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Khan MS, Cook K, Weickert MO, Davies L, Pritchard DM, Day M, Shah T, Hull D, Caplin M, Back M, Pommie C, Higgs K. PREF-NET: a patient preference and experience study of lanreotide autogel administered in the home versus hospital setting among patients with gastroenteropancreatic neuroendocrine tumours in the UK. Support Care Cancer 2024; 32:199. [PMID: 38421441 PMCID: PMC10904552 DOI: 10.1007/s00520-024-08377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE PREF-NET reported patients' experience of Somatuline® (lanreotide) Autogel® (LAN) administration at home and in hospital among patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs). METHODS PREF-NET was a multicentre, cross-sectional study of UK adults (aged ≥ 18 years) with GEP-NETs receiving a stable dose of LAN, which comprised of (1) a quantitative online survey, and (2) qualitative semi-structured interviews conducted with a subgroup of survey respondents. The primary objective was the description of overall patient preference for home versus hospital administration of LAN. Secondary objectives included describing patient-reported opinions on the experience and associated preference for each administration setting, and the impact on healthcare utilisation, societal cost, activities of daily living and health-related quality of life (HRQoL). RESULTS In the primary analysis (80 patients; mean age 63.9 years), 98.7% (95% confidence interval [CI]: 96.1-100.0) of patients preferred to receive LAN at home, compared with 1.3% (95% CI: 0.0-3.9) who preferred the hospital setting. Among participants, over half (60.3%) received their injection from a non-healthcare professional. Most patients (79.5% [95% CI: 70.5-88.4]) reported a positive effect on HRQoL after the switch from hospital to home administration. Qualitative interviews (20 patients; mean age 63.6 years) highlighted that patients preferred home administration because it improved overall convenience; saved time and costs; made them feel more comfortable and relaxed, and less stressed; and increased confidence in their ability to self-manage their treatment. CONCLUSION Almost all patients preferred to receive LAN treatment at home rather than in hospital with increased convenience and psychological benefits reported as key reasons for this preference.
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Affiliation(s)
- Mohid S Khan
- Cardiff and Vale University Health Board, Cardiff, UK.
| | - Kathryn Cook
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Martin O Weickert
- The ARDEN NET Centre, ENETS Centre of Excellence, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Louise Davies
- The ARDEN NET Centre, ENETS Centre of Excellence, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - D Mark Pritchard
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Melissa Day
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tahir Shah
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Diana Hull
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Melissa Back
- Royal Free London NHS Foundation Trust, London, UK
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Beaufrère A, Paisley S, Ba I, Laouirem S, Priori V, Cazier H, Favre L, Cauchy F, Lesurtel M, Calderaro J, Kannengiesser C, Paradis V. Differential diagnosis of small hepatocellular nodules in cirrhosis: surrogate histological criteria of TERT promoter mutations. Histopathology 2024; 84:473-481. [PMID: 37903649 DOI: 10.1111/his.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023]
Abstract
AIMS The differential diagnosis of small hepatocellular nodules in cirrhosis between dysplastic nodules and hepatocellular carcinoma (HCC) remains challenging on biopsy. As TERT promoter (pTERT) mutations may indicate the nodules already engaged in the malignant process, the aim of this study was to identify histological criteria associated with pTERT mutations by detecting these mutations by ddPCR in small formalin-fixed paraffin-embedded (FFPE) hepatocellular nodules arising in cirrhosis. METHODS AND RESULTS We built a bicentric cohort data set of 339 hepatocellular nodules < 2 cm from cirrhotic samples, divided into a test cohort of 299 resected samples and a validation cohort of 40 biopsies. Pathological review, based on the evaluation of 14 histological criteria, classified all nodules. pTERT mutations were identified by ddPCR in FFPE samples. Among the 339 nodules, ddPCR revealed pTERT mutations in 105 cases (31%), including 90 and 15 cases in the test and validation cohorts, respectively. On multivariate analysis, three histological criteria were associated with pTERT mutations in the test cohort: increased cell density (P = 0.003), stromal invasion (P = 0.036) and plate-thickening anomalies (P < 0.001). With the combination of at least two of these major criteria, the AUC for predicting pTERT mutations was 0.84 in the test cohort (sensitivity: 86%, specificity: 83%) and 0.81 in the validation cohort (sensitivity: 87%, specificity: 76%). CONCLUSIONS We identified three histological criteria as surrogate markers of pTERT mutations that may be used in routine biopsy to more clearly classify small hepatocellular nodules arising in cirrhosis.
