, in particular West Nile virus, are expected to emerge sooner or later in Germany as the virus is already circulating in neighboring countries, e.g. France, Austria and the Czech Republic. In upcoming years the risk for arbovirus transmission might increase in Germany due to increased occurrence of new so-called "invasive" mosquito species, such as the Asian bush mosquito Ochlerotatus japonicus or the Asian tiger mosquito Aedes albopictus. These invasive species are characterized by high vector competence for a broad range of pathogens and a preference for human blood meals. For risk assessment, a number of mosquito and pathogen surveillance projects have been initiated in Germany during the last few years; however, mosquito control strategies and plans of action have to be developed and put into place to allow early and efficient action against possible vector-borne epidemics.
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Fischer D, Thomas SM, Neteler M, Tjaden NB, Beierkuhnlein C. Climatic suitability of Aedes albopictus in Europe referring to climate change projections: comparison of mechanistic and correlative niche modelling approaches. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.6.20696] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Asian tiger mosquito, Aedes albopictus, is capable of transmitting a broad range of viruses to humans. Since its introduction at the end of the 20th century, it has become well established in large parts of southern Europe. As future expansion as a result of climate change can be expected, determining the current and projected future climatic suitability of this invasive mosquito in Europe is of interest. Several studies have tried to detect the potential habitats for this species, but differing data sources and modelling approaches must be considered when interpreting the findings. Here, various modelling methodologies are compared with special emphasis on model set-up and study design. Basic approaches and model algorithms for the projection of spatio-temporal trends within the 21st century differ substantially. Applied methods range from mechanistic models (e.g. overlay of climatic constraints based on geographic information systems or rather process-based approaches) to correlative niche models. We conclude that spatial characteristics such as introduction gateways and dispersal pathways need to be considered. Laboratory experiments addressing the climatic constraints of the mosquito are required for improved modelling results. However, the main source of uncertainty remains the insufficient knowledge about the species' ability to adapt to novel environments.
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Affiliation(s)
- D Fischer
- Department of Biogeography, University of Bayreuth, Bayreuth, Germany
- Technische Universität München (TUM), Munich, Germany (present affiliation)
| | - S M Thomas
- Department of Biogeography, University of Bayreuth, Bayreuth, Germany
| | - M Neteler
- Department of Biodiversity and Molecular Ecology, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige (Trento), Italy
| | - N B Tjaden
- Department of Biogeography, University of Bayreuth, Bayreuth, Germany
| | - C Beierkuhnlein
- Department of Biogeography, University of Bayreuth, Bayreuth, Germany
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Sok JC, Lee JA, Dasari S, Joyce S, Contrucci SC, Egloff AM, Trevelline BK, Joshi R, Kumari N, Grandis JR, Thomas SM. Collagen type XI α1 facilitates head and neck squamous cell cancer growth and invasion. Br J Cancer 2013; 109:3049-56. [PMID: 24231953 PMCID: PMC3859935 DOI: 10.1038/bjc.2013.624] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although it is well established that the extracellular matrix affects tumour progression, not much is known about the various components and their effect on head and neck squamous cell carcinoma (HNSCC) progression. Levels of collagen type XI α1 (colXIα1), a minor fibrillar collagen, have been shown to be increased in tumour compared with normal tissue in several cancers, including colorectal, breast, and non-small cell lung cancer. Currently, the functional significance of colXIα1 is not understood. METHODS We examined the expression levels of colXIα1 mRNA and elucidated the functional role of colXIα1 in HNSCC. Cell proliferation, invasion, and migration were examined with and without colXIα1 knockdown with siRNA in HNSCC cells. RESULTS Our data demonstrate that colXIα1 expression is increased in tumour samples compared with levels in normal adjacent tissue in 16/23 HNSCC patients. In addition, colα11 is increased in HNSCC cell lines compared with normal immortalised epithelial cells and is increased in tumour-derived fibroblasts compared with normal fibroblasts. Using an siRNA approach, we demonstrate that colXIα1 contributes to proliferation, migration, and invasion of HNSCC. CONCLUSION Our cumulative findings suggest that colXIα1 contributes to HNSCC tumorigenesis and may serve as a potential therapeutic target.
