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Rimmington D, Roberts R, Sawyer A, Sved-Williams A. Dissociation in mothers with borderline personality disorder: a possible mechanism for transmission of intergenerational trauma? A scoping review. Borderline Personal Disord Emot Dysregul 2024; 11:7. [PMID: 38462614 PMCID: PMC10926641 DOI: 10.1186/s40479-024-00250-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Dissociation is a feature of Borderline Personality Disorder (BPD), but rarely a focus for research, particularly in the perinatal literature. BPD partly has its aetiology in childhood and is characterised by emotional changes and difficulty with self-coherence that impacts on the processes of caregiving. METHODS A scoping review was conducted to synthesise current perspectives on the effect of dissociation in caregivers with BPD, particularly regarding the impact of caregiver dissociation on the interactional quality of relationship within parent-child dyads. Studies were included if they explicitly mentioned dissociation in the target population, or if dissociation was implied. A thematic analysis was conducted. RESULTS 20 studies were included; 10 experimental or quasi-experimental; 2 presenting case material; and 8 non-systematic review articles. 4 studies used the Dissociative Experiences Scale (DES) to measure dissociation, while 2 studies included a 'dissociative behaviour' subscale as part of an observational measure. The remaining studies did not measure dissociation but referenced directly or indirectly a concept of dissociation. CONCLUSIONS Findings suggested there was some evidence that dissociation plays a unique role in BPD caregivers' interactions with their offspring, however any findings should be interpreted with caution as the concept has been poorly operationalised and defined.
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Affiliation(s)
- David Rimmington
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia.
| | - Rachel Roberts
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Alyssa Sawyer
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Anne Sved-Williams
- School of Psychology, The University of Adelaide, North Terrace, Adelaide, SA, Australia
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, SA, Australia
- Australian National University, ACT, Canberra, SA, Australia
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Söderholm JJ, Socada JL, Ekelund J, Isometsä E. How changes in depression severity and borderline personality disorder intensity are linked - a cohort study of depressed patients with and without borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:3. [PMID: 38369499 PMCID: PMC10875744 DOI: 10.1186/s40479-024-00247-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is often complicated by comorbid major depressive episodes (MDEs), which can occur as part of major depressive disorder (MDD) or bipolar disorder (BD). Such comorbidity is related to worse outcomes in both disorders. Subsyndromal features of BPD are also common in depression. However, studies of simultaneous changes in BPD and depression severities are scarce, and their interactions are poorly understood. AIMS Studying the associations between changes in BPD and depression symptoms over the course of an MDE. METHODS In a 6-month naturalistic cohort study of MDE/BPD, MDE/MDD, and MDE/BD patients (N = 95), we measured change in BPD features between baseline and six months with the Borderline Personality Disorder Severity Index (BPDSI), an interviewer-rated instrument quantifying recent temporal frequency of BPD symptoms. We examined changes in BPD severity and their correlation with depression severity and other clinical measures and compared these across patient groups. RESULTS There were significant reductions in BPD severity, both in number of positive BPD criteria (-0.35, sd 1.38, p = 0.01672) and in BPDSI scores (-4.23, SD 6.74, p < 0.001), reflecting mainly a reduction in temporal frequency of symptoms. These were similar in all diagnostic groups. In multivariate regression models, changes in depression severity independently associated with changes in symptoms in the BDSI. This relationship was strongest in MDE/BPD patients but was not found in MDD patients without BPD. CONCLUSIONS In the six-month follow-up, BPD features in MDE patients alleviated mainly by decreasing temporal symptom frequency and intensity. In BPD patients with comorbid MDE, changes in both conditions are strongly correlated.
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Affiliation(s)
- John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jesper Ekelund
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of Psychiatry, University of Helsinki, P.O. Box 22, Helsinki, FI-00014, Finland.
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McGrath JL, Reynolds MS. Recognizing and Responding to Patients with Personality Disorders. Emerg Med Clin North Am 2024; 42:125-134. [PMID: 37977744 DOI: 10.1016/j.emc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Caring for patients with personality disorders and traits presents unique challenges for physicians and other providers. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, recognizes 10 personality disorders, which are organized into 3 clusters (A, B, and C) based on shared diagnostic features. Personality disorders or traits create difficulty in clinical and interpersonal interactions, promoting missed diagnosis or underdiagnosis, nonadherence to medical recommendations, or other dangerous outcomes. It is important to recognize patients with potential personality disorders and understand strategies to achieve optimal patient interactions and best possible medical outcomes.
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Affiliation(s)
- Jillian L McGrath
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 750 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA.
| | - Maegan S Reynolds
- Department of Emergency Medicine and Pediatrics, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital Division of Emergency Medicine, Columbus, OH, USA; Department of Emergency Medicine, 750 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA
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Wolf J, Reinhard MA, Goerigk S, Barton BB, Burkhardt G, Tang J, Eder J, Amann BL, Bertsch K, Jobst A, Musil R, Padberg F. Suicidal behaviors and adverse childhood experiences: A cross-diagnostic study in persistent depressive disorder and borderline personality disorder. Psychiatry Res 2023; 330:115562. [PMID: 37918208 DOI: 10.1016/j.psychres.2023.115562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Adverse childhood experiences (ACE) constitute a known risk factor for suicidality. There is a research gap regarding differential patterns of associations between variants of suicidal ideations and behaviors (SIB) and characteristics of ACE in severe mental disorders. This cross-diagnostic study investigates whether SIB are related to ACE subtypes in two high-risk conditions, i.e., persistent depressive disorder (PDD) and borderline personality disorder (BPD). Inpatients with PDD (n = 117; age 40.2 years ± 12.3) and BPD (n = 74; age 26.2 ± 7.9) were assessed with the Columbia-Suicide Severity Rating Scale for suicidal ideations (SI), suicidal behaviors (SB) and actual suicide attempts (SA); ACE were recorded with the Childhood Trauma Questionnaire. In PDD, SI and SA were associated with childhood physical abuse (ORs 7.2 and 2.3, respectively). In BPD, SA were associated with severe experiences of physical abuse (OR 6.5). Weaker yet significant associations were found for childhood emotional abuse in PDD with SB (including SA), and in BPD with SA. Recall of childhood physical abuse may be clinically relevant information for identifying particular risks of SIB. Future studies should investigate these differential patterns in more depth and in terms of causality.
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Affiliation(s)
- Johannes Wolf
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany.
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany; Charlotte Fresenius Hochschule, Munich, Germany
| | - Barbara B Barton
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Jeni Tang
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Julia Eder
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Benedikt L Amann
- Centro Fórum Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar Medical Research Institute (IMIM), Parc de Salut Mar, Barcelona, Spain; Pompeu Fabra University Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Jobst
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
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Sakai S, Kutsuna T, Kono K, Kinoshita T, Mashima N, Takao M. Femoral head translation in borderline and definite dysplastic hips during weight-bearing: 2D/3D image registration analysis. J Exp Orthop 2023; 10:126. [PMID: 38019419 PMCID: PMC10686934 DOI: 10.1186/s40634-023-00707-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The aims of this study were to 1) assess femoral head translation during weight-bearing in symptomatic developmental dysplasia of the hip (DDH) and 2) compare it between borderline DDH and definite DDH. METHODS The study included four individuals with borderline DDH and nine with definite DDH, scheduled for periacetabular osteotomy. Anteroposterior X-ray images of the hip joint were obtained in the standing position, and computed tomography images of the pelvis were obtained in the supine position. Femoral head translation from the supine to a standing position was measured using 2D/3D X-ray image registration. RESULTS From a supine to a standing position, the femoral head translated 0.3 mm laterally, 0.5 mm anteriorly, and 0.5 mm superiorly on average. The mean femoral head translation in 3D between the supine and standing positions was 1.5 mm. The 3D femoral head translation in the borderline DDH group was significantly greater than that in the definite DDH group. In the definite DDH group, there was a significant correlation between the center edge (CE) angle and 3D femoral head translation (ρ = -0.78, P = 0.012). CONCLUSIONS Symptomatic DDH showed femoral head translation in the anterior, lateral, and superior directions during weight-bearing. In definite DDH, the amount of femoral head translation was negatively correlated with the CE angle. The amount of 3D translation in patients with borderline DDH was larger than that in definite DDH. Dynamic joint instability during weight-bearing was observed in borderline DDH as well as definite DDH. Treatment to enhance joint stability during weight-bearing is important in both cases.
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Affiliation(s)
- Shinichiro Sakai
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan
| | - Tatsuhiko Kutsuna
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan
| | - Kohei Kono
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan
| | - Tomofumi Kinoshita
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan
| | - Masaki Takao
- Department of Bone and Joint Surgery, Graduate School of Medicine, Shitsukawa, Ehime University, Toon City, Ehime 791-0295, Japan.
