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Othman MO, Forsmark C, Yadav D, Singh VK, Lara LF, Park W, Zhang Z, Yu J, Kort JJ. Development of clinical screening tool for exocrine pancreatic insufficiency in patients with definite chronic pancreatitis. Pancreatology 2024:S1424-3903(24)00102-9. [PMID: 38693039 DOI: 10.1016/j.pan.2024.04.003] [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: 10/20/2023] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND/OBJECTIVES No simple, accurate diagnostic tests exist for exocrine pancreatic insufficiency (EPI), and EPI remains underdiagnosed in chronic pancreatitis (CP). We sought to develop a digital screening tool to assist clinicians to predict EPI in patients with definite CP. METHODS This was a retrospective case-control study of patients with definite CP with/without EPI. Overall, 49 candidate predictor variables were utilized to train a Classification and Regression Tree (CART) model to rank all predictors and select a parsimonious set of predictors for EPI status. Five-fold cross-validation was used to assess generalizability, and the full CART model was compared with 4 additional predictive models. EPI misclassification rate (mRate) served as primary endpoint metric. RESULTS 274 patients with definite CP from 6 pancreatitis centers across the United States were included, of which 58 % had EPI based on predetermined criteria. The optimal CART decision tree included 10 variables. The mRate without/with 5-fold cross-validation of the CART was 0.153 (training error) and 0.314 (prediction error), and the area under the receiver operating characteristic curve was 0.889 and 0.682, respectively. Sensitivity and specificity without/with 5-fold cross-validation was 0.888/0.789 and 0.794/0.535, respectively. A trained second CART without pancreas imaging variables (n = 6), yielded 8 variables. Training error/prediction error was 0.190/0.351; sensitivity was 0.869/0.650, and specificity was 0.728/0.649, each without/with 5-fold cross-validation. CONCLUSION We developed two CART models that were integrated into one digital screening tool to assess for EPI in patients with definite CP and with two to six input variables needed for predicting EPI status.
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Affiliation(s)
| | | | | | | | | | | | - Zuoyi Zhang
- AbbVie Inc., Data & Statistical Sciences, North Chicago, IL, USA
| | - Jun Yu
- AbbVie Inc., Data & Statistical Sciences, North Chicago, IL, USA
| | - Jens J Kort
- AbbVie Inc., Medical Affairs, Mettawa, IL, USA
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Fogel EL, Easler JJ, Yuan Y, Yadav D, Conwell DL, Vege SS, Han SY, Park W, Patrick V, White FA. Safety, Tolerability, and Dose-Limiting Toxicity of Lacosamide in Patients With Painful Chronic Pancreatitis: Protocol for a Phase 1 Clinical Trial to Determine Safety and Identify Side Effects. JMIR Res Protoc 2024; 13:e50513. [PMID: 38451604 PMCID: PMC10958339 DOI: 10.2196/50513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Chronic abdominal pain is the hallmark symptom of chronic pancreatitis (CP), with 50% to 80% of patients seeking medical attention for pain control. Although several management options are available, outcomes are often disappointing, and opioids remain a mainstay of therapy. Opioid-induced hyperalgesia is a phenomenon resulting in dose escalation, which may occur partly because of the effects of opioids on voltage-gated sodium channels associated with pain. Preclinical observations demonstrate that the combination of an opioid and the antiseizure drug lacosamide diminishes opioid-induced hyperalgesia and improves pain control. OBJECTIVE In this phase 1 trial, we aim to determine the safety, tolerability, and dose-limiting toxicity of adding lacosamide to opioids for the treatment of painful CP and assess the feasibility of performance of a pilot study of adding lacosamide to opioid therapy in patients with CP. As an exploratory aim, we will assess the efficacy of adding lacosamide to opioid therapy in patients with painful CP. METHODS Using the Bayesian optimal interval design, we will conduct a dose-escalation trial of adding lacosamide to opioid therapy in patients with painful CP enrolled in cohorts of size 3. The initial dose will be 50 mg taken orally twice a day, followed by incremental increases to a maximum dose of 400 mg/day, with lacosamide administered for 7 days at each dose level. Adverse events will be documented according to Common Terminology Criteria for Adverse Events (version 5.0). RESULTS As of December 2023, we have currently enrolled 6 participants. The minimum number of participants to be enrolled is 12 with a maximum of 24. We expect to publish the results by March 2025. CONCLUSIONS This trial will test the feasibility of the study design and provide reassurance regarding the tolerability and safety of opioids in treating painful CP. It is anticipated that lacosamide will prove to be safe and well tolerated, supporting a subsequent phase 2 trial assessing the efficacy of lacosamide+opioid therapy in patients with painful CP, and that lacosamide combined with opiates will lower the opioid dose necessary for pain relief and improve the safety profile of opioid use in treating painful CP. TRIAL REGISTRATION Clinicaltrials.gov NCT05603702; https://clinicaltrials.gov/study/NCT05603702. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50513.
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Affiliation(s)
- Evan L Fogel
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Jeffrey J Easler
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Darwin L Conwell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Samuel Y Han
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Walter Park
- Department of Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Vanessa Patrick
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Fletcher A White
- Department of Anesthesia, School of Medicine, Indiana University, Indianapolis, IN, United States
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Reyngold M, O'Reilly E, Zinovoy M, Hajj C, Wu AJ, Cuaron J, Romesser PB, Varghese AM, Park W, Yu K, Khalil DN, Lu W, Tyagi N, Diaz LA, Crane CH. Favorable Survival after Definitive Ablative RT in Surgically Resectable Pancreatic Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e335. [PMID: 37785177 DOI: 10.1016/j.ijrobp.2023.06.2390] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Surgical resection has been considered the only curative option for patients with pancreatic adenocarcinoma (PDAC). Ablative RT ≥100Gy BED10 (A-RT) is associated with favorable survival in patients with locally advanced unresectable disease. We sought to evaluate A-RT outcomes in patients with technically resectable disease who did not undergo surgery. MATERIALS/METHODS Our prospectively maintained database of patients treated with A-RT was queried for consecutive patients with radiographic T1/T2 resectable PDAC. Patients were treated with a standardized technique within a large academic cancer center regional network. Ablative RT using several hypofractionated regimens was delivered on either standard Linacs with respiratory motion management, CBCT image guidance and selective adaptive replanning or MR-Linac with compression belt and daily on-line adaptive replanning. Freedom from local progression (FFLP), distant metastasis-free and overall survival (DMFS and OS, respectively) were analyzed using the Kaplan Meier estimates. RESULTS Between 2016 and 2022, 28 patients (54% male) with radiographically resectable PDAC received definitive A-RT. Median age was 80 (interquartile range, 77-84) years and 23 (82.1%) had KPS of 80 or below. Eighteen patients (64.3%) had T2 cancer, 5 (17.9%) were node positive, and 23 (82.1%) had head location. Median size was 2.6 (range, 1.6-4.0) cm with a median carbohydrate antigen 19-9 (CA19-9) of 160.5 (0-1823) U/mL. Twenty patients (71.4%) received induction chemotherapy for a median of 2.4 (0-6.2) months. RT regimens delivered on conventional Linacs unless otherwise indicated included 75Gy in 25 fractions (n = 15), 67.5Gy in 15 fractions (n = 10), 50Gy in 5 (N = 2, MR Linac), 60Gy in 10 (n = 1). 24-month FFLP and DMFS were 78.8% (52.3-91.7%) and 17.7% (95% CI, 5.8%-34.8%), respectively. 24-month and 48-month rate of OS from A-RT were 49.1% (95% CI, 27.53-67.5%) and 36.3 (95%16.0-57.1%). Grade 3 acute and late GI toxicity was noted in 3 and 1 patients, respectively, including 2 bleeding events treated with transfusions. There were no ≥ grade 4 events. CONCLUSION In patients with surgically resectable PDAC we found that definitive A-RT following multiagent induction therapy was associated with oncologic outcomes similar to resection with minimal toxicity.
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Affiliation(s)
- M Reyngold
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Hajj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Cuaron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - P B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A M Varghese
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - W Park
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Yu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D N Khalil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - W Lu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L A Diaz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - C H Crane
- Memorial Sloan Kettering Cancer Center, New York, NY
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4
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Kim SW, Cho WK, Kim H, Park W. Reappraisal of an Adequate Negative Margin Following Breast Conservation Therapy in Young Patients with Invasive Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e186-e187. [PMID: 37784815 DOI: 10.1016/j.ijrobp.2023.06.1045] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study aimed to examine the relationship between resection margin (RM) width and ipsilateral breast tumor recurrence (IBTR). The current definition of an adequate negative margin was validated in young breast cancer patients (<40 years). MATERIALS/METHODS This study included 4,042 patients who underwent breast conservation therapy between 2006 and 2012. There were 595 women <40 years (14.7%). Re-excision to achieve a wider RM was not considered in patients with no ink on tumor. Systemic treatments were administered in 3,985 patients (98.6%). The impact of RM width on the incidence of IBTR was assessed using narrowly specified intervals (positive, >0 to <1 mm, 1 to <2 mm, 2 to <3 mm, and ≥3 mm). RESULTS A significant relationship was observed between RM width and incidence of IBTR. In young women, the 10-year cumulative incidence rates of IBTR were 21.6% for positive RM, 13.9% for >0 to <1 mm, 10.9% for 1 to <2 mm, 5.7% for 2 to <3 mm, and 5.8% for ≥3 mm (p <0.01). The corresponding incidence rates of IBTR in women ≥40 years were 8.6%, 8.0%, 4.4%, 2.7%, and 2.1%, respectively (p <0.01). The difference in the incidence of IBTR between each RM width interval increased over time, and the magnitude of the increment was greater in young women. RM width was the only risk factor for IBTR in young women. CONCLUSION The relationship between RM width and IBTR was definite in young women. Compared with women ≥40 years, young women might have long-term benefits from a wider RM than no ink on tumor.