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Affiliation(s)
- J C Sok
- Department of Otolaryngology, University of Pittsburgh and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA
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Thomas SM, Lam NN, Welk BK, Nguan C, Huang A, Nash DM, Prasad GVR, Knoll GA, Koval JJ, Lentine KL, Kim SJ, Lok CE, Garg AX. Risk of kidney stones with surgical intervention in living kidney donors. Am J Transplant 2013; 13:2935-44. [PMID: 24102981 DOI: 10.1111/ajt.12446] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 04/19/2013] [Revised: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 01/25/2023]
Abstract
A kidney stone in a person with a solitary kidney requires urgent attention, which may result in surgical and/or hospital attention. We conducted a matched retrospective cohort study to determine if living kidney donors compared to healthy nondonors have a higher risk of: (i) kidney stones with surgical intervention, and (ii) hospital encounters for kidney stones. We reviewed all predonation charts for living kidney donations from 1992 to 2009 at five major transplant centers in Ontario, Canada, and linked this information to healthcare databases. We selected nondonors from the healthiest segment of the general population and matched 10 nondonors to every donor. Of the 2019 donors and 20 190 nondonors, none had evidence of kidney stones prior to cohort entry. Median follow-up time was 8.4 years (maximum 19.7 years; loss to follow-up <7%). There was no difference in the rate of kidney stones with surgical intervention in donors compared to nondonors (8.3 vs. 9.7 events/10 000 person-years; rate ratio 0.85; 95% confidence interval [CI] 0.47-1.53). Similarly there was no difference in the rate of hospital encounters for kidney stones (12.1 vs. 16.1 events/10 000 person-years; rate ratio 0.75; 95% CI 0.45-1.24). These interim results are reassuring for the safety of living kidney donation.
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Affiliation(s)
- S M Thomas
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada
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Kearns BC, Michaels JA, Stevenson MD, Thomas SM. Cost-effectiveness analysis of enhancements to angioplasty for infrainguinal arterial disease. Br J Surg 2013; 100:1180-8. [DOI: 10.1002/bjs.9195] [Citation(s) in RCA: 26] [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] [Accepted: 05/10/2013] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The aim was to perform an economic evaluation of the cost-effectiveness of endovascular enhancements to percutaneous transluminal balloon angioplasty (PTA) with bail-out bare metal stents for infrainguinal peripheral arterial disease.
Methods
The following interventions were considered: PTA with no bail-out stenting, PTA with bail-out drug-eluting stents, drug-coated balloons, primary bare metal stents, primary drug-eluting stents, endovascular brachytherapy, stent-grafts and cryoplasty. A discrete-event simulation model was developed to assess the relative cost-effectiveness of the interventions from a health service perspective over a lifetime. Populations of patients with intermittent claudication (IC) and critical leg ischaemia (CLI) were modelled separately. Univariable and probabilistic sensitivity analyses were undertaken. Effectiveness was measured by quality-adjusted life-years (QALYs).
Results
For both patient populations, the use of drug-coated balloons dominated all other options by having both lower lifetime costs and greater effectiveness. For willingness-to-pay thresholds between £0 and £100 000 per additional QALY, the probability of drug-coated balloons being cost-effective was at least 58·3 per cent for patients with IC and at least 72·2 per cent for patients with CLI. Sensitivity analyses showed that the results were robust to different assumptions regarding the clinical benefits attributable to the interventions.
Conclusion
The use of drug-coated balloons represents a cost-effective alternative to the use of PTA with bail-out bare metal stents.
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Affiliation(s)
- B C Kearns
- Section of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J A Michaels
- Section of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M D Stevenson
- Section of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S M Thomas
- Section of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Simpson EL, Michaels JA, Thomas SM, Cantrell AJ. Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease. Br J Surg 2013; 100:1128-37. [DOI: 10.1002/bjs.9196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 11/07/2022]
Abstract
Abstract
Background
There are several additional techniques designed to enhance conventional percutaneous transluminal balloon angioplasty (PTA). This systematic review assessed current evidence on the clinical effectiveness of additional techniques for infrainguinal peripheral arterial occlusive disease (PAD).
Methods
Relevant electronic databases, including MEDLINE, were searched in May 2011. The population comprised participants with symptomatic PAD undergoing endovascular treatment for disease distal to the inguinal ligament. Interventions were additional techniques compared with conventional PTA. Main outcome measures were restenosis and need for reintervention. Randomized clinical trials (RCTs) of clinical effectiveness were assessed for quality and data were extracted. Where appropriate, meta-analysis was undertaken to produce risk ratios (RRs).
Results
Forty RCTs were selected. Meta-analysis showed a significant benefit in reducing restenosis rates at 6 months for self-expanding stents (RR 0·49) and drug-coated balloons (RR 0·40), and at 12 months for endovascular brachytherapy (RR 0·63). There was also evidence that use of a stent-graft significantly reduced restenosis compared with PTA, as did drug-eluting stents compared with bare-metal stents. Meta-analysis showed that use of drug-coated balloons was associated with significantly lower reintervention rates than PTA alone at 6 months (RR 0·24) and 24 months (RR 0·27) of follow-up. There was also evidence of significantly lower reintervention rates for self-expanding stents at 6 months. Other techniques did not show significant treatment effects for restenosis or reintervention.
Conclusion
The conclusions of this review should be tempered by small sample sizes, lack of clinical outcome measures and differing outcome definitions, making direct comparison across trials difficult. However, self-expanding stents, drug-eluting stents and drug-coated balloons appeared to be the most promising technologies worthy of future study.