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Langerbeck M, Baggio T, Messina I, Bhat S, Grecucci A. Borderline shades: Morphometric features predict borderline personality traits but not histrionic traits. Neuroimage Clin 2023; 40:103530. [PMID: 37879232 PMCID: PMC10618757 DOI: 10.1016/j.nicl.2023.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Borderline personality disorder (BPD) is one of the most diagnosed disorders in clinical settings. Besides the fully diagnosed disorder, borderline personality traits (BPT) are quite common in the general population. Prior studies have investigated the neural correlates of BPD but not of BPT. This paper investigates the neural correlates of BPT in a subclinical population using a supervised machine learning method known as Kernel Ridge Regression (KRR) to build predictive models. Additionally, we want to determine whether the same brain areas involved in BPD are also involved in subclinical BPT. Recent attempts to characterize the specific role of resting state-derived macro networks in BPD have highlighted the role of the default mode network. However, it is not known if this extends to the subclinical population. Finally, we wanted to test the hypothesis that the same circuitry that predicts BPT can also predict histrionic personality traits. Histrionic personality is sometimes considered a milder form of BPD, and making a differential diagnosis between the two may be difficult. For the first time KRR was applied to structural images of 135 individuals to predict BPT, based on the whole brain, on a circuit previously found to correctly classify BPD, and on the five macro-networks. At a whole brain level, results show that frontal and parietal regions, as well as the Heschl's area, the thalamus, the cingulum, and the insula, are able to predict borderline traits. BPT predictions increase when considering only the regions limited to the brain circuit derived from a study on BPD, confirming a certain overlap in brain structure between subclinical and clinical samples. Of all the five macro networks, only the DMN successfully predicts BPD, confirming previous observations on its role in the BPD. Histrionic traits could not be predicted by the BPT circuit. The results have implications for the diagnosis of BPD and a dimensional model of personality.
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Affiliation(s)
- Miriam Langerbeck
- Faculty of Psychology and Neuroscience (FPN), Maastricht University, Netherlands
| | - Teresa Baggio
- Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, Italy.
| | - Irene Messina
- Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, Italy; Universitas Mercatorum, Rome, Italy.
| | - Salil Bhat
- Department of Cognitive Neuroscience, Faculty of Psychology and Cognitive Neuroscience (FPN), Maastricht University, Netherlands.
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Sciences (DiPSCo), University of Trento, Italy; Centre for Medical Sciences (CISMed), University of Trento, Italy.
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Komasi S, Chamandoost Z, Vaysi A, Amirian M, Rezaeean H, Hopwood CJ. Validation of the hyperbolic temperament questionnaire in Iran. BMC Psychol 2023; 11:307. [PMID: 37798773 PMCID: PMC10557250 DOI: 10.1186/s40359-023-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Because of the importance of the cross-cultural study of hyperbolic temperament in increasing knowledge related to borderline personality disorder (BPD), the present study was conducted to test the reliability, construct, criterion, and discriminant validity of the Hyperbolic Temperament Questionnaire (HTQ) in three Iranian samples. METHODS Using a cross-sectional design, the HTQ 11-item version translated into Farsi was provided to three selected samples (total N = 558, 72% female, 18 to 77 years old with an average of 30.2 and a standard deviation of 10.3). The samples included non-personality disorder samples (n = 194), samples with BPD symptoms (n = 104), and samples with other personality disorder symptoms (n = 260). Data were collected using multiple validating measurements. Factor analysis was used to verify that the HTQ is unidimensional and correlations and regression models were used to examine its associations with other constructs. RESULTS Factor analysis confirmed the single-factor structure of the HTQ in two non-personality disorder and BPD samples. The internal consistency of all items and the total scale were acceptable across the samples (α = 0.87 to 0.91). Positive correlations with maladaptive constructs such as negative affectivity and interpersonal sensitivity and negative correlations with adaptive constructs supported the criterion validity of HTQ. The HTQ was specifically related to borderline symptoms, even after controlling for similar constructs such as depression. CONCLUSION The 11-item version of HTQ has acceptable reliability and validity in Iranian samples. Using this short tool for rapid screening of cases with BPD before common procedures such as clinical interviews helps to save diagnostic time and costs.
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Affiliation(s)
- Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran.
| | - Zahra Chamandoost
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Anis Vaysi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Mohadese Amirian
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Hadis Rezaeean
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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Lam NM, Noël JC, d'Haene N, Salmon I, Vandermeersch B, Catteau X. Borderline phyllodes tumour of the breast with eosinophilic inclusion bodies: Case report and molecular sequencing. Int J Surg Case Rep 2023; 111:108776. [PMID: 37699283 PMCID: PMC10498175 DOI: 10.1016/j.ijscr.2023.108776] [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: 07/10/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The presence of eosinophilic inclusion bodies in the breast is very rare and fewer than 20 cases were described in the literature. Herein we report the first case of borderline phyllodes tumour associated with this kind of cells. To the best of our knowledge, this is also the first time that a molecular sequencing is made targeting the stroma cells with inclusion bodies. CASE PRESENTATION A 33-yr-old woman presented a large mass in the right breast. Imaging techniques by mammogram and ultrasonographic examination were performed. After multidisciplinary approach, a breast conserving surgery has been decided. Microscopic analysis, immunohistochemical stains and molecular tests were performed on the lesion. The proposed diagnosis is borderline phyllodes tumour with eosinophilic inclusion bodies. CLINICAL DISCUSSION Inclusion bodies are typically found in the infantile digital fibromatosis. Finding them in extradigital fibromatosis is rare. Their signification is still unclear. Some studies suggest a disturbance in the metabolism of proliferating myofibroblasts. CONCLUSION The presence of inclusion bodies in breast tumour do not seem to have a prognosis impact. It might be interesting to perform others molecular tests on lesions with eosinophilic inclusion bodies to discover potential mutations.
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Affiliation(s)
- Ngoc My Lam
- Department of Pathology, CurePath (Chirec Institute-Brussels, CHU Tivoli-La Louviere), Rue de Borfilet 12A, 6040 Charleroi, Belgium.
| | - Jean-Christophe Noël
- Department of Pathology, Brussels University Hospital (HUB), Rue Meylemeersch 90, 1070 Anderlecht, Belgium
| | - Nicky d'Haene
- Department of Pathology, Brussels University Hospital (HUB), Rue Meylemeersch 90, 1070 Anderlecht, Belgium
| | - Isabelle Salmon
- Department of Pathology, Brussels University Hospital (HUB), Rue Meylemeersch 90, 1070 Anderlecht, Belgium
| | - Bruno Vandermeersch
- Department of Gynecology, Ste-Anne St-Rémy Clinic, Bd Jules Graindor 66, 1070 Anderlecht, Belgium
| | - Xavier Catteau
- Department of Pathology, CurePath (Chirec Institute-Brussels, CHU Tivoli-La Louviere), Rue de Borfilet 12A, 6040 Charleroi, Belgium
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Tepedino M, Esposito R, Potrubacz MI, Xhanari D, Ciavarella D. Evaluation of the relationship between incisor torque and profile aesthetics in patients having orthodontic extractions compared to non-extractions. Clin Oral Investig 2023; 27:5233-5248. [PMID: 37500932 PMCID: PMC10492872 DOI: 10.1007/s00784-023-05143-7] [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: 06/22/2022] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the relationship between soft tissues aesthetics and incisor torque, as well as the effect of crowding, anchorage, and extraction pattern, in adult patients treated without extraction or with two or four extractions. MATERIALS AND METHODS Seventy-seven subjects with permanent dentition were selected retrospectively. Among these, 24 patients were treated with four extractions, 24 with two extractions and 29 without extractions. Lateral cephalograms and photographies taken before (T0) and after (T1) treatment were retrieved. The amount of crowding and the type of anchorage were recorded, and a cephalometric analysis was performed. A one-way ANOVA was used to compare the variables within and between groups. Linear regressions were performed to evaluate the effect of different predictors on soft tissues variables at T1. RESULTS The statistical analysis showed no differences within and between groups for soft tissue aesthetics. A significant reduction of the angle obtained from the intersection of Frankfurt plane and mandibular plane was observed in the four-extractions group, and a significant proclination of the lower incisors was observed in the two-extraction group. Linear regressions revealed that the change in soft tissue profile aesthetics was affected by the type of anchorage and the two-extractions pattern. CONCLUSIONS Similar soft tissue aesthetics were observed after treatment in the three groups, despite the presence of some skeletal and dental differences. CLINICAL RELEVANCE A well-controlled incisor torque helps to preserve soft tissues aesthetics. The type of anchorage could influence soft tissues.