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Affiliation(s)
- Aurélie Beaufrère
- Université Paris Cité, Paris, France
- AP-HP.Nord, Department of Pathology, FHU MOSAIC, Beaujon Hospital, Clichy, France
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Sarah Paisley
- AP-HP.Nord, Department of Pathology, FHU MOSAIC, Beaujon Hospital, Clichy, France
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Ibrahima Ba
- AP-HP.Nord, Department of Molecular Genetics, Bichat Hospital, Paris, France
| | - Samira Laouirem
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Victoria Priori
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Hélène Cazier
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Loëtitia Favre
- AP-HP, Department of Pathology, Henri Mondor Hospital, Créteil, France
| | - François Cauchy
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
| | - Mickael Lesurtel
- Université Paris Cité, Paris, France
- AP-HP.Nord, Department of HPB Surgery an d Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Julien Calderaro
- AP-HP, Department of Pathology, Henri Mondor Hospital, Créteil, France
| | | | - Valérie Paradis
- Université Paris Cité, Paris, France
- AP-HP.Nord, Department of Pathology, FHU MOSAIC, Beaujon Hospital, Clichy, France
- Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Paris, France
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Officer E, Johnson M, Blickwedel J, Reynolds A, Pearse R, Pearse J, Basu AP. Evaluation of the Training in Early Detection for Early Intervention (TEDEI) e-learning course using Kirkpatrick's method. BMC Med Educ 2023; 23:129. [PMID: 36842995 PMCID: PMC9968638 DOI: 10.1186/s12909-023-04113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Early intervention in cerebral palsy could improve motor outcome but is only possible following early identification of those affected. There is a need for training of healthcare professionals (HCPs) in early detection of atypical motor development. We developed a video-based e-learning course - Training in Early Detection for Early Intervention (TEDEI) - to address this need. We evaluated whether participation in the course improved knowledge and changed behaviour of HCPs. METHODS Participants were 332 HCPs (38% physiotherapists, 35.8% occupational therapists), predominantly UK-based (83.7%). Analysis of training effects used mixed methods and followed Kirkpatrick's model, first assessing "Reaction" through a feedback questionnaire involving Likert scale and free text responses (n = 141). "Learning" was assessed through multiple choice questions (MCQs): all 332 HCPs completed a pre-course quiz of 6 MCQs followed by the course, then a 16 item post-course quiz including the 6 pre-course questions. "Behaviour" was assessed through in-depth qualitative interviewing of 23 participants. RESULTS "Reaction": TEDEI was found to be effective, engaging and well structured. "Learning": Scores improved significantly between the pre-course and post-course quiz, median improvement 1/6 (z = 5.30, p < 0.001). HCPs also reported a perceived improvement in their knowledge, confidence and ability. "Behaviour": HCPs could see how TEDEI would improve their clinical practice through having an assessment framework, ways of working better with parents, and developing observational skills useful for tele-health assessments. CONCLUSION Our brief e-learning course on early detection for early intervention was viewed positively, improved knowledge and showed potential for positive changes in practice. Kirkpatrick's model provided a useful framework for undertaking this evaluation.
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Affiliation(s)
- Eleanor Officer
- School of Psychology, Newcastle University, Newcastle upon Tyne, England, UK
| | - Maisie Johnson
- School of Psychology, Newcastle University, Newcastle upon Tyne, England, UK
| | | | - Ashley Reynolds
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK
| | - Rachel Pearse
- North East and North Cumbria GP Training Programme, Newcastle upon Tyne, England, UK
| | - Janice Pearse
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK
- Therapy Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK
| | - Anna Purna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK.
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK.
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Arshad MF, Ogunleye O, Ross R, Debono M. Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study). Pituitary 2021; 24:768-777. [PMID: 33982222 PMCID: PMC8416856 DOI: 10.1007/s11102-021-01153-4] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. METHODS QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into-Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). RESULTS There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = - 2.5, 95% CI - 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = - 4.9, 95% CI - 10.9 to 1.2; p = 0.12; mental component score MD = - 3.0, 95% CI - 10.5 to 4.4; p = 0.44], or FSS (MD = - 0.004, 95% CI - 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = - 8.3, 95% CI - 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. CONCLUSIONS Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.
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Affiliation(s)
- Muhammad Fahad Arshad
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Oluwafunto Ogunleye
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
| | - Richard Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Miguel Debono
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Yoo C, Oh CR, Kim ST, Bae WK, Choi HJ, Oh DY, Lee MA, Ryoo BY. Systemic Treatment of Advanced Gastroenteropancreatic Neuroendocrine Tumors in Korea: Literature Review and Expert Opinion. Cancer Res Treat 2021; 53:291-300. [PMID: 33421978 PMCID: PMC8053871 DOI: 10.4143/crt.2020.1233] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine tumors (NETs) are a group of malignancies arising from neuroendocrine cells and frequently originate in the gastrointestinal tract and pancreas. Although curative resection is the main treatment for localized disease, systemic therapy is needed for relapsed or metastatic/unresectable gastroenteropancreatic NETs (GEP-NETs). Although there are several NET treatment guidelines from various countries, the geographical discrepancies between patient clinical characteristics, the regulatory approval status for therapeutic agents, and medical practices necessitate specific guidelines for Korean patients. We here provide a consensus review of the diagnosis, staging and systemic treatment of Korean GEP-NET patients. Systemic therapy options and the current Korean expert consensus on these treatments, including somatostatin analogs, targeted therapies such as everolimus and sunitinib, peptide receptor radionuclide treatments, and cytotoxic chemotherapies are addressed.