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Affiliation(s)
- E L Simpson
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - S M Thomas
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - A J Cantrell
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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Winkley K, Thomas SM, Sivaprasad S, Chamley M, Stahl D, Ismail K, Amiel SA. The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D). Diabetologia 2013; 56:1272-81. [PMID: 23494447 DOI: 10.1007/s00125-013-2873-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/05/2013] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS This study aimed to investigate the clinical features of newly diagnosed type 2 diabetes in an urban multi-ethnic cohort. METHODS A population-based cross-sectional design was used. People diagnosed with type 2 diabetes in the preceding 6 months were recruited from primary care practices in three adjacent inner-city boroughs of South London, serving a population in which 20% of residents are of black African or Caribbean ethnicity. Sociodemographic and biomedical data were collected by standardised clinical assessment and from medical records. Multiple logistic regression methods were used to report associations between ethnicity and diabetes-complication status. RESULTS From 96 general practices, 1,506 patients were recruited. Their mean age was 55.6 (± 11.07) years, 55% were men, 60% were asymptomatic at diagnosis and 51%, 38% and 11% were of white, black and South Asian/other ethnicity, respectively. Compared with white participants, black and South Asian/other participants were: younger (mean age 58.9 [± 10.09], 52.4 [± 11.19] and 51.5 [± 10.42] years, respectively; p < 0.0001); less likely to have neuropathy (10.1%, 3.6% and 4.4%; p < 0.0001) or report coronary artery disease (12.7%, 4.8% and 7.3%; p < 0.0001). In logistic regression, compared with white participants, black participants had lower levels of macrovascular complications (OR 0.52, 95% CI 0.32, 0.84; p = 0.01). Male sex was independently associated with microvascular disease (OR 1.69, 95% CI 1.26, 2.28; p < 0.0001). CONCLUSIONS/INTERPRETATION The prevalence of complications at time of diagnosis was lower than expected, especially in black and South Asian/other ethnic groups. However, in multi-ethnic inner-city populations, onset of type 2 diabetes occurred almost 10 years earlier in non-white populations than in white participants, predicating a prolonged morbidity.
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Affiliation(s)
- K Winkley
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AZ, UK.
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Affiliation(s)
- H C J Godfray
- Department of Zoology and Institute of Biodiversity at the Oxford Martin School, University of Oxford, Oxford, OX1 3PS, UK
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Gunjiyal J, Thomas SM, Gupta AK, Sharma BS, Mathur P, Gupta B, Sawhney C, Misra MC. Device-associated and multidrug-resistant infections in critically ill trauma patients: towards development of automated surveillance in developing countries. J Hosp Infect 2010; 77:176-7. [PMID: 21130523 DOI: 10.1016/j.jhin.2010.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/07/2010] [Indexed: 11/28/2022]
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Potter JD, McDowell WH, Merriam JL, Peterson BJ, Thomas SM. Denitrification and total nitrate uptake in streams of a tropical landscape. Ecol Appl 2010; 20:2104-2115. [PMID: 21265445 DOI: 10.1890/09-1110.1] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Rapid increases in nitrogen (N) loading are occurring in many tropical watersheds, but the fate of N in tropical streams is not well documented. Rates of nitrate uptake and denitrification were measured in nine tropical low-order streams with contrasting land use as part of the Lotic Intersite Nitrogen eXperiment II (LINX II) in Puerto Rico using short term (24-hour) additions of K(15)NO3 and NaBr. Background nitrate concentrations ranged from 105 to 997 microg N/L, and stream nitrate uptake lengths were long, varying from 315 to 8480 m (median of 1200 m). Other indices of nitrate uptake (mass transfer coefficient, V(f) [cm/s], and whole-stream nitrate uptake rate, U [microg N m(-2) s(-1)]) were low in comparison to other regions and were related to chemical, biological, and physical parameters. Denitrification rates were highly variable (0-133 microg N m(-2) min(-1); median = 15 microg N m(-2) min(-1)), were dominated by the end product N2 (rather than N2O), and were best predicted by whole-stream respiration rates and stream NO3 concentration. Denitrification accounted for 1-97% of nitrate uptake with five of nine streams having 35% or more of nitrate uptake via denitrification, showing that denitrification is a substantial sink for nitrate in tropical streams. Whole-stream nitrate uptake and denitrification in our study streams closely followed first-order uptake kinetics, indicating that NO3 uptake is limited by delivery of substrate (NO3) to the organisms involved in uptake or denitrification. In the context of whole-catchment nitrogen budgets, our finding that in-stream denitrification results in lower proportional production of N2O than terrestrial denitrification suggests that small streams can be viewed as the preferred site of denitrification in a watershed in order to minimize greenhouse gas N2O emissions. Conservation of small streams is thus critical in tropical ecosystem management.
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Affiliation(s)
- J D Potter
- Department of Natural Resources and the Environment, University of New Hampshire, Durham, New Hampshire 03824, USA.
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