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Affiliation(s)
- Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Maciej Iancu Potrubacz
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Doniano Xhanari
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Stanghellini G. Homo dissipans: Excess and Expenditure as Keys for Understanding the Borderline Condition? Psychopathology 2023; 56:478-491. [PMID: 36889295 DOI: 10.1159/000529130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
This paper sheds light on some aspects of what contemporary clinical theory calls "borderline" condition providing a description of a key figure of late-modern culture that I will call Homo dissipans (from Latin dissipatio, -onis = scattering, dispersion). Homo dissipans is the opposite of Homo œconomicus, the form that "narcissism" takes on in contemporary "achievement society," solely concerned with rational action aimed to utility and production. In order to define Homo dissipans, I follow French philosopher, anthropologist, and novelist Georges Bataille's descriptions of two core phenomena: "excess" and "expenditure." The former can be defined as a surplus of energy that according to Bataille characterizes human existence, animated by a general movement of exudation and dilapidation and an inexhaustible drive to "pour out" of oneself, especially outside the limits of composure and reasonableness. The latter is an ethical attitude which gives its approval to excess and to its metamorphic and destructive power. The Homo dissipans' credo is to profitlessly dissipate the surplus of energy, escape into a world of pure intensities in which all forms - including identity - dissolve and surrender themselves to transformation. I argue that Bataille's ideas about "dissipation" can help us reconsider two features attributed to borderline personality disorder which have been extensively described and sometimes stigmatized - "identity diffusion" and "stable instability" - and to better recognize, understand, and make sense of their phenomenology in the clinical context.
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Affiliation(s)
- Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Centro de Estudios de Fenomenologìa y Psiquiatrìa, 'Diego Portales' University, Santiago, Chile
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Hartley S, Baker C, Birtwhistle M, Burgess JL, Chatburn E, Cobbaert L, Howley M, Huggett C, MacKenzie-Nash C, Newton A, Parry S, Smith J, Taylor CDJ, Taylor PJ, Timoclea R. Commentary: Bringing together lived experience, clinical and research expertise - a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?). Child Adolesc Ment Health 2022; 27:246-249. [PMID: 35869030 DOI: 10.1111/camh.12586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. METHOD We bring together lived experience, clinical and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. RESULTS We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. CONCLUSIONS We ask readers to consider these concerns, perspectives and ideas.
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Affiliation(s)
- Samantha Hartley
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Bradford District Care NHS Foundation Trust, Shipley, UK
| | | | | | - Jennifer L Burgess
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Charlotte Huggett
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Alice Newton
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Parry
- Manchester Metropolitan University, Manchester, UK
| | | | - Christopher D J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Pennine Care NHS Foundation Trust, Ashton under Lyne, UK
| | - Peter James Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Li D, Kiryu S, Wang F. Computed Tomography and Clinical Analysis of Ovarian Mucinous Tumors in Adolescent Patients. J Pediatr Adolesc Gynecol 2022; 35:346-352. [PMID: 34728347 DOI: 10.1016/j.jpag.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To investigate the clinical and computed tomography features of ovarian mucinous tumors in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of clinical and preoperative computed tomography (CT) data was performed in 59 patients who were 20 years or younger with ovarian mucinous tumors confirmed by histopathology. Patients' age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded. INTERVENTIONS None. MAIN OUTCOME MEASURES Identification of the clinical and CT features of ovarian mucinous tumors in pediatric and adolescent patients. RESULTS There were 41 mucinous cystadenomas in 39 cases, 12 borderline mucinous cystadenomas in 11 cases, and 9 mucinous cystadenocarcinomas in 9 patients. A total of 55 tumors were multilocular (55/62, 88.7%), including fewer than 10 loculations in 23 tumors, 10-20 loculations in 17 tumors, and over 20 loculations in 15 tumors. Eleven borderline mucinous cystadenomas were multilocular (11/12, 91.7%), with over 10 loculations in 7 tumors (7/12, 58.3%). Twelve tumors appeared as multilocular cystic-solid (12/62, 19.4%), and a case of mucinous cystadenocarcinoma was predominantly solid (1/62, 1.6%). Seventeen tumors showed honeycomb sign and stained glass appearance. Six mural nodules, with sizes ranging from 1.1 to 3.5 cm (average: 2.8 cm), were found in borderline mucinous cystadenoma and mucinous cystadenocarcinoma. CONCLUSIONS The CT findings of ovarian mucinous tumors in children are characteristic. The preoperative CT is helpful in making differential diagnoses.
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Affiliation(s)
- Dumin Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Shigeru Kiryu
- Department of Radiology, Narita Hospital, International University of Health and Welfare, Narita City, Chiba, Japan
| | - Fang Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
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Euler S, Pape E, Matthes O. [ Borderline Personality Disorder in the Somatic Hospital Setting]. Praxis (Bern 1994) 2022; 110:76-84. [PMID: 35105215 DOI: 10.1024/1661-8157/a003807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Borderline Personality Disorder in the Somatic Hospital Setting Abstract. The Borderline Personality Disorder is a common mental illness characterized by emotional instability, interactional difficulties, an unstable sense of self and impulsive behaviour which is often self-destructive. Since these problems frequently occur in the doctor-patient relationship, patients might be regarded as "difficult" or even manipulative. This may lead to stigmatization and medical undertreatment when due to common mental and somatic comorbidities the condition requires thorough high-standard medical care. Whereas the core symptoms of BPD are well treatable by specific evidence-based psychotherapy, pharmacological interventions are less effective and should be restricted to crisis management. Through a better understanding of the disorder, proactive communication with all involved care providers and a collaborative doctor-patient relationship providing support and boundaries simultaneously the quality of medical care can be improved with long-lasting effects.
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Affiliation(s)
- Sebastian Euler
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
| | - Eva Pape
- Psychiatrische Universitätsklinik Zürich, Konsiliarpsychiatrie Spital Limmattal, Schlieren
| | - Oliver Matthes
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
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Andermann M, Izurieta Hidalgo NA, Rupp A, Schmahl C, Herpertz SC, Bertsch K. Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: are there differences between men and women? Eur Arch Psychiatry Clin Neurosci 2022; 272:1583-1594. [PMID: 35661904 PMCID: PMC9653371 DOI: 10.1007/s00406-022-01434-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
Emotional dysregulation is a core feature of borderline personality disorder (BPD); it is, for example, known to influence one's ability to read other people's facial expressions. We investigated behavioral and neurophysiological foundations of emotional face processing in individuals with BPD and in healthy controls, taking participants' sex into account. 62 individuals with BPD (25 men, 37 women) and 49 healthy controls (20 men, 29 women) completed an emotion classification task with faces depicting blends of angry and happy expressions while the electroencephalogram was recorded. The cortical activity (late positive potential, P3/LPP) was evaluated using source modeling. Compared to healthy controls, individuals with BPD responded slower to happy but not to angry faces; further, they showed more anger ratings in happy but not in angry faces, especially in those with high ambiguity. Men had lower anger ratings than women and responded slower to angry but not happy faces. The P3/LPP was larger in healthy controls than in individuals with BPD, and larger in women than in men; moreover, women but not men produced enlarged P3/LPP responses to angry vs. happy faces. Sex did not interact with behavioral or P3/LPP-related differences between healthy controls and individuals with BPD. Together, BPD-related alterations in behavioral and P3/LPP correlates of emotional face processing exist in both men and women, supposedly without sex-related interactions. Results point to a general 'negativity bias' in women. Source modeling is well suited to investigate effects of participant and stimulus characteristics on the P3/LPP generators.
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Affiliation(s)
- Martin Andermann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Natalie A. Izurieta Hidalgo
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany ,School of Medicine, Universidad San Francisco de Quito, Quito, Pichincha Ecuador
| | - André Rupp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine C. Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Bertsch
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany. .,Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, 80802, Munich, Germany. .,NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany.