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Affiliation(s)
- S W Kim
- Department of Radiation Oncology, Konyang University College of Medicine, Daejeon, Korea, Republic of (South) Korea
| | - W K Cho
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South) Korea
| | - H Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South) Korea
| | - W Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South) Korea
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Sallée JB, Abrahamsen EP, Allaigre C, Auger M, Ayres H, Badhe R, Boutin J, Brearley JA, de Lavergne C, ten Doeschate AMM, Droste ES, du Plessis MD, Ferreira D, Giddy IS, Gülk B, Gruber N, Hague M, Hoppema M, Josey SA, Kanzow T, Kimmritz M, Lindeman MR, Llanillo PJ, Lucas NS, Madec G, Marshall DP, Meijers AJS, Meredith MP, Mohrmann M, Monteiro PMS, Mosneron Dupin C, Naeck K, Narayanan A, Naveira Garabato AC, Nicholson SA, Novellino A, Ödalen M, Østerhus S, Park W, Patmore RD, Piedagnel E, Roquet F, Rosenthal HS, Roy T, Saurabh R, Silvy Y, Spira T, Steiger N, Styles AF, Swart S, Vogt L, Ward B, Zhou S. Southern ocean carbon and heat impact on climate. Philos Trans A Math Phys Eng Sci 2023; 381:20220056. [PMID: 37150205 PMCID: PMC10164461 DOI: 10.1098/rsta.2022.0056] [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] [Received: 08/17/2022] [Accepted: 02/24/2023] [Indexed: 05/09/2023]
Abstract
The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea-ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.
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Affiliation(s)
- The SO-CHIC consortium
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - J. B. Sallée
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | | | - C. Allaigre
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - M. Auger
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - H. Ayres
- University of Reading, Reading, UK
| | - R. Badhe
- European Polar Board, Den Haag, The Netherlands
| | - J. Boutin
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | | | - C. de Lavergne
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - A. M. M. ten Doeschate
- AirSea Laboratory and Ryan Institute, School of Natural Sciences, University of Galway, Galway, Ireland
- Department of Oceanography, Dalhousie University, Halifax, Canada
| | - E. S. Droste
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | - M. D. du Plessis
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - I. S. Giddy
- Department of Oceanography, University of Cape Town, Rondebosch, South Africa
| | - B. Gülk
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | | | - M. Hoppema
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | - S. A. Josey
- National Oceanography Centre, Southampton, UK
| | - T. Kanzow
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | - M. Kimmritz
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | | | - P. J. Llanillo
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research, Bremerhaven, Germany
| | | | - G. Madec
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | | | | | | | - M. Mohrmann
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - P. M. S. Monteiro
- Southern Ocean Carbon-Climate Observatory (SOCCO), CSIR, Cape Town, South Africa
| | - C. Mosneron Dupin
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - K. Naeck
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - A. Narayanan
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - S-A. Nicholson
- Southern Ocean Carbon-Climate Observatory (SOCCO), CSIR, Cape Town, South Africa
| | | | - M. Ödalen
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Kiel, Germany
| | - S. Østerhus
- Norwegian Research Centre (NORCE), Bergen, Norway
| | - W. Park
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Kiel, Germany
- IBS Center for Climate Physics and Department of Climate System, Pusan National University, Busan, Republic of Korea
| | | | - E. Piedagnel
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - F. Roquet
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - H. S. Rosenthal
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - R. Saurabh
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - Y. Silvy
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - T. Spira
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - N. Steiger
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | | | - S. Swart
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Oceanography, University of Cape Town, Rondebosch, South Africa
| | - L. Vogt
- Laboratoire d’Océanographie et du Climat Expérimentations et Approches Numériques (LOCEAN), Sorbonne Université, CNRS/IRD/MNHN, Paris, France
| | - B. Ward
- AirSea Laboratory and Ryan Institute, School of Natural Sciences, University of Galway, Galway, Ireland
| | - S. Zhou
- British Antarctic Survey, Cambridge, UK
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Fletcher JD, Park W, Ryu S, See P, Griffiths JP, Jones GAC, Farrer I, Ritchie DA, Sim HS, Kataoka M. Time-resolved Coulomb collision of single electrons. Nat Nanotechnol 2023:10.1038/s41565-023-01369-4. [PMID: 37169897 DOI: 10.1038/s41565-023-01369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/10/2023] [Indexed: 05/13/2023]
Abstract
A series of recent experiments have shown that collision of ballistic electrons in semiconductors can be used to probe the indistinguishability of single-electron wavepackets. Perhaps surprisingly, their Coulomb interaction has not been seen due to screening. Here we show Coulomb-dominated collision of high-energy single electrons in counter-propagating ballistic edge states, probed by measuring partition statistics while adjusting the collision timing. Although some experimental data suggest antibunching behaviour, we show that this is not due to quantum statistics but to strong repulsive Coulomb interactions. This prevents the wavepacket overlap needed for fermionic exchange statistics but suggests new ways to utilize Coulomb interactions: microscopically isolated and time-resolved interactions between ballistic electrons can enable the use of the Coulomb interaction for high-speed sensing or gate operations on flying electron qubits.
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Affiliation(s)
| | - W Park
- Department of Physics, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
| | - S Ryu
- Instituto de Física Interdisciplinary Sistemas Complejos IFISC (CSIC-UIB), Palma de Mallorca, Spain
| | - P See
- National Physical Laboratory, Teddington, UK
| | - J P Griffiths
- Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - G A C Jones
- Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - I Farrer
- Cavendish Laboratory, University of Cambridge, Cambridge, UK
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - D A Ritchie
- Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - H-S Sim
- Department of Physics, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
| | - M Kataoka
- National Physical Laboratory, Teddington, UK.
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7
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Park W, Schwendicke F, Krois J, Huh JK, Lee JH. Identification of Dental Implant Systems Using a Large-Scale Multicenter Data Set. J Dent Res 2023:220345231160750. [PMID: 37085970 DOI: 10.1177/00220345231160750] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
This study aimed to evaluate the efficacy of deep learning (DL) for the identification and classification of various types of dental implant systems (DISs) using a large-scale multicenter data set. We also compared the classification accuracy of DL and dental professionals. The data set, which was collected from 5 college dental hospitals and 10 private dental clinics, contained 37,442 (24.8%) periapical and 113,291 (75.2%) panoramic radiographic images and consisted of a total of 10 manufacturers and 25 different types of DISs. The classification accuracy of DL was evaluated using a pretrained and modified ResNet-50 architecture, and comparison of accuracy performance and reading time between DL and dental professionals was conducted using a self-reported questionnaire. When comparing the accuracy performance for classification of DISs, DL (accuracy: 82.0%; 95% confidence interval [CI], 75.9%-87.0%) outperformed most of the participants (mean accuracy: 23.5% ± 18.5%; 95% CI, 18.5%-32.3%), including dentists specialized (mean accuracy: 43.3% ± 20.4%; 95% CI, 12.7%-56.2%) and not specialized (mean accuracy: 16.8% ± 9.0%; 95% CI, 12.8%-20.9%) in implantology. In addition, DL tends to require lesser reading and classification time (4.5 min) than dentists who specialized (75.6 ± 31.0 min; 95% CI, 13.1-78.4) and did not specialize (91.3 ± 38.3 min; 95% CI, 74.1-108.6) in implantology. DL achieved reliable outcomes in the identification and classification of various types of DISs, and the classification accuracy performance of DL was significantly superior to that of specialized or nonspecialized dental professionals. DL as a decision support aid can be successfully used for the identification and classification of DISs encountered in clinical practice.
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Affiliation(s)
- W Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Korea
- Korean Academy of Oral and Maxillofacial Implantology (KAOMI) Implant Research Institute, Seoul, Korea
| | - F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany
| | - J Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany
| | - J-K Huh
- Korean Academy of Oral and Maxillofacial Implantology (KAOMI) Implant Research Institute, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - J-H Lee
- Korean Academy of Oral and Maxillofacial Implantology (KAOMI) Implant Research Institute, Seoul, Korea
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Wang M, Nair A, Smith B, Nguyen T, Kehoe N, Vyas H, Liu D, Murthy V, Yip D, Steidley D, Clavell A, Kushwaha S, Park W, Eisen H, Stegall M, Pereira N. Transcriptomic Profiling of Acute Cellular Rejection after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Smith B, Grande J, Ryan M, Smith M, Denic A, Hermsen M, Park W, Kremers W, Stegall M. Automated scoring of total inflammation in renal allograft biopsies. Clin Transplant 2023; 37:e14837. [PMID: 36259615 DOI: 10.1111/ctr.14837] [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: 08/12/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Computer-assisted scoring is gaining prominence in the evaluation of renal histology; however, much of the focus has been on identifying larger objects such as glomeruli. Total inflammation impacts graft outcome, and its quantification requires tools to identify objects at the cellular level or smaller. The goal of the current study was to use CD45 stained slides coupled with image analysis tools to quantify the amount of non-glomerular inflammation within the cortex. METHODS Sixty renal transplant whole slide images were used for digital image analysis. Multiple thresholding methods using pixel intensity and object size were used to identify inflammation in the cortex. Additionally, convolutional neural networks were used to separate glomeruli from other objects in the cortex. This combined measure of inflammation was then correlated with rescored Banff total inflammation classification and outcomes. RESULTS Identification of glomeruli on biopsies had high fidelity (mean pixelwise dice coefficient of .858). Continuous total inflammation scores correlated well with Banff rescoring (maximum Pearson correlation .824). A separate set of thresholds resulted in a significant correlation with alloimmune graft loss. CONCLUSIONS Automated scoring of inflammation showed a high correlation with Banff scoring. Digital image analysis provides a powerful tool for analysis of renal pathology, not only because it is reproducible and can be automated, but also because it provides much more granular data for studies.