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Affiliation(s)
- Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Chung Ryul Oh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Seung-Tae Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju,
Korea
| | - Hye-Jin Choi
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Do-Youn Oh
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Myung-Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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Genc CG, Klümpen HJ, van Oijen MGH, van Eijck CHJ, Nieveen van Dijkum EJM. A Nationwide Population-Based Study on the Survival of Patients with Pancreatic Neuroendocrine Tumors in The Netherlands. World J Surg 2018; 42:490-497. [PMID: 29018912 PMCID: PMC5762791 DOI: 10.1007/s00268-017-4278-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Large population-based studies give insight into the prognosis and treatment outcomes of patients with pancreatic neuroendocrine tumors (pNETs). Therefore, we provide an overview of the treatment and related survival of pNET in the Netherlands. Methods Patients diagnosed with pNET between 2008 and 2013 from the Netherlands Cancer Registry were included. Patient, tumors and treatment characteristics were reported. Survival analyses with log-rank testing were performed to compare survival. Results In total, 611 patients were included. Median follow-up was 25.7 months, and all-cause mortality was 42%. Higher tumor grade and TNM stage were significantly associated with worse survival in both the overall and metastasized population. The effect of distant metastases on survival was more significant in lower tumor stages (T1–3 p < 0.05, T4 p = 0.074). Resection of the primary tumor was performed in 255 (42%) patients. Patients who underwent surgery had the highest 5-year survival (86%) compared to PRRT (33%), chemotherapy (21%), targeted therapy and somatostatin analogs (24%) (all p < 0.001). Patients with T1M0 tumors (n = 115) showed favorable survival after surgical resection (N = 95) compared to no therapy (N = 20, p = 0.008). Resection also improved survival significantly in patients with metastases compared to other treatments (all p > 0.05). Without surgery, PRRT showed the best survival curves in patients with distant metastases. Grade 3 tumors and surgical resection were independently associated with survival (HR 7.23 and 0.12, respectively). Conclusion Surgical resection shows favorable outcome for all pNET tumors, including indolent tumors and tumors with distant metastases. Prospective trials should be initiated to confirm these results.
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Affiliation(s)
- C G Genc
- Department of Surgery, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - H J Klümpen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M G H van Oijen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Research, Comprehensive Cancer Centers Netherlands (IKNL), Utrecht, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands.
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Woodmansee WW, Gordon MB, Molitch ME, Ioachimescu AG, Carver DW, Mirakhur B, Cox D, Salvatori R. Screening for comorbid conditions in patients enrolled in the SODA registry: a 2-year observational analysis. Endocrine 2018; 61:105-117. [PMID: 29767287 PMCID: PMC5997114 DOI: 10.1007/s12020-018-1615-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This 2-year analysis assessed frequency of comorbidities and comorbidity screening in the Somatuline® (lanreotide, LAN) Depot for Acromegaly (SODA) registry. METHODS Patient data collected included pituitary hormone deficiencies, sleep studies, echocardiograms, gallbladder sonographies, colonoscopies, and glycated hemoglobin (HbA1c) levels. Insulin-like growth factor-1 (IGF-1) and growth hormone levels in patients with (DM) and without (non-DM) diabetes mellitus were analyzed. RESULTS There were 241 patients enrolled. Pituitary hormone deficiencies were reported more frequently at enrollment in male (56.9%) vs female patients (32.0%; p < 0.001). TSH deficiency was the most common endocrine deficiency (69.8%), followed by gonadotropin deficiency (62.3%). Screening tests reported at enrollment: sleep studies in 29.9% (79.2% had sleep apnea), echocardiogram in 46.1% (46.8% abnormal), gallbladder sonography in 18.7% (17.8% had gallstones), and colonoscopy in 48.1% (35.3% had polyps). Follow-up studies were reported less frequently at 1 and 2 years. HbA1c data were reported in 30.8% and 41.2% after 1 and 2 years. HbA1c levels were similar at 1 and 2 years of LAN therapy among DM and non-DM patients with available data. Fewer DM vs non-DM patients achieved IGF-1 below upper limit of normal at Month 24 (58.3% vs 80.6%; p = 0.033). CONCLUSIONS Fewer than half of patients in SODA had screening results reported at enrollment for sleep apnea, cardiomyopathy, and colon polyps. Gallbladder imaging was reported in a minority of patients. Lower IGF-1 control rates were observed in DM vs non-DM patients at Month 24. These data suggest a need for better monitoring of comorbidities in US acromegaly patients.
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Affiliation(s)
- Whitney W Woodmansee
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Division of Endocrinology, Allegheny General Hospital, 420 E North Ave, Suite 205, Pittsburgh, PA, 15212, USA
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL, 60611, USA
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, and Department of Neurosurgery, Emory University School of Medicine, 1365 B Clifton Rd, NE, B6209, Atlanta, GA, 30322, USA
| | - Don W Carver
- Ipsen Biopharmaceuticals statistician consultant, 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Beloo Mirakhur
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - David Cox
- Medical Affairs, Ipsen Biopharmaceuticals, Inc., 106 Allen Road, Basking Ridge, NJ, 07920, USA
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes and Metabolism and Pituitary Center, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD, 21287, USA
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