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15
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Wainsztein AE, Castro MN, Goldberg X, Camacho-Téllez V, Vulcano M, Abulafia C, Ladrón-de-Guevara S, Cardoner N, Nemeroff CB, Menchón JM, Soriano-Mas C, Villarreal MF, Guinjoan SM. Childhood adversity modulation of central autonomic network components during cognitive regulation of emotion in major depressive disorder and borderline personality disorder. Psychiatry Res Neuroimaging 2021; 318:111394. [PMID: 34673383 DOI: 10.1016/j.pscychresns.2021.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
Adverse childhood experiences (ACEs) have lifelong effects on emotional behavior and are frequent in Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD). The Central Autonomic Network (CAN), which modulates heart rate variability (HRV), comprises brain regions that mediate emotion regulation processes. However, it remains unclear the effect of ACEs on CAN dynamics and its relationship with HRV in these disorders. We studied the effects of ACEs on the brain and HRV simultaneously, during regulation of psychological stress in 19 BPD, 20 MDD and 20 healthy controls (HC). Participants underwent a cognitive reappraisal task during fMRI with simultaneous ECG acquisition. ACEs exposure was associated with increased activity of CAN and salience network components in patients with MDD compared to BPD during cognitive reappraisal. A brain-autonomic coupling was found in BPD relative to HC during emotion regulation, whereby greater activity of left anterior cingulate and medial superior frontal gyrus areas was coupled with increased HRV. Results suggest that ACEs exposure is associated with a distinct activation of the CAN and salience network regions governing responses to psychological stress in MDD compared to BPD. These alterations may constitute a distinctive neurobiological mechanism for abnormal emotion processing and regulation related to ACEs in MDD.
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Affiliation(s)
- Agustina E Wainsztein
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Mariana N Castro
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Department of Physiology, School of Medicine, UBA, Argentina
| | - Ximena Goldberg
- Mental Health Department, Neuroscience and Mental Health Research Area, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Vicente Camacho-Téllez
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Department of Psychiatry, FLENI, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Mercedes Vulcano
- Department of Psychiatry, FLENI, Buenos Aires, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina
| | - Carolina Abulafia
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Institute for Biomedical Research, School of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Soledad Ladrón-de-Guevara
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Narcís Cardoner
- Mental Health Department, Neuroscience and Mental Health Research Area, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Charles B Nemeroff
- Institute for Early Life Adversity Research, Dell Medical School, The University of Texas at Austin, United States of America
| | - José M Menchón
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Physics, UBA, Argentina; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Mirta F Villarreal
- Grupo INAAC, Fleni-CONICET Neurosciences Institute, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Department of Physics, UBA, Argentina
| | - Salvador M Guinjoan
- Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Laureate Institute for Brain Research, Tulsa, United States of America; Neurophysiology, School of Psychology, UBA, Argentina.
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16
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Mukai T, Sato Y, Shimodaira O, Furuya J, Isobe A, Omori T. Development of an optimal relief method for the palatal plate by stress analysis. BMC Oral Health 2021; 21:659. [PMID: 34930235 PMCID: PMC8686641 DOI: 10.1186/s12903-021-02014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Plate dentures cannot be easily modified after fabrication; therefore, the sites and magnitude of relief must be effectively assessed at the time of fabrication. However, a considerable variation exists in the magnitude of optimal relief and relief range, and there are no guidelines that present these clearly, leading the dentists to decide subjectively. Thus, this study aims to develop an optimal relief method to improve the stress bearing capacity of the palatal mucosa. METHODS The objective of this study, namely, the borderline, was set in steps. A three-dimensional finite element model for the pseudopalatal plate was created and used to evaluate the changes in stress distribution in the palatal mucosa due to the selective relief of stresses above the borderline. The resulting data were used to develop the optimal relief method. RESULTS In the relief model with a borderline of 0.04 MPa or higher, the distribution volume at which a high stress of 0.20 MPa or higher is generated was approximately 800% of that with the no-relief model, and in the relief model with a borderline of 0.06 MPa or higher, the respective ratio was approximately 280%. On the other hand, the relief models with a borderline of 0.14 MPa or higher were approximately 60%. In the mid-palatal relief model, the distribution volume at which a stress of 0.20 MPa or higher was generated was 180% of that in the relief model. CONCLUSIONS The supportive strength of plates can be increased by selectively applying optimal relief rather than standard relief, allowing for easier and more effective plate-denture treatment.
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Affiliation(s)
- Tomoko Mukai
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan.
| | - Yuji Sato
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan
| | - Osamu Shimodaira
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan
| | - Junichi Furuya
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan
| | - Akio Isobe
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan
| | - Tomoka Omori
- Department of Geriatric Dentistry, School of Dentistry, Showa University, Ota, Tokyo, 145-8515, Japan
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17
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Sanjay S, Ketul P, Mohit S, Jahnavi G, Ajay YK, Abhishek J, Shashank JP. Study of clinicopathological factors and their impact on survival in phyllodes tumour of breast at tertiary care cancer centre in India. Cancer Treat Res Commun 2021; 29:100482. [PMID: 34757273 DOI: 10.1016/j.ctarc.2021.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. AIMS Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. SETTING AND DESIGN A retrospective analysis. MATERIAL AND METHODS From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. STATISTICAL ANALYSIS Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of <0.05 was considered statistically significant. RESULTS Mitotic count and presence of heterologous component had significant effect on overall survival (OS) and disease free survival (DFS) on multivariate analysis. No effect of adjuvant radiotherapy and the type of surgery (breast conservation surgery v/s mastectomy) was found on survival (OS, DFS). CONCLUSION Surgery with adequate margins should be the treatment of choice for tumours with borderline and malignant histological type Histological features like high mitotic count and stromal overgrowth are known prognostic factors, however, heterologous component is also an important prognostic factor and should be studied in large randomized trials. Role of adjuvant radiotherapy remains controversial.
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Affiliation(s)
- Singh Sanjay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Puj Ketul
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Sharma Mohit
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Gandhi Jahnavi
- Department of Pathology, Gujarat Cancer & Research Institute Ahmedabad, Gujarat 380016, India.
| | - Yadav Kumar Ajay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Jain Abhishek
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - J Pandya Shashank
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
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Sedlinská T, Mühle C, Richter-Schmidinger T, Weinland C, Kornhuber J, Lenz B. Male depression syndrome is characterized by pronounced Cluster B personality traits. J Affect Disord 2021; 292:725-32. [PMID: 34161891 DOI: 10.1016/j.jad.2021.05.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/05/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Male depression syndrome (Male-DS) refers to alternative depression symptoms related to the male sex, such as externalizing behaviors, emotional suppression, substance misuse, and risk-seeking. Although these symptoms contribute to gender bias in the diagnosis of depression, Male-DS can be found in both sexes. In this cross-sectional study, we analyzed associations between Male-DS and clinical personality accentuations. METHODS We compared clinical personality accentuations between 78 depressed patients with high Male-DS scores (46% women; mean age ± standard error of the mean: 36.5 ± 1.6 years) and 76 depressed patients with low Male-DS scores (43% women; age 44.8 ± 1.7 years). We also explored differences between the two patient groups and 176 healthy controls (51% women; age 37.2 ± 1.0 years). RESULTS Depressed patients with high Male-DS scores showed stronger borderline (partial η2 0.121), impulsive (0.112), and antisocial (0.078) personality accentuations than those with low Male-DS scores after Bonferroni adjustment and controlling for sex, depression severity, and age. Relative to healthy controls, patients with high Male-DS values scored higher in all personality dimensions except for the narcissistic dimension. Patients with low Male-DS values scored higher in all Cluster A and C dimensions and the impulsive and borderline dimensions, but their scores were lower in the narcissistic dimension. LIMITATIONS Cross-sectional design and focus on in-patients. CONCLUSIONS We found pronounced Cluster B personality in patients with high Male-DS scores versus patients with low scores. Further prospective research is needed to verify that Cluster B personality traits represent a pre-morbid risk factor for Male-DS.
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Rouffiac M, Ghirardi S, Chevalier C, Bessières I, Peignaux-Casasnovas K, Truc G, Créhange G. [Extreme hypofractionated radiation therapy for pancreatic cancer]. Cancer Radiother 2021; 25:692-698. [PMID: 34284971 DOI: 10.1016/j.canrad.2021.06.031] [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: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022]
Abstract
Pancreatic cancer has poor prognosis and a continuously growing incidence. By 2030, it should become the second cause of death by cancer worldwide and in France. The only curative treatment is surgery that is achievable in only 20% of patients at the time of initial diagnosis, with a high rate of incomplete resection. Neoadjuvant treatments using chemotherapy with or without radiotherapy are more often admitted to play an important role by selecting non-progressing cases who will benefit from surgery, by increasing the number of complete resection, and by making locally advanced and borderline tumours accessible to resection. However, the role of radiotherapy is still debated. Because of its dosimetric advantages, its short total duration, and its good tolerance with reduced volumes of irradiation, stereotactic radiotherapy has been largely studied. Compared to chemoradiotherapy, this technique could improve the therapeutic index helping to preserve the general status of patients in order to give them access to secondary surgery. It remains a promising technique still under evaluation, to be delivered ideally, as part of a clinical trial, or within an experimented team.