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Affiliation(s)
- Byron Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Grande
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Maggie Ryan
- Department of Anatomic Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Maxwell Smith
- Department of Anatomic Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Aleksandar Denic
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Meyke Hermsen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walter Park
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Nakamoto R, Ferri V, Duan H, Hatami N, Goel M, Rosenberg J, Kimura R, Wardak M, Haywood T, Kellow R, Shen B, Park W, Iagaru A, Gambhir SS. Pilot-phase PET/CT study targeting integrin α vβ 6 in pancreatic cancer patients using the cystine-knot peptide-based 18F-FP-R 01-MG-F2. Eur J Nucl Med Mol Imaging 2022; 50:184-193. [PMID: 34729628 DOI: 10.1007/s00259-021-05595-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A novel cystine-knot peptide-based PET radiopharmaceutical, 18F-FP-R01-MG-F2 (knottin), was developed to selectively bind to human integrin αvβ6 which is overexpressed in pancreatic cancer. The purpose of this study is to evaluate the safety, biodistribution, dosimetry, and lesion uptake of 18F-FP-R01-MG-F2 in patients with pancreatic cancer. METHODS Fifteen patients (6 men, 9 women) with histologically confirmed pancreatic cancer were prospectively enrolled and underwent knottin PET/CT between March 2017 and February 2021 (ClinicalTrials.gov Identifier NCT02683824). Vital signs and laboratory results were collected before and after the imaging scans. Maximum standardized uptake values (SUVmax) and mean SUV (SUVmean) were measured in 24 normal tissues and pancreatic cancer lesions for each patient. From the biodistribution data, the organ doses and whole-body effective dose were calculated using OLINDA/EXM software. RESULTS There were no significant changes in vital signs or laboratory values that qualified as adverse events or serious adverse events. At 1 h post-injection, areas of high 18F-FP-R01-MG-F2 uptake included the pituitary gland, stomach, duodenum, kidneys, and bladder (average SUVmean: 9.7-14.5). Intermediate uptake was found in the normal pancreas (average SUVmean: 4.5). Mild uptake was found in the lungs and liver (average SUVmean < 1.0). The effective dose was calculated to be 2.538 × 10-2 mSv/MBq. Knottin PET/CT detected all known pancreatic tumors in the 15 patients, although it did not detect small peri-pancreatic lymph nodes of less than 1 cm in short diameter in two of three patients who had lymph node metastases at surgery. Knottin PET/CT detected distant metastases in the lungs (n = 5), liver (n = 4), and peritoneum (n = 2), confirmed by biopsy and/or contrast-enhanced CT. CONCLUSION 18F-FP-R01-MG-F2 is a safe PET radiopharmaceutical with an effective dose comparable to other diagnostic agents. Evaluation of the primary pancreatic cancer and distant metastases with 18F-FP-R01-MG-F2 PET is feasible, but larger studies are required to define the role of this approach. TRIAL REGISTRATION NCT02683824.
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Affiliation(s)
- Ryusuke Nakamoto
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Valentina Ferri
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Heying Duan
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Negin Hatami
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Mahima Goel
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Jarrett Rosenberg
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
| | - Richard Kimura
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Mirwais Wardak
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Tom Haywood
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Rowaid Kellow
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Bin Shen
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Walter Park
- Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA.
| | - Sanjiv Sam Gambhir
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305-5281, USA
- Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA
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Keane F, Park W, Varghese A, Balogun F, Yu K, El Dika I, Khalil D, Kelsen D, Reidy-Lagunes D, Ku G, Raj N, Chou J, Capanu M, Schultz N, Yaeger R, O'Reilly E. 1304P Characterizing the clinico-genomic landscape and outcomes of KRAS G12C mutated pancreas cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kim H, Joo E, Bae J, Park J, Bang Y, Park C, Gulati N, Park W. 096 Deconvolution of adult T-cell leukemia/lymphoma with single-cell RNA-seq using frozen archived skin tissue reveals new subset of cancer-associated fibroblast. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meda R, Fu S, Yu K, Charya A, Kong H, Jang M, Andargie T, Park W, Lee J, Tunc I, Berry G, Marboe C, Shah P, Nathan S, Keller M, Agbor-Enoh S. Comparative Performance Analysis of Donor-Derived Cell-Free DNA to Detect Acute Rejection in Single and Double Lung Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Jang M, Singh K, Andargie T, Seifuddin F, Tunc I, Park W, Lee J, Kong H, Agbor-Enoh S. Genome-Wide DNA Methylation Analysis to Define Pulmonary Antibody-Mediated Rejection (AMR) Treatment Response. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Li AA, Raghu P, Chen A, Triadafilopoulos G, Park W. Sticky Situation: Bleeding Duodenal Lymphangiectasias Treated with Lymphatic Glue Embolization. Dig Dis Sci 2022; 67:71-74. [PMID: 33638090 DOI: 10.1007/s10620-021-06898-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Andrew A Li
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Preethi Raghu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Anne Chen
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Walter Park
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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Gujral D, Lim S, Park W. PO-0964 Survival outcomes of hypopharyngeal SCC versus cervical oesophageal SCC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Huang RJ, Barakat MT, Park W, Banerjee S. Quality metrics in the performance of EUS: a population-based observational cohort of the United States. Gastrointest Endosc 2021; 94:68-74.e3. [PMID: 33476611 DOI: 10.1016/j.gie.2020.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/31/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There are few data on the quality of EUS in the community setting. We characterized EUS performance at the individual facility level in 3 large American states, using need for repeat biopsy (NRB) as a metric for procedural failure, and the rate of unplanned hospital encounters (UHEs) as a metric for adverse events. METHODS We collected data on 76,614 EUS procedures performed at 166 facilities in California, Florida, and New York (2009-2014). The endpoints for the study were 7-day rate of UHEs after EUS, and 30-day rate of NRB after EUS with fine-needle aspiration. Facility-level factors analyzed included annual procedure volume, urban/rural location, and free-standing status (facilities not attached to a larger hospital). Predictors for UHE and NRB were analyzed in both multivariable regression and nonparametric local regression. RESULTS Facility volume did not predict risk for UHEs. However, high facility volume protected against NRB (P trend <.001) even after adjustment for other facility-level factors. When regressing facility volume against risk for NRB in local regression, a join point (inflection point) was identified at 97 procedures per annum. Once facilities reached this threshold volume, there appeared little additional protective effect of higher volume. Rural facility location (odds ratio, 1.81; 95% confidence interval, 1.36-2.40) and free-standing status (odds ratio, 1.57; 95% confidence interval, 1.16-2.13) were also associated with NRB. CONCLUSION Facility volume does not predict risk for adverse events after EUS. However, high facility volume is associated with decreased rates of technical failure (as assessed by NRB). These data provide one of the first descriptions of EUS practice in community settings and highlight opportunities to improve endoscopic quality nationally.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA
| | - Walter Park
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA
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Zeng X, Zhao D, Radominski S, Keiserman M, Lee CK, Martin N, Meerwein S, Sui Y, Park W. AB0260 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS: RESULTS AT 64 WEEKS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Upadacitinib (UPA), an oral Janus kinase inhibitor, in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), showed significant improvements in clinical and functional measures compared with placebo (PBO) up to 12 weeks (wks), in patients (pts) from China, Brazil, and South Korea with rheumatoid arthritis (RA) and prior inadequate response to csDMARDs (csDMARD-IR).1Objectives:To assess the efficacy and safety of UPA up to 64 wks (long-term extension; LTE) in csDMARD-IR pts with RA from China, Brazil, and South Korea.Methods:Pts were randomized to 12 wks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. From Wk 12 onward, pts could continue to receive open-label UPA 15 mg QD. Efficacy endpoints were analyzed by original randomized treatment group sequences over 64 wks and included American College of Rheumatology (ACR) responses, and key remission and low disease activity measures. Non-responder imputation was used to handle missing data for binary endpoints. Treatment-emergent adverse events (TEAEs) per 100 patient-years (PY) were summarized for pts receiving ≥1 dose of UPA from baseline through to Wk 64.Results:Of 338 randomized pts who received ≥1 dose of study drug, 310 (91.7%) entered the LTE and 275 (81.4%) completed 64 wks of treatment. Among those initially randomized to UPA, the proportion of pts achieving 20%/50%/70% improvement in ACR criteria, and key remission and low disease activity measures increased over 64 wks of treatment (Figure 1). Improvements from baseline in the Health Assessment Questionnaire-Disability Index and pts’ assessment of pain were observed over 64 wks of UPA treatment (data not shown). By Wk 64, efficacy results for pts who switched from PBO to UPA at Wk 12 followed a similar trajectory to those originally randomized to UPA.The observed rate of serious infections was 8.1 events/100 PY. Herpes zoster events were mostly non-serious, involving only 1 or 2 dermatomes. Most cases of hepatic disorders were Grade 1 or 2 hepatic transaminase elevations. There was 1 case of venous thromboembolic event (VTE; concurrent pulmonary embolism and deep vein thrombosis [DVT] in a patient with a history of DVT) and 3 cases of malignancy. Adjudicated major adverse cardiovascular events (Table 1) occurred in 2 pts (1 with non-fatal myocardial infarction and 1 with non-fatal stroke) who had underlying risk factors for cardiovascular disease. There were no deaths, active tuberculosis, or renal dysfunction.Conclusion:UPA 15 mg was effective in treating the signs and symptoms of RA and in improving physical function over 64 wks with no new safety signals1 in csDMARD-IR pts with RA from China, Brazil, and South Korea.References:[1]Zeng A, et al. Ann Rheum Dis 2020;79(Suppl 1):1016 [abstract SAT0160]Table 1.TEAEs at Wk 64Event (E/100 PY)UPA 15 mg(n=322; PY=334.5)Any AE421.5 (399.8–444.1) Serious AE19.1 (14.7–24.4) AE leading to discontinuation of study drug9.0 (6.1–12.8) Deathsa0AEs of special interest Serious infection8.1 (5.3–11.7) Opportunistic infection0.9 (0.2–2.6) Herpes zoster9.0 (6.1–12.8) Hepatic disorder42.2 (35.5–49.7) Gastrointestinal perforation (adjudicated)0.3 (0.0–1.7) Any malignancy (excluding NMSC)0.6 (0.1–2.2) NMSC0.3 (0.0–1.7) MACE (adjudicated)b0.6 (0.1–2.2) VTE (adjudicated)c0.3 (0.0–1.7) Anemia11.1 (7.8–15.2) Neutropenia11.7 (8.3–15.9) Lymphopenia7.8 (5.1–11.4) CPK elevation11.1 (7.8–15.2)aIncluding non-treatment-emergent deaths. bDefined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. cIncluding DVT and pulmonary embolism.AE, adverse event; CPK, creatine phosphokinase; E, events; MACE, major adverse cardiovascular event; NMSC, non-melanoma skin cancerAcknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Yanna Song, PhD, of AbbVie provided statistical support. Medical writing support was provided by Laura Chalmers, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Xiaofeng Zeng: None declared, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN: None declared, Chang-Keun Lee: None declared, Naomi Martin Employee of: AbbVie employee and may own stock or options, Sebastian Meerwein Employee of: AbbVie employee and may own stock or options, Yunxia Sui Employee of: AbbVie employee and may own stock or options, Won Park: None declared