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Affiliation(s)
- M Rouffiac
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France.
| | - S Ghirardi
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France
| | - C Chevalier
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France
| | - I Bessières
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France
| | - K Peignaux-Casasnovas
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France
| | - G Truc
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 77980, 21079 Dijon cedex, France
| | - G Créhange
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
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Pabla S, Seager RJ, Van Roey E, Gao S, Hoefer C, Nesline MK, DePietro P, Burgher B, Andreas J, Giamo V, Wang Y, Lenzo FL, Schoenborn M, Zhang S, Klein R, Glenn ST, Conroy JM. Integration of tumor inflammation, cell proliferation, and traditional biomarkers improves prediction of immunotherapy resistance and response. Biomark Res 2021; 9:56. [PMID: 34233760 PMCID: PMC8265007 DOI: 10.1186/s40364-021-00308-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Contemporary to the rapidly evolving landscape of cancer immunotherapy is the equally changing understanding of immune tumor microenvironments (TMEs) which is crucial to the success of these therapies. Their reliance on a robust host immune response necessitates clinical grade measurements of immune TMEs at diagnosis. In this study, we describe a stable tumor immunogenic profile describing immune TMEs in multiple tumor types with ability to predict clinical benefit from immune checkpoint inhibitors (ICIs). METHODS A tumor immunogenic signature (TIGS) was derived from targeted RNA-sequencing (RNA-seq) and gene expression analysis of 1323 clinical solid tumor cases spanning 35 histologies using unsupervised analysis. TIGS correlation with ICI response and survival was assessed in a retrospective cohort of NSCLC, melanoma and RCC tumor blocks, alone and combined with TMB, PD-L1 IHC and cell proliferation biomarkers. RESULTS Unsupervised clustering of RNA-seq profiles uncovered a 161 gene signature where T cell and B cell activation, IFNg, chemokine, cytokine and interleukin pathways are over-represented. Mean expression of these genes produced three distinct TIGS score categories: strong (n = 384/1323; 29.02%), moderate (n = 354/1323; 26.76%), and weak (n = 585/1323; 44.22%). Strong TIGS tumors presented an improved ICI response rate of 37% (30/81); with highest response rate advantage occurring in NSCLC (ORR = 36.6%; 16/44; p = 0.051). Similarly, overall survival for strong TIGS tumors trended upward (median = 25 months; p = 0.19). Integrating the TIGS score categories with neoplastic influence quantified via cell proliferation showed highly proliferative and strong TIGS tumors correlate with significantly higher ICI ORR than poorly proliferative and weak TIGS tumors [14.28%; p = 0.0006]. Importantly, we noted that strong TIGS and highly [median = not achieved; p = 0.025] or moderately [median = 16.2 months; p = 0.025] proliferative tumors had significantly better survival compared to weak TIGS, highly proliferative tumors [median = 7.03 months]. Importantly, TIGS discriminates subpopulations of potential ICI responders that were considered negative for response by TMB and PD-L1. CONCLUSIONS TIGS is a comprehensive and informative measurement of immune TME that effectively characterizes host immune response to ICIs in multiple tumors. The results indicate that when combined with PD-L1, TMB and cell proliferation, TIGS provides greater context of both immune and neoplastic influences on the TME for implementation into clinical practice.
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Affiliation(s)
- Sarabjot Pabla
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - R J Seager
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Erik Van Roey
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Shuang Gao
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Carrie Hoefer
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Mary K Nesline
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Paul DePietro
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Blake Burgher
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | | | - Vincent Giamo
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Yirong Wang
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | | | | | - Shengle Zhang
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Roger Klein
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
| | - Sean T Glenn
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14206, USA
| | - Jeffrey M Conroy
- OmniSeq, Inc, 700 Ellicott Street, Buffalo, NY, 14203, USA.
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14206, USA.
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Villarreal MF, Wainsztein AE, Mercè RÁ, Goldberg X, Castro MN, Brusco LI, de Guevara SL, Bodurka J, Paulus M, Menchón JM, Soriano-Mas C, Guinjoan SM. Distinct Neural Processing of Acute Stress in Major Depression and Borderline Personality Disorder. J Affect Disord 2021; 286:123-133. [PMID: 33721739 DOI: 10.1016/j.jad.2021.02.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and borderline personality disorder (BPD) are highly prevalent and often comorbid psychiatric conditions, with abnormal processing of negative affect resulting from psychological stress. Characteristics of central processing of autonomic response to stress in each disorder are not clearly settled. METHODS We obtained whole brain 3T fMRI with concurrent skin conductance, respiration rate, and heart rate variability measures in a cohort of MDD (N=19), BPD (N=19) patients, and healthy (N=20) individuals. Experiments were conducted in resting conditions, during a control mental arithmetic task, during highly stressful mental arithmetic, and in the period immediately following psychological stress. RESULTS Widespread activation of central autonomic network (CAN) structures was observed during stress compared to a control task in the group of healthy participants, whereas CAN activation during stress was less intense in both BPD and MDD. Both patient groups displayed increased sympathetic and decreased parasympathetic activation compared to healthy subjects, as previously reported. The relationship between peripheral sympathetic or parasympathetic activity and simultaneous regional brain BOLD activity was similar in BPD patients and healthy subjects, and markedly different from that seen in MDD patients. LIMITATIONS The sample size, the fact it belonged to a single study site, and low grade affective symptomatology in both patient groups limit the generalizability of the present findings. CONCLUSIONS The diverging neurobiological signature in the homeostatic response to stress in MDD and BPD possibly represents a heuristically valuable candidate biomarker to help discern MDD and BPD patients.
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Affiliation(s)
- Mirta F Villarreal
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Argentina; Departamento de Física, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Agustina E Wainsztein
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Argentina; Departamento de Física, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rocío Álvarez Mercè
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Argentina
| | - Ximena Goldberg
- Mental Health Department, Neuroscience and Mental Health Research Area, Institut d'Investigació i Innovació Parc Taulí I3PT, CIBERSAM, Sabadell, Spain
| | - Mariana N Castro
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Argentina; Department of Psychiatry and Mental Health, School of Medicine, University of Buenos Aires (UBA), Argentina; Department of Physiology, School of Medicine, UBA, Argentina
| | - Luis Ignacio Brusco
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Soledad Ladrón de Guevara
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias FLENI-CONICET, Argentina
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Oklahoma, United States of America
| | - Martin Paulus
- Laureate Institute for Brain Research, Oklahoma, United States of America
| | - José M Menchón
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Network Center for Biomedical Research on Mental Health (CIBERSAM), Carlos III Health Institute (ISCIII), Barcelona, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador M Guinjoan
- Consejo Nacional de Investigación Científica y Tecnológica (CONICET), Buenos Aires, Argentina; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Neurofisiología I, Facultad de Psicología, Universidad de Buenos Aires, Argentina; Laureate Institute for Brain Research, Oklahoma, United States of America.
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Boeckmans J, Cartuyvels R, Hilkens P, Bruckers L, Magerman K, Waumans L, Raymaekers M. Follow-up testing of borderline SARS-CoV-2 patients by rRT-PCR allows early diagnosis of COVID-19. Diagn Microbiol Infect Dis 2021; 100:115350. [PMID: 33689985 PMCID: PMC7891066 DOI: 10.1016/j.diagmicrobio.2021.115350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 01/05/2023]
Abstract
Detection of SARS-CoV-2 RNA in nasopharyngeal samples using the real-time reverse transcription polymerase chain reaction (rRT-PCR) is the gold standard for diagnosing COVID-19. Determination of SARS-CoV-2 RNA by rRT-PCR sometimes results in an inconclusive test result due to a high cycle threshold-value. We retrospectively analyzed 30,851 SARS-CoV-2 rRT-PCR test results. Borderline positivity was considered as the presence of ≤25 viral copies per milliliter, while no amplification was considered as a negative test result. Of all test results, 204 were answered as borderline, of which 107 were accompanied by a follow-up test within 96 hours. Of the 107 follow-up samples, 10 (9.35%) were found positive for SARS-CoV-2. COVID-19 symptoms were not predictive for testing positive in the follow-up test. The positive SARS-CoV-2 samples in the follow-up group represented 0.92% of all positive test results, highlighting the need for retesting and increased hygienic measures for borderline SARS-CoV-2 patients [NCT04636294].
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Affiliation(s)
| | | | - Petra Hilkens
- Clinical Laboratory, Jessa Hospital, Hasselt, Belgium
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Koen Magerman
- Clinical Laboratory, Jessa Hospital, Hasselt, Belgium; Immunity and Infectious Diseases, Hasselt University, Hasselt, Belgium
| | - Luc Waumans
- Clinical Laboratory, Jessa Hospital, Hasselt, Belgium
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Abstract
Acetabular dysplasia represents a structural pathomorphology associated with hip pain, instability, and osteoarthritis. The wide spectrum of dysplasia anatomically refers to a 3-dimensional volumetric- and surface area-based insufficiency in coverage and is classified based on the magnitude and location of undercoverage. Borderline dysplasia has been variably defined and leads to management challenges. In symptomatic dysplasia, treatment addresses coverage with periacetabular osteotomy. Concomitant simultaneous or staged hip arthroscopy has significant advantages to address intra-articular pathology. In nonarthritic individuals, there is evidence PAO alters the natural history of dysplasia and decreases the risk of hip arthritis and total hip arthroplasty.
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Affiliation(s)
- Joshua D Harris
- The Houston Methodist Hip Preservation Program, Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX 77030, USA; Houston Methodist Academic Institute; Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA; Weill Cornell Medical College, New York, NY, USA; Texas A&M University, College Station, TX, USA.
| | - Brian D Lewis
- Department of Orthopedics, Duke University Medical Center, Box 3389, Durham, NC 27710, USA
| | - Kwan J Park
- The Houston Methodist Hip Preservation Program, Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX 77030, USA
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Bouri S, Simon P, D'Haene N, Catteau X, Noël JC. Invasive ductal carcinoma arising in borderline phyllode tumor: A potential role of PIK3CA mutation. Int J Surg Case Rep 2020; 77:701-703. [PMID: 33395878 PMCID: PMC7711183 DOI: 10.1016/j.ijscr.2020.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
Invasive carcinomatous lesions associated with borderline phyllodes tumors are extremely rare. Molecular biological mechanisms associated with this kind of lesions are unknown. PIK3CA gene mutation could be implicated in the development of these lesions.
Introduction Carcinomatous lesions associated with phyllodes tumors are extremely rare and are found in less than 1% of all cases. To date, the molecular biological mechanisms associated with this carcinomatous transformation remain unknown. Presentation of case We present here the case of a 61-year-old patient with invasive ductal of no special type (NST) carcinoma originating in a borderline phyllode tumor with mutation in the PIK3CA gene. Discussion To the best of our knowledge, this mutation has never been described in this type of association. Conclusion Based on these data, we can better understand the ethiopathogenic molecular mechanisms in this type of lesion. Consequently, they could also in the future give rise to new therapeutic alternatives.
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Affiliation(s)
- Sarah Bouri
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Centre Universitaire Inter Regional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), Jumet, Belgium.
| | - Philippe Simon
- Department of Gynecology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicky D'Haene
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Centre Universitaire Inter Regional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), Jumet, Belgium
| | - Xavier Catteau
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Centre Universitaire Inter Regional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), Jumet, Belgium
| | - Jean-Christophe Noël
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Centre Universitaire Inter Regional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), Jumet, Belgium
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Sangnier E, Ouldamer L, Bendifallah S, Huchon C, Collinet P, Bricou A, Mimoun C, Lecointre L, Graesslin O, Raimond E. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2020; 50:101961. [PMID: 33127559 DOI: 10.1016/j.jogoh.2020.101961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Borderline ovarian tumors (BOTs) although rare, have shown an increase in the incidence worldwide. Although the survival rate is high, the recurrence rate is estimated to be between 5% and 34%. The objective of this study was to identify risk factors for recurrence of BOTs. METHODS This retrospective multicenter study included 493 patients treated surgically for BOT between January 2001 and December 2018. RESULTS Thirty-seven patients showed recurrence (group R, 7.5%), while 456 did not (group NR, 92.5%). With an average follow-up of 30.5 months (1-276), the overall recurrence rate was 7.5%. Recurrence rates for the BOT and invasive types were 5.7% (n = 28) and 1.4% (n = 7), respectively. The mean time to recurrence was 44.1 (3-251) months. Univariate analysis showed that age at diagnosis, type of surgical procedure, histological type, and FIGO stage were factors influencing recurrence. Multivariate analysis showed that the risk factors for recurrence of BOT were conservative treatment (OR = 7 [95% CI 3.01-16.23]; p < 0.05) and advanced FIGO stage (OR = 5.86 [95% CI 2.21-15.5]; p < 0.05). DISCUSSION To the best of our knowledge, this multicenter study was one of the largest studies on the risk factors for BOT recurrence. Conservative treatment and advanced FIGO stage were identified as risk factors for BOT recurrence. These results reinforce the need for restaging of patients who did not have an optimal initial surgical staging so as not to avoid missing a tumor in the advanced stage. Referral to a surgical oncology center is suggested to optimize overall patient management.
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Affiliation(s)
- E Sangnier
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Tours, Bretonneau Hospital, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - S Bendifallah
- Department of Obstetrics and Gynaecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Huchon
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center of Poissy, Poissy, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Lille, Lille, France
| | - A Bricou
- Department of Obstetrics and Gynaecology, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Mimoun
- Department of Obstetrics and Gynaecology, Lariboisière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 7, Paris, France
| | - L Lecointre
- Department of Obstetrics and Gynaecology, University Hospital Center, Strasbourg, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France.
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Alipour S, Eskandari A. Phyllodes Tumor of the Breast in Pregnancy and Lactation. Adv Exp Med Biol 2020; 1252:137-142. [PMID: 32816274 DOI: 10.1007/978-3-030-41596-9_19] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Phyllodes tumor constitutes around 1% of all and 2.5% of fibroepithelial breast lumps. Three types including benign, borderline, and malignant tumors have been described. The benign variant is the most common, is close to fibroadenoma, but is usually larger and recurs more frequently. The rare malignant type is aggressive. Standard treatment consists of lumpectomy with appropriate margins for benign phyllodes tumor, while the borderline and malignant variants must be treated by wide resection or mastectomy. Phyllodes tumor is a rare tumor in pregnancy and lactation, and the effect of gestational alterations in hormone levels on this tumor have not been discussed in the literature, except for several case reports. In summary and alluding to our recent literature review, large size, fast growth, bilaterality, and probably malignancy are more commonly expected in gestational phyllodes tumors.
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Affiliation(s)
- Sadaf Alipour
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Ahn S, Jo E, Min SK, Min S, Ha J, Park KW, Min KB. Predictive Value of Abnormal and Borderline Ankle-Brachial Index for Coronary Re-Intervention and Mortality in Patients with Coronary Artery Disease: An Observational Cohort Study. Vasc Specialist Int 2020; 36:89-95. [PMID: 32611841 PMCID: PMC7333080 DOI: 10.5758/vsi.200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose This study aimed to investigate the abnormal and borderline ABIs for predicting coronary re-intervention and mortality in patients with coronary artery disease (CAD). Materials and Methods Data from a previous study were obtained and used to investigate the prevalence of peripheral arterial disease among Korean patients with CAD (n=285) in 2010. All patients underwent follow-up coronary angiography as scheduled (asymptomatic: 2-, 5-, and 7-month intervals) or as clinically indicated (symptomatic). Results In total, 33 patients had an abnormal ABI (ab-ABI: <1.0 or >1.4), and 252 had a normal ABI (nl-ABI: 1.0≤ABI≤1.4). The mean follow-up was 47 months. The mortality was significantly higher in the ab-ABI group than in the nl-ABI group (18.2% vs. 6.7%, P=0.0233). MACEs were significantly more common in the ab-ABI group (60.6% vs. 34.5%, P=0. 0036). Moreover, the ab-ABI group had a greater CAD progression than the nl-ABI group (48.5% vs. 31.3%, P=0.0496). The incidence of clinically indicated coronary re-intervention was significantly higher in the ab-ABI group than in the nl-ABI group (33.3% vs. 13.1%, P=0.0025). After adjusting for age, diabetes, dyslipidemia, dialysis, smoking, and obesity, the incidence of clinically indicated re-intervention was significantly higher in the ab-ABI group than in the nl-ABI group (HR, 2.80; 95% CI, 1.24 to 6.34). Conclusion Abnormal and borderline ABI significantly increased the incidence of clinically indicated coronary revascularization and all-cause mortality during a 4-year follow-up among patients with CAD. Hence, ABI could be used to stratify extremely high-risk patients with CAD who may require aggressive surveillance or treatment.