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Lee SS, Kim TH, Park W, Song YW, Suh CH, Kim S, Yoo D. POS0911 SIMILAR CLINICAL RESPONSES ACHIEVED WITH LOWER VERSUS STANDARD DOSES OF INFLIXIMAB BIOSIMILAR CT-P13 IN PATIENTS WITH ANKYLOSING SPONDYLITIS: REAL-WORLD RESULTS FROM THE RAAS STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:CT-P13, an infliximab biosimilar, is effective for treating ankylosing spondylitis (AS) at a dose of 5 mg/kg infused once every 6–8 weeks. Evidence suggests that patients with AS may benefit from a lower dose, and individualised dose/interval adjustments should be based on treatment response.Objectives:To analyse real-world treatment patterns (doses and infusion intervals) and outcomes for CT-P13-treated patients with AS over 5 years.Methods:The RAAS study collected medical record data for adults with AS treated with CT-P13 at five referral hospitals in the Republic of Korea (2012–2017). Patients were infliximab naïve at CT-P13 initiation (‘naïve’) or had switched to CT-P13 from reference infliximab (‘switched’). Patients were analysed by baseline dose (BD) (<4 mg/kg; ≥4–<5 mg/kg; ≥5 mg/kg), defined as the third (naïve) or first (switched) infusion dose. Baseline infusion intervals were the average of the three infusion intervals after BD. Over time, patients with both constant dose and infusion interval were compared with those with changes in dose and/or infusion interval. Data were analysed by Kruskal–Wallis test, chi-squared test and one-way analysis of variance, and drug survival by log-rank test.Results:Overall, 337 patients (219 naïve; 118 switched) were identified. Of those with BD data, 71, 117 and 82 patients had BDs of <4 mg/kg, ≥4–<5 mg/kg and ≥5 mg/kg, respectively. Most patients were male (74.8%). Patients with higher BDs tended to have higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores; switched patients had lower scores than naïve patients. Of 186 evaluable patients (118 naïve; 68 switched), 85 (46 naïve; 39 switched) did not have dose and/or interval changes (‘combined constant’ group). More naïve (n=72; 61.0%) versus switched (n=29; 42.6%) patients had dose and/or interval changes (‘combined changed’ group). Considering dose and interval separately, 18/235 evaluable patients (152 naïve; 83 switched) had dose changes (12 increased; 6 decreased) and 110/224 evaluable patients (140 naïve; 84 switched) had interval changes (79 increased; 31 decreased). Cumulative annual doses were similar between naïve and switched patients; switched patients had longer infusion intervals than naïve patients (Figure 1). There were no significant differences in drug survival between BD groups overall or for naïve and switched patients. BASDAI scores over time showed that disease activity was well controlled (Table 1). Patients in the combined changed versus combined constant group had greater improvements in BASDAI score.Table 1.BASDAI scoresGroupStatisticW0W54W102W156W210Combined constantTotal (N=85)n7273574231Mean (SD)5.50 (3.12)2.50 (1.71)2.35 (1.66)2.42 (1.66)2.36 (1.68)Median6.322.602.402.552.60Naïve (n=46)n3939261812Mean (SD)7.86 (1.45)2.49 (1.82)2.41 (1.75)2.34 (1.70)1.94 (1.58)Median7.802.201.751.901.44Switched (n=39)n3334312419Mean (SD)2.71 (2.07)2.50 (1.60)2.31 (1.60)2.48 (1.67)2.63 (1.73)Median2.582.752.502.802.70Combined changedTotal (N=101)n8785765335Mean (SD)5.68 (2.89)1.81 (1.45)1.58 (1.27)1.49 (1.34)1.40 (1.24)Median6.701.321.191.201.00Naïve (n=72)n6360543418Mean (SD)7.18 (1.37)2.01 (1.44)1.65 (1.22)1.54 (1.26)1.52 (0.97)Median7.301.831.351.311.35Switched (n=29)n2425221917Mean (SD)1.74 (1.94)1.33 (1.36)1.42 (1.41)1.39 (1.50)1.28 (1.50)Median0.920.800.850.700.58SD, standard deviation; W, WeekConclusion:These real-world data demonstrate that adjusting dose and infusion interval can improve clinical outcomes for CT-P13-treated patients with AS. Drug survival and BASDAI results show that patients with lower baseline BASDAI receiving low CT-P13 doses can achieve the same outcomes as those dosed with ≥5 mg/kg. Findings support the lack of impact of switching from reference infliximab to CT-P13 on efficacy, underlining conclusions previously drawn for efficacy and safety.1References:[1]Kim T-H, et al. Clin Drug Investig 2020;40:541–53.Acknowledgements:Funding: This study was supported by Celltrion Healthcare Co., Ltd. (Incheon, Republic of Korea). Medical writing support was provided by Beatrice Tyrrell, DPhil (Aspire Scientific, Bollington, UK), and funded by Celltrion Healthcare Co., Ltd. (Incheon, Republic of Korea).Disclosure of Interests:Shin-Seok Lee: None declared, Tae-Hwan Kim: None declared, Won Park Consultant of: Celltrion, Inc., Yeong Wook Song: None declared, Chang-Hee Suh Speakers bureau: AbbVie Inc., Astellas Pharma Inc., Samsung Bioepis Co., Ltd, Consultant of: Celltrion Healthcare Co., Ltd., Eli Lilly and Company, GlaxoSmithKline plc, Janssen Pharmaceuticals, Yungjin Pharmaceutical, Co., Ltd, SooKyoung Kim Shareholder of: Celltrion Healthcare Co., Ltd., Employee of: Celltrion Healthcare Co., Ltd., DaeHyun Yoo Speakers bureau: Celltrion, Consultant of: Celltrion, Grant/research support from: Celltrion
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Wei MT, Hwang JH, Watson RR, Park W, Friedland S. Novel rigidizing overtube for colonoscope stabilization and loop prevention (with video). Gastrointest Endosc 2021; 93:740-749. [PMID: 32739483 DOI: 10.1016/j.gie.2020.07.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Loop formation can impede endoscope advancement, destabilize the tip, and cause pain. Strategies to mitigate looping include torque-based reduction maneuvers, variable stiffness shafts, and abdominal splinting. In some cases, these strategies are insufficient, and there is need for novel instruments. Loop formation is of particular concern in colonoscopy, but it can also impact performance of other endoscopic procedures such as enteroscopy and altered-anatomy ERCP. In this case series we demonstrate the utility of a novel rigidizing overtube (Pathfinder; Neptune Medical, Burlingame, Calif, USA) in colonoscopy and other endoscopic procedures where loop management is critical. METHODS We describe our initial experience with the Pathfinder overtube in 29 patients. The overtube is 85 cm long and can accommodate a pediatric colonoscope. In its native state, the overtube is extremely flexible. Once the overtube is advanced to the desired location, application of a vacuum to the device causes the device to become 15 times stiffer. The endoscope can then be advanced through the overtube without loop formation in the region that the overtube traverses. RESULTS The overtube was used in 29 patients to assist with difficult procedures. Patients were predominantly men (n = 18; 62.1%), with a median age of 66 years (interquartile range, 57-72). One patient received an upper endoscopy (3.4%), 24 received colonoscopy (82.8%), and 4 received enteroscopy (13.8%). The overtube was used in 12 procedures for incomplete colonoscopy (41.4%), 6 for depth (20.7%), and 11 for stability (37.9%). Colonoscopy was performed in the setting of screening (n = 3), surveillance given polyp history (n = 7), referrals for polyp removal (n = 10), workup of iron deficiency anemia (n = 2), and incomplete colonoscopy (n = 1). The lower endoscopy cases had a median cecal intubation time of 5 minutes (interquartile range, 4.25-7). Enteroscopy was performed in 4 patients: In one patient the distal 60 cm of the ileum was examined with a pediatric colonoscope to exclude ileitis, in another the overtube was used to stabilize a 6-mm endoscope to traverse a tight Crohn's ileocolonic stricture, in a third patient altered-anatomy ERCP was performed using an enteroscope through the overtube to reach a hepaticojejunostomy, and in the final patient upper enteroscopy was performed and the mid-jejunum was reached. We present 4 cases that demonstrate the use of the overtube. There were no adverse events. CONCLUSIONS Initial experience with a novel rigidizing overtube suggests that this tool can be useful in colonoscopy and other endoscopic procedures affected by looping.
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Affiliation(s)
- Mike Tzuhen Wei
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Walter Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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21
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Park W, Park M, Choi K, Heo Y, Choi SY, Cho J, Ko YH, Jeong HS. Analysis of local invasion and regional spread in malignant sublingual gland tumour: Implications for surgical planning. Int J Oral Maxillofac Surg 2021; 50:1280-1288. [PMID: 33602646 DOI: 10.1016/j.ijom.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Malignant tumours arising from the sublingual glands are very rare, and the extent and frequency of local invasion or regional spread in malignant sublingual gland tumour (MSLT) has not been fully studied due to the disease rarity. To provide comprehensive features of local and regional spread of MSLT, we reviewed 20 surgical cases for detailed pathological analyses among 26 cases diagnosed as having primary MSLT. Adenoid cystic carcinoma (ACC) was the most common pathological subtype, followed by mucoepidermoid carcinoma. Disease-free and overall survivals at 5 years were 76.1 % and 77.7 %, respectively. High-grade malignant tumours and grade 2-3 ACC accounted for 41.7 % and 85.7 %. Clinical and pathological extraparenchymal extensions were found in 34.6 % and 80.0 %, respectively. Tumour invasion to the lingual nerve and submandibular gland/ductal system were also detected in 40.0 % and 28.6 %. The incidences of lingual nerve invasion in ACC and ACC ≥4 cm were 30.8 % and 42.9 %. Regional nodal involvement occurred in seven of 26 cases, and all metastatic lymph nodes were found in neck levels Ib and IIa. In summary, a significant portion of MSLT cases consisted of high-grade tumours and grade 2-3 ACC; therefore local invasion into adjacent structures should be cautiously evaluated in cases of MSLT.
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Affiliation(s)
- W Park
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - M Park
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y Heo
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S Y Choi
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-H Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H-S Jeong
- Departments of Otorhinolaryngology - Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Gubatan J, Levitte S, Patel A, Balabanis T, Sharma A, Jones E, Lee B, Manohar M, Swaminathan G, Park W, Habtezion A. Prevalence, risk factors and clinical outcomes of COVID-19 in patients with a history of pancreatitis in Northern California. Gut 2021; 70:440-441. [PMID: 32493828 PMCID: PMC8099023 DOI: 10.1136/gutjnl-2020-321772] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Affiliation(s)
- John Gubatan
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Steven Levitte
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Akshar Patel
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Tatiana Balabanis
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Arpita Sharma
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Elaina Jones
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Bomi Lee
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Murli Manohar
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Gayathri Swaminathan
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Walter Park
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Aida Habtezion
- Divison of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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23
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Choi W, Park W, Kim S. Usability assessment of cone beam computed tomography with a full-fan mode bowtie filter compared to that with a half-fan mode bowtie filter. INT J RADIAT RES 2021. [DOI: 10.29252/ijrr.19.1.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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24
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Kukla A, Alexander MP, Turkevi-Nagy S, Merzkani M, Park W, Smith B, Zhang P, Benavides X, D'Costa M, Morales Alvarez C, Denic A, Bentall A, Kudva YC, Stegall M. Mesangial expansion at 5 years predicts death and death-censored graft loss after renal transplantation. Clin Transplant 2020; 35:e14147. [PMID: 33170556 DOI: 10.1111/ctr.14147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
Death with a functioning graft and death-censored renal allograft failure remain major problems for which effective preventative protocols are lacking. The retrospective cohort study aimed to determine whether histologic changes on a 5-year surveillance kidney biopsy predict adverse outcomes after transplantation in recipients who had: both Type 2 diabetes (T2DM) and obesity (BMI ≥ 30 kg/m2 ) at the time of transplantation (T2DM/Obesity, n = 75); neither (No T2DM/No obesity, n = 78); No T2DM/Obesity (n = 41), and T2DM/No obesity (n = 47). On 5-year biopsies, moderate-to-severe mesangial expansion was more common in the T2DM/Obesity group (Banff mm score ≥2 = 49.3%; Tervaert classification MS ≥ 2b = 26.7%) compared to the other groups (p < .001 for both scores). Risk factors included older age, higher BMI, HbA1C, and triglycerides at 1-year post-transplant. Moderate-to-severe mesangial expansion correlated with death with function (HR 1.74 (1.01, 2.98), p = .045 Banff and 1.89 (1.01, 3.51) p = .045 Tervaert) and with death-censored graft loss (HR 3.2 (1.2, 8.8), p = .02 Banff and HR 3.8 (1.3, 11.5), p = .01 Tervaert) over a mean of 11.6 years of recipient follow-up post-transplant. These data suggest that mesangial expansion in recipients with T2DM and obesity may reflect systemic vascular injury and might be a novel biomarker to predict adverse outcomes post renal transplant.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | | | - Sandor Turkevi-Nagy
- Department of Pathology, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Massini Merzkani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Walter Park
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Division of Transplant Surgery, Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Byron Smith
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Division of Transplant Surgery, Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Pingchuan Zhang
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Xiomara Benavides
- Division of Transplant Surgery, Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Matthew D'Costa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Catalina Morales Alvarez
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Division of Transplant Surgery, Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrew Bentall
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Yogish C Kudva
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Mark Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Division of Transplant Surgery, Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA
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25
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Choi S, Kim Y, Yu J, Nam T, Kim J, Jang B, Kim J, Kim Y, Jung B, Chang A, Park Y, Lee S, Cho K, Kim J, Kim H, Choi Y, Kim Y, Lee D, Shin Y, Shim S, Park W, Cho J. PO-1188: Optimal radiotherapy strategy as risk-group in non-metastatic prostate cancer patients (KROG 18-15). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Van Loon E, Aboumsallem JP, Lerut E, Bogojevic M, Denic A, Park W, Muthuramu I, Mishra M, Stegall M, Naesens M, De Geest B. Mesangial matrix expansion in a novel mouse model of diabetic kidney disease associated with the metabolic syndrome. J Nephropathol 2020. [DOI: 10.34172/jnp.2021.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Elisabet Van Loon
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Leuven, Belgium
| | - Joseph Pierre Aboumsallem
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, Division of Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Marija Bogojevic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter Park
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Ilayaraja Muthuramu
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Mudit Mishra
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Mark Stegall
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Maarten Naesens
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- University Hospitals Leuven, Department of Nephrology and Renal Transplantation, Leuven, Belgium
| | - Bart De Geest
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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27
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Springer S, Masica DL, Dal Molin M, Douville C, Thoburn CJ, Afsari B, Li L, Cohen JD, Thompson E, Allen PJ, Klimstra DS, Schattner MA, Schmidt CM, Yip-Schneider M, Simpson RE, Fernandez-Del Castillo C, Mino-Kenudson M, Brugge W, Brand RE, Singhi AD, Scarpa A, Lawlor R, Salvia R, Zamboni G, Hong SM, Hwang DW, Jang JY, Kwon W, Swan N, Geoghegan J, Falconi M, Crippa S, Doglioni C, Paulino J, Schulick RD, Edil BH, Park W, Yachida S, Hijioka S, van Hooft J, He J, Weiss MJ, Burkhart R, Makary M, Canto MI, Goggins MG, Ptak J, Dobbyn L, Schaefer J, Sillman N, Popoli M, Klein AP, Tomasetti C, Karchin R, Papadopoulos N, Kinzler KW, Vogelstein B, Wolfgang CL, Hruban RH, Lennon AM. A multimodality test to guide the management of patients with a pancreatic cyst. Sci Transl Med 2020; 11:11/501/eaav4772. [PMID: 31316009 DOI: 10.1126/scitranslmed.aav4772] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/07/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Pancreatic cysts are common and often pose a management dilemma, because some cysts are precancerous, whereas others have little risk of developing into invasive cancers. We used supervised machine learning techniques to develop a comprehensive test, CompCyst, to guide the management of patients with pancreatic cysts. The test is based on selected clinical features, imaging characteristics, and cyst fluid genetic and biochemical markers. Using data from 436 patients with pancreatic cysts, we trained CompCyst to classify patients as those who required surgery, those who should be routinely monitored, and those who did not require further surveillance. We then tested CompCyst in an independent cohort of 426 patients, with histopathology used as the gold standard. We found that clinical management informed by the CompCyst test was more accurate than the management dictated by conventional clinical and imaging criteria alone. Application of the CompCyst test would have spared surgery in more than half of the patients who underwent unnecessary resection of their cysts. CompCyst therefore has the potential to reduce the patient morbidity and economic costs associated with current standard-of-care pancreatic cyst management practices.
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Affiliation(s)
- Simeon Springer
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - David L Masica
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Biomedical Engineering, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD 21287, USA.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Marco Dal Molin
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Christopher Douville
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Biomedical Engineering, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD 21287, USA.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Christopher J Thoburn
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Bahman Afsari
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Lu Li
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Joshua D Cohen
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Biomedical Engineering, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Elizabeth Thompson
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Peter J Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Mark A Schattner
- Department of Gastroenterology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Michele Yip-Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rachel E Simpson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Mari Mino-Kenudson
- Department of Histopathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - William Brugge
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Randall E Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh PA 15213, USA
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Aldo Scarpa
- ARC-Net Research Centre, University and Hospital Trust of Verona, Verona 37134, Italy.,Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona 37134, Italy
| | - Rita Lawlor
- ARC-Net Research Centre, University and Hospital Trust of Verona, Verona 37134, Italy.,Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona 37134, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona 37134, Italy
| | - Giuseppe Zamboni
- Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar 37024, Italy
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Dae Wook Hwang
- Hepatobiliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Niall Swan
- Department of Histopathology, St. Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | - Justin Geoghegan
- Department of Surgery, St. Vincent's University Hospital, Dublin D04 T6F4, Ireland
| | - Massimo Falconi
- Division of Pancreatic Surgery, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Stefano Crippa
- Division of Pancreatic Surgery, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Jorge Paulino
- Department of Surgery, Centro Hepatobiliopancreático e Transplantação, Hospital Curry Cabral, Lisbon 1050-099, Portugal
| | | | - Barish H Edil
- Department of Surgery, University of Colorado, Aurora, CO 80045, USA
| | - Walter Park
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA 94304, USA
| | - Shinichi Yachida
- Department of Hepatobiliary and Pancreatic Surgery, Pathology and Cancer Genomics, National Cancer Center Hospital and National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Susumu Hijioka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Jeanin van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam 1017 ZX, Netherlands
| | - Jin He
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Richard Burkhart
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Martin Makary
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Marcia I Canto
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Michael G Goggins
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Janine Ptak