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Affiliation(s)
- Sanghyun Ahn
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - EunAh Jo
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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Burns T, Hammond ER, Cree L, Morbeck DE, Consedine NS. Do patient factors influence embryologists' decisions to freeze borderline blastocysts? J Assist Reprod Genet 2020; 37:1975-97. [PMID: 32592074 DOI: 10.1007/s10815-020-01843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Abstract
RESEARCH QUESTION To investigate whether patient factors influence the decision to freeze a blastocyst with low implantation potential. DESIGN This experimental study assessed 170 practicing embryologists from a variety of countries who were recruited via an online survey. Participants were currently practicing embryologists, who grade blastocysts as part of this role. The survey presented decision-making 'vignettes' to participants. These included specific patient information, as well as an image of an expanded blastocyst that was of borderline quality for inner cell mass and trophectoderm, for which the embryologist selected whether or not to freeze. High/low maternal age, the presence/absence of other top quality blastocysts, and the presence/absence of previously unsuccessful IVF cycles were systematically varied within the patient information in a 2 × 2 × 2 design. Participants reported how likely they would be to freeze a particular blastocyst on a scale of 1 (Extremely Unlikely) to 7 (Extremely Likely), and whether or not they would ultimately freeze each blastocyst (Yes or No). RESULTS Lower maternal age, no other high-quality blastocysts within the cohort, and multiple unsuccessful IVF cycles were associated with greater likelihood of recommending to freeze (P < .001). Furthermore, significant interactions among all three patient factors were noted. CONCLUSION This study provides evidence suggesting that when faced with an uncertain blastocyst, factors pertaining to the patient (maternal age, the presence/absence of other top quality blastocysts, and the presence/absence of previously unsuccessful IVF cycles) influence the decision to freeze.
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Calvo FA, Asencio JM, Roeder F, Krempien R, Poortmans P, Hensley FW, Krengli M. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer. Clin Transl Radiat Oncol 2020; 23:91-99. [PMID: 32529056 PMCID: PMC7280753 DOI: 10.1016/j.ctro.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 12/20/2022] Open
Abstract
Radiation dose-escalation with intraoperative electron beam radiation therapy to the posterior resection margin and/or to residual disease is feasible with limited toxicity. Preoperative therapy prolongs the interval to surgery and IOERT, allowing an improved selection of patients who are candidates for local treatment intensification. Primary systemic therapy combined with chemoradiation allows to boost with IOERT in over 70% of patients with R0 surgical tumour beds. Median survival time ranges from 19 to 35 months in electron boosted patients. Overall survival at 5 years of over 30% is reported by contemporary expert IOERT institutions.
Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT). Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging survival rates have been documented in patients treated with preoperative chemoradiation followed by radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears to prolong long-term survival within the subset of patients who remain relapse-free for>2 years (>30 months median survival; >40% survival at 3 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer.
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Affiliation(s)
- Felipe A Calvo
- Department of Oncology, Clínica Universidad de Navarra, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - Jose M Asencio
- Department of General Surgery, Hospital General Universitario Gregorio Marañón, Institute for Sanitary Research Gregorio Marañón (IiSGM), Madrid, Spain, Complutense University of Madrid, Madrid, Spain
| | - Falk Roeder
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria.,CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Krempien
- Department of Radiotherapy, Helios Hospital Berlin-Buch, Berlin, Germany
| | | | - Frank W Hensley
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Marco Krengli
- Radiotherapy Unit, Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy
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Medrano J, Garnier J, Ewald J, Marchese U, Gilabert M, Launay S, Poizat F, Giovannini M, Delpero JR, Turrini O. Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma. Pancreatology 2020; 20:223-228. [PMID: 31839458 DOI: 10.1016/j.pan.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/13/2019] [Revised: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B). METHODS From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 < 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; n = 53) groups. RESULTS The 3 groups were comparable according to patient characteristics (except for back pain (P < .01) and CA 19-9 (P < .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P < .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P < .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively. CONCLUSIONS The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.
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Affiliation(s)
- J Medrano
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - J Garnier
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - U Marchese
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - M Gilabert
- Departement of Oncology, Institut Paoli-Calmettes, Marseille, France
| | - S Launay
- Departement of Oncology, Institut Paoli-Calmettes, Marseille, France
| | - F Poizat
- Departement of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - M Giovannini
- Departement of Endoscopy, Institut Paoli-Calmettes, Marseille, France
| | - J R Delpero
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - O Turrini
- Departement of Surgery, Aix-Marseille University, Institut Paoli-Calmettes, CRCM, Marseille, France.
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Recio-Boiles A, Vondrak J, Veeravelli S, Mancuso JJ, Saboda K, Roe DJ, Riaz IB, Scott AJ, Elquza E, McBride A, Babiker HM. Analyzing outcomes of neoadjuvant and adjuvant treatment for borderline-resectable pancreatic adenocarcinoma in the perioperative period at an academic institution. Ann Pancreat Cancer 2020; 3:2. [PMID: 32313882 PMCID: PMC7170377 DOI: 10.21037/apc.2020.02.01] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only 15-20% of pancreatic ductal adenocarcinoma (PDAC) patients are upfront surgical candidates at presentation, and for this cohort of patients, the 5-year survival is a mere 20% despite adjuvant therapy. Previous data indicate that in clinical practice most of these cases are "borderline-resectable," and there is currently no mature data on perioperative treatment. METHODS We performed a retrospective electronic chart review of patients with "borderline-resectable"PDAC treated at an academic comprehensive cancer center, dividing them into groups based on surgery alone, surgery plus neoadjuvant, adjuvant, or neoadjuvant plus adjuvant perioperative treatment groups. The objectives were to determine the median overall survival (mOS), progression-free survival (PFS) and disease-free survival (DFS). Statistical analysis was performed to assess the association of demographic, tumor traits, and interventions with OS, PFS and DFS. RESULTS Only surgery followed by adjuvant therapy showed an increase in mOS [hazard ratio (HR) 0.22; 95% CI, 0.09-0.51; P<0.001), after adjustment for radiation (yes vs. no), resection margins (R0 vs. R1 or R2), and tumor location (head vs. body or tail). Patients who received adjuvant therapy after surgery had 2.1 times greater odds to be alive at 24 months after diagnosis than those who had surgery alone (P=0.015). PFS and DFS were not statistically significantly different among treatment groups after adjustment. Those whose disease was located in the head of the pancreas had a significantly improved OS (HR =0.27; 95% CI, 0.11-0.64; P=0.003), PFS (HR =0.40; 95% CI, 0.17-0.94; P=0.035), and DFS (HR =0.30; 95% CI, 0.13-0.67; P=0.004). Negative margins led to a significant improvement in PFS (HR =0.30; 95% CI, 0.16-0.57; P<0.001) and DFS (HR =0.30; 95% CI, 0.16-0.57; P<0.001). Those who received radiation had a non-significantly improved OS, PFS, and DFS (P>0.05). CONCLUSIONS Our study corroborated that patients treated with adjuvant therapy after surgical resection had an mOS benefit as reported on prior phase III clinical trials. Patients with "borderline-resectable" pancreatic cancer are encouraged to participate in a clinical trial or clinically be treated with adjuvant therapy until more mature results from the ongoing perioperative prospective study are available.
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Affiliation(s)
| | - Jessica Vondrak
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | - James J. Mancuso
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathylynn Saboda
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Denise J. Roe
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Aaron J. Scott
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Emad Elquza
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Ali McBride
- University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Hani M. Babiker
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
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Abdel Wahab C, Rousset P, Bolze PA, Thomassin-Naggara I. [ Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Imaging]. ACTA ACUST UNITED AC 2020; 48:260-276. [PMID: 32004779 DOI: 10.1016/j.gofs.2020.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the place of imaging and the performance of different imaging techniques (transvaginal ultrasound with or without Doppler, scoring, CT, MRI) to differentiate benign tumour, borderline ovarian tumour (BOT) and malignant ovarian tumor. Differentiate the histological subtypes of BOT (serous, sero-mucinous, mucinous) and prediction in imaging of the possibility of conservative treatment. METHODS The research was carried out over the last 16 years using the terms "MeSH" based on the query of the Medline® database and supplemented by the review of references contained in the meta-analyzes, systematic reviews and original articles included. RESULTS Endo-vaginal and suprapubic ultrasonography is recommended for analysis of an ovarian mass (grade A). In the case of ultrasound by a referent, subjective analysis is the recommended technique (grade A). In case of echography by a non-referent, the use of "Simple Rules" is recommended (grade A) and should be best combined with subjective analysis to rejoin the performance of a sonographer refer (grade A). In cases of undetermined ovarian lesions in endovaginal ultrasound and suprapubic ultrasound, it is recommended to perform a pelvic MRI (grade A). The MRI protocol should include T2, T1, T1 sequences with fat saturation, diffusion, injected dynamics, and after gadolinium injection (grade B). To characterize an MRI-adnexal image, it is recommended to include a risk score for malignancy (ADNEX-MR/O-RADS) (grade C) in the report and to formulate an anatomopathological hypothesis (Grade C). The predictive signs of benignity in front of a cyst with endocystic vegetations are the low number, the small size, the presence of calcifications and the absence of Doppler flow in case of size greater than 10mm in echography (LP 4) and a curve of type 1 MRI (LP4). MRI is recommended for suspicious lesions of BOT in ultrasound (grade B) or indeterminate lesions in ultrasound (grade A). There is no data to support the usefulness of CT or PET-CT for BOT. Morphological criteria in ultrasound and MRI exist to differentiate BOT from invasive tumors regardless of grade (NP 2). Pelvic MRI is recommended to characterize a tumor suggestive of ultrasound BOT (grade C). No recommendations can be made about the use of combined ultrasound, biological, and menopausal status scores for the diagnosis of BOT. The diagnostic performance of imaging to detect peritoneal implants of BOT is not known. The assessment of the invasiveness of peritoneal implants of imaging BOT has not been evaluated. The association of macroscopic signs in MRI makes it possible to differentiate the different subtypes - serous, sero-mucinous and mucinous (intestinal type) - of BOT, despite the overlap of certain presentations (LP3). The analysis of macroscopic MRI signs must be performed to differentiate the different subtypes of TFO (grade C). No recommendation can be made on imaging prediction of the possibility of conservative BOT treatment.