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Lisa Dobbyn
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Joy Schaefer
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Natalie Sillman
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Maria Popoli
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Alison P Klein
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Cristian Tomasetti
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA. .,Department of Biostatistics and Bioinformatics, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Rachel Karchin
- Department of Biomedical Engineering, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD 21287, USA.,Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Nickolas Papadopoulos
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Kenneth W Kinzler
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Bert Vogelstein
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA. .,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Christopher L Wolfgang
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA. .,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ralph H Hruban
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA.,Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Anne Marie Lennon
- Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA. .,Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Oncology, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.,Department of Radiology, Johns Hopkins University, Baltimore, MD 21287, USA
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Zeng X, Zhao D, Radominski S, Keiserman M, Lee CK, Meerwein S, Enejosa J, Sui Y, Mohamed ME, Park W. SAT0160 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS WHO HAVE HAD INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Upadacitinib (UPA), an oral, selective JAK-1 inhibitor was effective in global ph 3 trials in rheumatoid arthritis (RA) patients with inadequate response (IR)/intolerance to csDMARDs and bDMARDs.Objectives:This Phase 3, randomized, double-blind, placebo (PBO)-controlled study assessed the efficacy and safety of UPA in combination with csDMARDs in csDMARD-IR patients with RA from China, Brazil, and South Korea.Methods:Patients were randomized 1:1 to receive UPA 15 mg once daily (QD) or PBO in combination with csDMARDs. The primary endpoint was ACR20 response at Week 12, using non-responder imputation.Results:338 patients were randomized, and 310 (91.7%) completed Week 12. At Week 12, statistically significantly more patients receiving UPA vs PBO achieved the primary endpoint of ACR20 (71.6% vs 31.4%, p<0.001). UPA also demonstrated statistically significant improvements in all ranked secondary endpoints vs PBO at Week 12 (Table 1), including mean change in DAS28(CRP), HAQ-DI, and SF-36 PCS, and patients achieving DAS28(CRP) ≤3.2, DAS28(CRP) <2.6, and CDAI ≤10. Greater responses were also seen with UPA vs PBO for other key secondary endpoints including ACR50 and ACR70. Onset of UPA action was rapid with more patients on UPA achieving ACR20 by Week 1 (25.4% vs 5.9%, p<0.001). The frequency of AEs (61.5% vs 49.1%) and serious AEs (7.1% vs 3.0%) was higher with UPA vs PBO. The frequency of AEs of special interest was generally similar between UPA and PBO, with the exception of herpes zoster (1.8% vs 0.6%), hepatic disorders (9.5% vs 7.1%), neutropenia (3.0% vs 0%), and elevated creatine phosphokinase (1.8% vs 0.6%), which were higher with UPA. One case of breast cancer (on Day 1 of study) and one VTE (pulmonary embolism and deep vein thrombosis in a patient with history of deep vein thrombosis) were reported with UPA treatment.Table 1.Efficacy endpoints at Week 12EndpointaUPA 15 mg QD (n=169)PBO(n=169)Primary endpointACR20, %71.6***31.4Secondary endpointsΔ DAS28(CRP)-2.56***-0.95Δ HAQ-DI-0.62***-0.18Δ SF-36 PCS8.93c***3.36dDAS28(CRP) ≤3.2, %46.2***13.6DAS28(CRP) <2.6, %29.6***5.3CDAI ≤10, %35.5***11.2ACR50, %b40.8***8.3ACR70, %b21.3***3.6ACR20 at Week 1, %b25.4***5.9***p<0.001 vs PBOaNRI for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpointsbUnranked secondary endpoint.cn=143.dn=149Conclusion:Efficacy of UPA was demonstrated in this csDMARD-IR population from China, Brazil, and South Korea. The safety of UPA was comparable with the global Phase 3 program.Disclosure of Interests: :Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN Speakers bureau: Pfizer, Abbott, Actelion, AstraZeneca, Amgen, Roche, Bristol Myers Squibb, and Janssen and has received clinical trial honoraria from Pfizer, Amgen, AstraZeneca, Anthera Pharmaceuticals, Bristol-Myers Squibb, Biogen Idec Inc, Celltrion Inc., Eli Lilly, Human Genome Sciences, Novartis, Roche, Sanofi, UCB Inc., Chang-Keun Lee: None declared, Sebastian Meerwein Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jeffrey Enejosa Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yunxia Sui Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Mohamed-Eslam Mohamed Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Won Park: None declared
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Kwon SR, Yoon SA, Lee SY, Jung KH, Park SG, Jung KH, Park W, Hong SS, Jeon MS, Lim MJ. SAT0355 WNT SIGNALING CAN PLAY AN IMPORTANT ROLE IN VASCULAR CALCIFICATION IN PATIENTS WITH ANKYLOSING SPONDYLITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Vascular calcification is highly correlated with atherosclerosis. Ankylosing spondylitis (AS) is associated with a process of accelerated atherosclerosis. Wnt signaling plays an important role in the pathogenesis of vascular calcification. However, there has been no study of the role of Wnt signaling in vascular calcification in patients with AS.Objectives:We investigated the relationship between vascular calcification and Wnt signaling in patients with AS.Methods:Sixteen male patients aged over 20 years with AS were enrolled. They fulfilled the modified New York criteria and each of their ankylosing spondylitis disease activity score was more than 2.1. Sex and age matched nineteen healthy controls were also recruited.Mouse MOVAS vascular smooth muscle cell line (American Type Culture Collection, ATCC® CRL-2797™) were stabilized in maintain media for 24 hours. Then media were exchanged for the 10% serum of patients with AS or controls in maintain media. Cells were stimulated for another 72hours. We exchanged this medium with calcification medium. Cells were cultured until 2 weeks then stained with Alizarin Red S and the optical density (OD) was measured.For Western blotting and RT-qPCR, cells were stabilized for 24 hours and stimulated for another 72 hours through the same procedure as that of Alizarin Red S staining. After cell stimulation, the level of mRNA and protein were measured by RT-qPCR and western blot, respectably. We measure the level of Low-density lipoprotein receptor-related protein (LRP)5, LRP6, Dickkopf-related protein 1, Wnt3a, matrix metalloproteinase-7(MMP-7), beta-catenin for canonical Wnt signaling; Receptor Tyrosine Kinase Like Orphan Receptor 2, Wnt5a, Runt-related transcription factor 2 (RUNX2) for non-canonical Wnt signaling. We also checked the level of Alkaline phosphatase (ALP), IL-17, IL-23 and TNF-a.Results:The level of OD of MOVAS cells treated with serum from AS patients (19.503 ± 6.422, mean ± SD) was significantly higher than that from controls (10.994 ± 4.291) (P=0.000, Mann-Whitney test). The protein level of MMP-7 and beta-catenin of MOVAS cells treated with serum from AS patients (1.881 ± 0.687; 1.301 ± 0.342) was significantly higher than that from controls (0.779 ± 0.48; 0.854 ± 0.285) respectively (P=0.005,: P=0.002, Mann-Whitney test). The mRNA level of RUNX2, ALP, IL-17 and IL-23 of serum from AS patients (2.697 ± 1.46; 2.687 ± 1.753; 2.253 ± 1.128; 2.574 ± 1.142) was significantly higher than that from controls (1.396 ± 0.587; 1.696 ± 0.637; 1.358 ± 0.473; 1.386 ± 0.714) respectively (P=0.000; P=0.037; P=0.044; P=0.007, Mann-Whitney test). There was positive correlation between the mRNA level of WNT5a and RUNX2 (rho=-0.705, p=0.002, Spearman rank correlation coefficient) and the protein level of WNT5a and ALP, MMP-7 and TNF-a, MMP-7 and IL-17, MMP-7 and IL-23 (rho=-0.601, p=0.039; rho=-0.769, p=0.026; rho=-0.828, p=0.011; rho=-0.777, p=0.003), respectively.Conclusion:1. Vascular smooth muscle cell calcification was increased in patients with ankylosing spondylitis than those of the control group.2. The level of several molecules(i.e. Beta-catenin, RUNX2, MMP-7) related to Wnt signaling of vascular smooth muscle cells treated with serum of patients with AS was elevated significantly compared to those of controls and positively related.3. Wnt signaling can play an important role in vascular calcification in patients with ankylosing spondylitis.Acknowledgments:This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03030825)Disclosure of Interests:None declared
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Jung KH, Kim HJ, Park W, Lim MJ, Kang T, Kang MJ, Kim KB, Ahn HS. Incidence, survival, and risk of cardiovascular events in adult inflammatory myopathies in South Korea: a nationwide population-based study. Scand J Rheumatol 2020; 49:323-331. [PMID: 32286141 DOI: 10.1080/03009742.2019.1707281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Epidemiological studies on inflammatory myopathies (IMs) show widely variable results, and studies on Asians are lacking. Despite emerging interest in the cardiovascular disease (CVD) risk associated with IMs, the prevalence of CVD in IM patients and its impact on mortality remain unclear. We conducted a nationwide, population-based study on the incidence, mortality, and associated major CVD events of IMs in the Republic of Korea over 11 years. METHOD Using the nationwide, population-based National Health Insurance claims database and the Rare Intractable Disease registration programme, we estimated incidence, mortality, and CVD occurrence. Survival was examined using the Kaplan-Meier method. Mortality rate in IMs with CVD was analysed by Cox proportional hazards regression. RESULTS There were 3014 incident cases, 640 of whom died during the study period. The mean annual incidence was 7.16/106. Dermatomyositis (DM) and polymyositis (PM) had 5 year survival rates of 76.8% and 79.3%, respectively. Cardiovascular events occurred in 155 patients and 40.6% of IM patients with CVD died. Acute myocardial infarction in men had the highest risk of any CVD event in both DM [standardized incidence ratio (SIR) 4.2, 95% confidence interval (95% CI) 2.4-7.2] and PM (SIR 3.5, 95% CI 1.8-7.0). Haemorrhagic stroke had the highest hazard ratio (HR) in both DM (HR 2.31, 95% CI 1.13-4.70) and PM patients (HR 2.10, 95% CI 1.03-4.27) compared with the general population with CVD. CONCLUSION We found persistently low incidence, poor survival, and high major CVD incidence in IMs, and increased mortality in IMs with CVD.
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Affiliation(s)
- K H Jung
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University , Incheon, Republic of Korea
| | - H J Kim
- Department of Preventive Medicine, College of Medicine, Korea University , Seoul, Republic of Korea
| | - W Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University , Incheon, Republic of Korea
| | - M J Lim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University , Incheon, Republic of Korea
| | - T Kang
- Health Insurance Policy Research Institute, National Health Institute Service , Wonju, Republic of Korea
| | - M J Kang
- Department of Public Health, Graduate School, Korea University , Seoul, Republic of Korea
| | - K-B Kim
- Department of Public Health, Graduate School, Korea University , Seoul, Republic of Korea
| | - H S Ahn
- Department of Preventive Medicine, College of Medicine, Korea University , Seoul, Republic of Korea
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Goggins M, Overbeek KA, Brand R, Syngal S, Del Chiaro M, Bartsch DK, Bassi C, Carrato A, Farrell J, Fishman EK, Fockens P, Gress TM, van Hooft JE, Hruban RH, Kastrinos F, Klein A, Lennon AM, Lucas A, Park W, Rustgi A, Simeone D, Stoffel E, Vasen HFA, Cahen DL, Canto MI, Bruno M. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69:7-17. [PMID: 31672839 PMCID: PMC7295005 DOI: 10.1136/gutjnl-2019-319352] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [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: 06/23/2019] [Revised: 09/05/2019] [Accepted: 09/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals). METHODS A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed. RESULTS Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions. CONCLUSIONS Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.
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Affiliation(s)
- Michael Goggins
- Pathology, Medicine Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Randall Brand
- Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sapna Syngal
- GI Cancer Genetics and Prevention Program, Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marco Del Chiaro
- Department of Surgery, Division of Surgical Oncology, Denver, Colorado, USA
| | - Detlef K Bartsch
- Division of Visceral, Thoracic and Vascular Surgery, University of Marburg, Marburg, Germany
| | - Claudio Bassi
- Department of Surgey, University of Verona, Verona, Italy
| | | | - James Farrell
- Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elliot K Fishman
- The Russell H Morgan Department of Radiology and Radiological Science, Baltimore, Maryland, USA
| | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Thomas M Gress
- Gastroenterology, Endocrinology, Metabolism and Infectiology, University of Marburg, Marburg, Germany
| | - Jeanin E van Hooft
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - R H Hruban
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, New York, USA,Division of Digestive and Liver Diseases, Columbia University, New York City, New York, USA
| | - Allison Klein
- Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Aimee Lucas
- Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Walter Park
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, New York, USA
| | - Anil Rustgi
- Division of Digestive and Liver Diseases, Columbia University, New York City, New York, USA
| | - Diane Simeone
- New York University Medical Center, New York City, New York, USA
| | | | - Hans F A Vasen
- Gastroenterology and Hepatology, Leiden University, Leiden, The Netherlands
| | - Djuna L Cahen
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Marco Bruno
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kim ST, Banks KC, Pectasides E, Kim SY, Kim K, Lanman RB, Talasaz A, An J, Choi MG, Lee JH, Sohn TS, Bae JM, Kim S, Park SH, Park JO, Park YS, Lim HY, Kim NKD, Park W, Lee H, Bass AJ, Kim K, Kang WK, Lee J. Impact of genomic alterations on lapatinib treatment outcome and cell-free genomic landscape during HER2 therapy in HER2+ gastric cancer patients. Ann Oncol 2019; 29:1037-1048. [PMID: 29409051 PMCID: PMC5913644 DOI: 10.1093/annonc/mdy034] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To identify predictive markers for responders in lapatinib-treated patients and to demonstrate molecular changes during lapatinib treatment via cell-free genomics. Patients and methods We prospectively evaluated the efficacy of combining lapatinib with capecitabine and oxaliplatin as first line neoadjuvant therapy in patients with previously untreated, HER2-overexpressing advanced gastric cancer. A parallel biomarker study was conducted by simultaneously performing immunohistochemistry and next-generation sequencing (NGS) with tumor and blood samples. Results Complete response was confirmed in 7/32 patients (21.8%), 2 of whom received radical surgery with pathologic-confirmed complete response. Fifteen partial responses (46.8%) were observed, resulting in a 68.6% overall response rate. NGS of the 16 tumor specimens demonstrated that the most common co-occurring copy number alteration was CCNE1 amplification, which was present in 40% of HER2+ tumors. The relationship between CCNE1 amplification and lack of response to HER2-targeted therapy trended toward statistical significance (66.7% of non-responders versus 22.2% of responders harbored CCNE1 amplification; P = 0.08). Patients with high level ERBB2 amplification by NGS were more likely to respond to therapy, compared with patients with low level ERBB2 amplification (P = 0.02). Analysis of cfDNA showed that detectable ERBB2 copy number amplification in plasma was predictive to the response (100%, response rate) and changes in plasma-detected genomic alterations were associated with lapatinib sensitivity and/or resistance. The follow-up cfDNA genomics at disease progression demonstrated that there are emergences of other genomic aberrations such as MYC, EGFR, FGFR2 and MET amplifications. Conclusions The present study showed that HER2+ GC patients respond differently according to concomitant genomic aberrations beyond ERBB2, high ERBB2 amplification by NGS or cfDNA can be a positive predictor for patient selection, and tumor genomic alterations change significantly during targeted agent therapy.
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Affiliation(s)
- S T Kim
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - K C Banks
- Department of Medical Affair, Guardant Health, Dana-Farber Cancer Institute, Boston, USA
| | - E Pectasides
- Division of Molecular and Cellular Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S Y Kim
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - K Kim
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - R B Lanman
- Department of Medical Affair, Guardant Health, Dana-Farber Cancer Institute, Boston, USA
| | - A Talasaz
- Department of Medical Affair, Guardant Health, Dana-Farber Cancer Institute, Boston, USA
| | - J An
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - M G Choi
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - J H Lee
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - T S Sohn
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - J M Bae
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - S Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Surgery, Samsung Medical Center, Seoul, Korea
| | - S H Park
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J O Park
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Y S Park
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - H Y Lim
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - N K D Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - W Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - H Lee
- Sungkyunkwan University School of Medicine, Seoul, Korea; Division of Gastroenterolog, Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - A J Bass
- Division of Molecular and Cellular Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - K Kim
- Pathology and Translational Genomics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - W K Kang
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J Lee
- Division of Hematology-Oncolog, Department of Medicine, Samsung Medical Center, Seoul, Korea; Sungkyunkwan University School of Medicine, Seoul, Korea.
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Mezquita L, Preeshagul I, Auclin E, Saravia D, Hendriks L, Rizvi H, Planchard D, Park W, Nadal E, Ruffinelli J, Ponce S, Audigier-Valette C, Carnio S, Novello S, Zalcman G, Majem M, Mariniello A, Dingemans A, Lopes G, Rossoni C, Pignon J, Chaput N, Hellmann M, Arbour K, Besse B. MA07.02 Early Change of dNLR Is Correlated with Outcomes in Advanced NSCLC Patients Treated with Immunotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chang J, Choi S, Shin K, Park W, Kim K, Lee I, Yoon W, Cha J, Lee K, Kim J, Choi J, Ahn S, Ha B, Lee S, Kim W, Shin S, Kim Y. Radiation Practice Patterns and the Impact of Radiotherapy on Complications after Breast Reconstruction: A Multicenter Study (KROG 18-04). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim J, Kim K, Shin K, Kim J, Kim S, Kim T, Kim Y, Park W, Kim J. M1 Neck Lymph Node Positive without Distant Metastasis in Breast Cancer: Comparison with Stage IIIc. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hwang J, Park N, Choi H, Hwang J, Lee S, Min D, Kim K, Park W. 564 Melasolv, a skin lightening compound with different mechanisms to regulate skin pigmentation. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Issa N, Vaughan LE, Denic A, Kremers WK, Chakkera HA, Park W, Matas AJ, Taler SJ, Stegall MD, Augustine J, Rule AD. Larger nephron size, low nephron number, and nephrosclerosis on biopsy as predictors of kidney function after donating a kidney. Am J Transplant 2019; 19:1989-1998. [PMID: 30629312 PMCID: PMC6591036 DOI: 10.1111/ajt.15259] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 10/14/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 01/25/2023]
Abstract
It is unclear whether structural findings in the kidneys of living kidney donors predict postdonation kidney function. We studied living kidney donors who had a kidney biopsy during donation. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Age-specific thresholds were defined for low nephron number (calculated from CT and biopsy measures) and nephrosclerosis (global glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis). These structural measures were assessed as predictors of postdonation measured GFR, 24-hour urine albumin, and hypertension. Analyses were adjusted for baseline age, gender, body mass index, systolic and diastolic blood pressure, hypertension, measured GFR, urine albumin, living related donor status, and time since donation. Of 2673 donors, 1334 returned for a follow-up visit at a median 4.4 months after donation, with measured GFR <60 mL/min/1.73 m2 in 34%, urine albumin >5 mg/24 h in 13%, and hypertension in 5.3%. Larger glomerular volume and interstitial fibrosis/tubular atrophy predicted follow-up measured GFR <60 mL/min/1.73 m2 . Larger cortex volume per glomerulus and low nephron number predicted follow-up urine albumin >5 mg/24 h. Arteriosclerosis predicted hypertension. Microstructural findings predict GFR <60 mL/min/1.73 m2 , modest increases in urine albumin, and hypertension shortly after kidney donation.
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Affiliation(s)
- Naim Issa
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Lisa E. Vaughan
- Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Denic
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | | | - Walter Park
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Sandra J. Taler
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | | | - Andrew D. Rule
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
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Steinig S, Harlaß J, Park W, Latif M. Author Correction: Sahel rainfall strength and onset improvements due to more realistic Atlantic cold tongue development in a climate model. Sci Rep 2019; 9:7055. [PMID: 31043626 PMCID: PMC6494867 DOI: 10.1038/s41598-019-42950-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- S Steinig
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Wischhofstr. 1-3, 24148, Kiel, Germany.
| | - J Harlaß
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Wischhofstr. 1-3, 24148, Kiel, Germany
| | - W Park
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Wischhofstr. 1-3, 24148, Kiel, Germany
| | - M Latif
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Wischhofstr. 1-3, 24148, Kiel, Germany.,Kiel University, Kiel, Germany
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Lee E, Park N, Ahn Y, Jung W, Bae I, Yoo J, Baek H, Park W. 951 The wound healing effect of a novel synthetic retinoid, seletinoid G, on cultured keratinocytes and human skin equivalents. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Choi E, Kim J, Kang Y, Choe S, Cho G, Kim J, Kim S, Choi E, Park W, Kim H, Son E. 308 Beneficial effect of coumestrol on the psychological stress-induced skin barrier dysfunction through inhibition of 11β-hydroxysteroid dehydrogenase type 1. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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KIim J, Kim K, Shin K, Kim J, Kim S, Kim T, Kim Y, Park W, Kim J. EP-1279 M neck lymph node positive without distant metastasis in breast cancer: comparison with stage IIIC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim H, Park W, Choi DH, Ahn SJ, Kim SS, Kim ES, Lee JH, Lee KC, Kim JH, Lee HS, Kim JH, Kim MY, Park HJ, Kim K, Song SH, Kwon J, Lee IJ, Kim TH, Kim TG, Chang AR, Cho O, Jeong BK, Ha B, Lee J, Ki Y. Abstract OT2-04-02: A phase 3 study of post-lumpectomy radiotherapy to whole breast + regional lymph nodes vs whole breast alone for patients with pN1 breast cancer treated with taxane-based chemotherapy (KROG 1701): Trial in progress. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background
In patients with early stage breast cancer, regional nodal irradiation (RNI) is added to whole breast irradiation (WBI) in order to control microscopic regional disease and to prevent systemic spread of cancer. According to recent randomized trials (MA.20 and EORTC 22922-10925), prophylactic RNI was associated with improvement in disease-free survival (DFS) in the patients with high-risk node negative or pN1 breast cancer. However, systemic agents now known to improve loco-regional control, such as taxane or endocrine therapy, were prescribed to a small percentage of patients in the studies. The benefit of RNI found in the previous studies might be attributed to incorporation of less effective systemic treatments. The impact of prophylactic RNI in pN1 breast cancer should be evaluated in the patients receiving modern systemic treatment. The current study was conducted to compare the effect of post-lumpectomy WBI vs WBI plus RNI on DFS in pN1 breast cancer patients who received adjuvant taxane-based chemotherapy.
Methods
This study is a multicenter, phase 3, randomized controlled non-inferiority trial (NCT03269981). Eligibility criteria are ≥ 20 years female; pathologically proven invasive carcinoma of the breast; one to three positive axillary lymph nodes (pN1) in pathologic specimen; receiving breast-conserving surgery followed by taxane-based chemotherapy; having adjuvant endocrine therapy or anti-HER2 treatment according to molecular subtype of tumor. Patients are randomly assigned in a 1:1 ratio to receive WBI or WBI plus RNI. Patient randomization was stratified by molecular subtype of tumor (i.e. luminal A/luminal B/luminal HER2/HER2-enriched/triple-negative) and methods of axillary management (i.e. sentinel lymph node biopsy/axillary lymph node dissection). The primary outcome is DFS. The secondary outcomes include DFS according to molecular subtype, treatment-related toxicity, and patient's quality of life per EORTC QLQ-C30 and QLQ-BR23. Patients will be followed for survival and disease recurrence for seven years. A total of 1,926 patients are planned to be enrolled, with recruitment initiated in April 2017. As of June 2018, a total of 236 patients were enrolled.
Acknowledgement
This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (grant number: HA17C0043010018).
Citation Format: Kim H, Park W, Choi DH, Ahn SJ, Kim SS, Kim ES, Lee JH, Lee KC, Kim JH, Lee H-S, Kim JH, Kim MY, Park HJ, Kim K, Song SH, Kwon J, Lee IJ, Kim TH, Kim TG, Chang AR, Cho O, Jeong BK, Ha B, Lee J, Ki Y. A phase 3 study of post-lumpectomy radiotherapy to whole breast + regional lymph nodes vs whole breast alone for patients with pN1 breast cancer treated with taxane-based chemotherapy (KROG 1701): Trial in progress [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-02.
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Affiliation(s)
- H Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - W Park
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - DH Choi
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SJ Ahn
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SS Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - ES Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - KC Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - H-S Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - JH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - MY Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - HJ Park
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - K Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - SH Song
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - J Kwon
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - IJ Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - TH Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - TG Kim
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - AR Chang
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - O Cho
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - BK Jeong
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - B Ha
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - J Lee
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
| | - Y Ki
- Samsung Medical Center, Seoul, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea; Asan Medical Center, Seoul, Republic of Korea; Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea; Gachon University Gil Medical Center, Incheon, Republic of Korea; Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea; Dong-A University Hospital, Busan, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea; Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Kangwon National University School of Medicine, Chuncheon, Republic of Korea; Chungnam National University College of Medicine, Daejeon, Republic of Korea; Gangnam Severance Hospital, Yonsei Univer
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Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh CO, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ. Abstract P3-12-12: Impact of regional nodal irradiation for breast cancer patients with supraclavicular and/or internal mammary lymph node involvement: A multicenter, retrospective study (KROG 16-14). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-12] [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
Purpose: To evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
Methods: A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjvant systemic therapy followed by breast conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
Results: The median follow-up duration was 61 months (range, 7-173). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥4, triple negative subtype, and mastectomy were significant adverse prognosticators for DFS (p = 0.022, 0.001, 0.001, and 0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥54 Gy was not associated with DFS (5-yr rate, 52.9% vs. 50.9%, p = 0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-yr rate, 56.1% vs. 78.1%, p = 0.099) in IMN-involved patients.
Conclusion: Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.
Citation Format: Kim K, Jeong Y, Shin KH, Kim JH, Ahn SD, Kim SS, Suh C-O, Kim YB, Choi DH, Park W, Cha J, Chun M, Lee DS, Lee SY, Kim JH, Park HJ. Impact of regional nodal irradiation for breast cancer patients with supraclavicular and/or internal mammary lymph node involvement: A multicenter, retrospective study (KROG 16-14) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-12.
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Affiliation(s)
- K Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - Y Jeong
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - KH Shin
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - JH Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SD Ahn
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SS Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - C-O Suh
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - YB Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - DH Choi
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - W Park
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - J Cha
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - M Chun
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - DS Lee
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - SY Lee
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - JH Kim
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
| | - HJ Park
- Ewha Womans University College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Wonju Severance Christian Hospital, Wonju, Korea; Ajou University School of Medicine, Suwon, Korea; Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea; Chonbuk National University Hospital, Jeonju, Korea; Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea; Hanyang University College of Medicine, Seoul, Korea
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Tirkes T, Shah ZK, Takahashi N, Grajo JR, Chang ST, Venkatesh SK, Conwell DL, Fogel EL, Park W, Topazian M, Yadav D, Dasyam AK. Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology 2019; 290:207-215. [PMID: 30325281 PMCID: PMC6314625 DOI: 10.1148/radiol.2018181353] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [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: 06/07/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Chronic pancreatitis is an inflammatory condition of the pancreas with clinical manifestations ranging from abdominal pain, acute pancreatitis, exocrine and/or endocrine dysfunction, and pancreatic cancer. There is a need for longitudinal studies in well-phenotyped patients to ascertain the utility of cross-sectional imaging findings of chronic pancreatitis for diagnosis and assessment of disease severity. CT and MR cholangiopancreatography are the most common cross-sectional imaging studies performed for the evaluation of chronic pancreatitis. Currently, there are no universal reporting standards for chronic pancreatitis. Several features of chronic pancreatitis are applied clinically, such as calcifications, parenchymal T1 signal changes, focal or diffuse gland atrophy, or irregular contour of the gland. Such findings have not been incorporated into standardized diagnostic criteria. There is also lack of consensus on quantification of disease severity in chronic pancreatitis, other than by using ductal features alone as described in the Cambridge classification. The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was established by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute in 2015 to undertake collaborative studies on chronic pancreatitis, diabetes mellitus, and pancreatic adenocarcinoma. CPDPC investigators from the Adult Chronic Pancreatitis Working Group were tasked with development of a new consensus approach to reporting features of chronic pancreatitis aimed to standardize diagnosis and assessment of disease severity for clinical trials. This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Megibow in this issue.
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Affiliation(s)
- Temel Tirkes
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Zarine K. Shah
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Naoki Takahashi
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Joseph R. Grajo
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Stephanie T. Chang
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Darwin L. Conwell
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Evan L. Fogel
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Walter Park
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Mark Topazian
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Dhiraj Yadav
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Anil K. Dasyam
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - For the Consortium for the Study of Chronic Pancreatitis, Diabetes, and
Pancreatic Cancer
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
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Park W, Srikanth K, Lim D, Park M, Hur T, Kemp S, Dessie T, Kim MS, Lee SR, te Pas MFW, Kim JM, Park JE. Comparative transcriptome analysis of Ethiopian indigenous chickens from low and high altitudes under heat stress condition reveals differential immune response. Anim Genet 2018; 50:42-53. [DOI: 10.1111/age.12740] [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] [Accepted: 09/16/2018] [Indexed: 01/22/2023]
Affiliation(s)
- W. Park
- Animal Genomics and Bioinformatics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
| | - K. Srikanth
- Animal Genomics and Bioinformatics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
| | - D. Lim
- Animal Genomics and Bioinformatics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
| | - M. Park
- Animal Breeding and Genomics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
| | - T. Hur
- Animal Genomics and Bioinformatics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
| | - S. Kemp
- Animal Biosciences; International Livestock Research Institute (ILRI); P.O. Box 30709 Nairobi 00100 Kenya
| | - T. Dessie
- Animal Biosciences; International Livestock Research Institute (ILRI); P.O. Box 5689 Addis Ababa Ethiopia
| | - M. S. Kim
- Department of Animal Science; College of Agriculture and Life Sciences; Chonnam National University; Republic of Korea Gwangju 61186 Korea
| | - S.-R. Lee
- Department of Agro-biotechnology Convergence; Jeonju University; Republic of Korea 55069 Jeonju Korea
| | - M. F. W. te Pas
- Animal Breeding and Genomics; Wageningen UR Livestock Research; 6700AH Wageningen The Netherlands
| | - J.-M. Kim
- Department of Animal Science and Technology; Chung-Ang University; Anseong Gyeonggi-do 17546 Korea
| | - J.-E. Park
- Animal Genomics and Bioinformatics Division; National Institute of Animal Science, RDA; Wanju 55365 Korea
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Smith B, Cornell LD, Smith M, Cortese C, Geiger X, Alexander MP, Ryan M, Park W, Morales Alvarez MC, Schinstock C, Kremers W, Stegall M. A method to reduce variability in scoring antibody-mediated rejection in renal allografts: implications for clinical trials - a retrospective study. Transpl Int 2018; 32:173-183. [PMID: 30179275 DOI: 10.1111/tri.13340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/14/2018] [Accepted: 08/30/2018] [Indexed: 12/24/2022]
Abstract
Poor reproducibility in scoring antibody-mediated rejection (ABMR) using the Banff criteria might limit the use of histology in clinical trials. We evaluated the reproducibility of Banff scoring of 67 biopsies by six renal pathologists at three institutions. Agreement by any two pathologists was poor: 44.8-65.7% for glomerulitis, 44.8-67.2% for peritubular capillaritis, and 53.7-80.6% for chronic glomerulopathy (cg). All pathologists agreed on cg0 (n = 20) and cg3 (n = 9) cases, however, many disagreed on scores of cg1 or cg2. The range for the incidence of composite diagnoses by individual pathologists was: 16.4-22.4% for no ABMR; 17.9-47.8% for active ABMR; and 35.8-59.7% for chronic, active antibody-mediated rejection (cABMR). A "majority rules" approach was then tested in which the scores of three pathologists were used to reach an agreement. This increased consensus both for individual scores (ex. 67.2-77.6% for cg) and for composite diagnoses (ex. 74.6-86.6% cABMR). Modeling using these results showed that differences in individual scoring could affect the outcome assessment in a mock study of cABMR. We conclude that the Banff schema has high variability and a majority rules approach could be used to adjudicate differences between pathologists and reduce variability in scoring in clinical trials.
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Affiliation(s)
- Byron Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Maxwell Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Cherise Cortese
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Xochiquetzal Geiger
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Margaret Ryan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Walter Park
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | | | - Carrie Schinstock
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Walter Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA
| | - Mark Stegall
- The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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Saravia D, Agte S, Okabe N, Park W, Kwon D, Mudad R, Suzuki H, Chae Y, Oh M, Rahbari A, Lopes G. P2.01-82 Neutrophil-to-Lymphocyte Ratio Complements the Prognostic Ability of PD-L1 in Non-Small Cell Lung Cancer Treated with PD-1/PD-L1 Inhibitors. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chae Y, Park W, Saravia D, Florou V, Chang S, Wang S, Chiec L, Rahbari A, Mohindra N, Villaflor V, Park L, Lopes G. MA19.04 The Clinical Implication of Frameshift Indel Mutation Burden in Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mezquita L, Arbour K, Auclin E, Saravia D, Rizvi H, Hendriks L, Planchard D, Park W, Nadal E, Ruffinelli Rodriguez J, Ponce S, Audigier-Valette C, Marilniello A, Zalcman G, Majem M, Schiavone G, Dingemans AM, Lopes G, Hellmann M, Besse B. Derived neutrophil-to lymphocyte ratio (dNLR) change between baseline and cycle 2 is correlated with benefit during immune checkpoint inhibitors (ICI) in advanced non-small cell lung cancer (NSCLC) patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kang E, Shin D, Yun J, Park W, Park H. Verification motor and cognitive load in dual task interference. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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