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Affiliation(s)
- C Abdel Wahab
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France
| | - P Rousset
- HCL, EMR 3738, service de radiologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon 1, 43, boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - P-A Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France
| | - I Thomassin-Naggara
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; ISCD, équipe médecine, Sorbonne université, université Paris 06, IUC, 75005 Paris, France.
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Thind A, Patel B, Thind K, Isherwood J, Phillips B, Dhaliwal K, Remoundos DD. Surgical margins for borderline and malignant phyllodes tumours. Ann R Coll Surg Engl 2020; 102:165-173. [PMID: 31918563 DOI: 10.1308/rcsann.2019.0140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. METHODS MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. CONCLUSION Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.
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Affiliation(s)
- A Thind
- Croydon University Hospital, Croydon Health Services NHS Trust, Thornton Heath, UK
| | - B Patel
- Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - K Thind
- King's College Hospital NHS Foundation Trust, London, UK
| | - J Isherwood
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - B Phillips
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Dhaliwal
- University of Western Ontario, London, Ontario, Canada
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Hassiotis A, Brown E, Harris J, Helm D, Munir K, Salvador-Carulla L, Bertelli M, Baghdadli A, Wieland J, Novell-Alsina R, Cid J, Vergés L, Martínez-Leal R, Mutluer T, Ismayilov F, Emerson E. Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort. BMC Psychiatry 2019; 19:387. [PMID: 31805899 PMCID: PMC6896708 DOI: 10.1186/s12888-019-2376-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/17/2019] [Accepted: 11/27/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity. METHODS We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity. RESULTS Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity. CONCLUSIONS The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.
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Affiliation(s)
- Angela Hassiotis
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
- Camden & Islington Foundation Trust, St Pancras Hospital, London, UK
| | - Emma Brown
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - James Harris
- Developmental Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Bloomberg Children’s Center, The Johns Hopkins Hospital, Baltimore, MD USA
| | - David Helm
- Institute for Community Inclusion, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Kerim Munir
- Institute for Community Inclusion, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA USA
- Developmental Medicine Center, Division of Developmental Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | | | - Marco Bertelli
- CREA, Research and Clinical Centre, San Sebastiano Foundation, Florence, Italy
| | - Amaria Baghdadli
- Child and Adolescent Psychiatry Department, Montpellier Hospital University, Montpellier, France
| | - Jannelien Wieland
- Kristal Centre for Psychiatry and Intellectual Disability, Rivierduinen, Leiden, The Netherlands
| | - Ramon Novell-Alsina
- Mental Health and Intellectual Disability Specialized Service, Catalan Health Govenment. Martí i Julià Hospital, Girona, Spain
| | - Jordi Cid
- Mental Health and Intellectual Disability Specialized Service, Catalan Health Govenment. Martí i Julià Hospital, Girona, Spain
| | - Laura Vergés
- Mental Health and Intellectual Disability Specialized Service, Catalan Health Govenment. Martí i Julià Hospital, Girona, Spain
| | - Rafael Martínez-Leal
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Tuba Mutluer
- Department of Child and Adolescent Psychiatry, Koc University Hospital, Istanbul, Turkey
| | - Fuad Ismayilov
- Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | - Eric Emerson
- Centre for Disability Research & Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Han X, Sun M, Wang M, Fan R, Chen D, Xie L, Liu A. The enhanced T 2 star weighted angiography (ESWAN) value for differentiating borderline from malignant epithelial ovarian tumors. Eur J Radiol 2019; 118:187-193. [PMID: 31439240 DOI: 10.1016/j.ejrad.2019.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the potential of ESWAN in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD Thirty-four patients with 37 lesions were enrolled, including 14 BEOTs and 23 MEOTs. The magnitude, phase, R2* and T2* maps were analyzed by two observers. The regions of interest were drawn along the boundaries of tumors on the slice with maximal solid area, according to fat suppression T2WI and T1WI. The consistency among the three measurements taken by two observers was tested by intra-class correlation coefficients. Agreement of average values measured by two observers was evaluated by Bland-Altman plots. All the data of BEOTs and MEOTs were compared using the independent-sample t test. The receiver operating characteristic curve was used to evaluate the diagnostic performance. RESULTS No statistical differences were observed in the magnitude and phase values between two tumor groups. The R2* value of BEOTs was lower than that of MEOTs (P < 0.001), whereas the T2* value of BEOTs was higher than that of MEOTs (P = 0.01). The area under the curve of R2* values was 0.894 and the corresponding cutoff value was 7.50 Hz, with the sensitivity, specificity and accuracy of 85.7%, 82.6% and 86.5%, respectively. The AUC of T2* values was 0.776 and the corresponding cutoff value was 143.73 ms with the sensitivity, specificity and accuracy of 71.4%, 82.6% and 78.4%, respectively. CONCLUSIONS R2* and T2* values can be used for quantificationally differentiating BEOTs from MEOTs and the R2* has better diagnostic performance.
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Affiliation(s)
- Xu Han
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Meiyu Sun
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Mengyao Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Rui Fan
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Dan Chen
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Lizhi Xie
- GE Healthcare, MR Research China, Beijing, China.
| | - Ailian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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Lu J, Pi S, Ma FH, Zhao SH, Li HM, Cai SL, Qiang JW. Value of normalized apparent diffusion coefficients in differentiating between borderline and malignant epithelial ovarian tumors. Eur J Radiol 2019; 118:44-50. [PMID: 31439257 DOI: 10.1016/j.ejrad.2019.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the diagnostic performance of normalized apparent diffusion coefficients (nADCs) of different references with that of ADCs at differentb factors in differentiating borderline epithelial ovarian tumors (BEOTs) from malignant epithelial ovarian tumors (MEOTs). METHOD This retrospective study included 53 BEOTs and 148 MEOTs. Conventional magnetic resonance and diffusion-weighted imaging withb factors of 800 and 1000s/mm2 were performed. ADC was measured three times at solid components of tumors, gluteus maximus muscle (GMM), iliopsoas muscle (IM) and urine and then averaged. ADCtumor, nADCs were then obtained. Differences and the diagnostic performance of ADCtumor and nADCs between BEOTs and MEOTs with different b factors were compared. RESULTS ADCtumor, nADCs regardless of b factors were significantly higher in BEOTs than MEOTs. The diagnostic performance of nADCurine regardless of b factors was significantly larger than that of nADCGMM and nADCIM. There was no significant difference in the diagnostic performance between ADCtumor and nADCurine regardless of b factors. A significantly lower ADCtumor and a larger diagnostic performance for ADCtumor was found with a b factor of 1000s/mm2 than 800 s/mm2. There were no significant differences in nADCurine of BEOTs or MEOTs or in the diagnostic performance of nADCurine with b factors between 800 and 1000s/mm2. CONCLUSIONS ADCtumor and nADCs were both capable of differentiating BEOTs from MEOTs. nADCurine was the best of all nADCs and was superior to ADCtumor because of its stable performance in differentiating BEOTs from MEOTs, regardless of b factors.
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Moradi-Asl E, Vatandoost H, Adham D, Emdadi D, Moosa-Kazemi H. Investigation on the Occurrence of Aedes Species in Borderline of Iran and Azerbaijan for Control of Arboviral Diseases. J Arthropod Borne Dis 2019; 13:191-197. [PMID: 31803780 PMCID: PMC6885136] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 05/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To investigate the diversity of the genus Aedes present in the natural areas of Ardabil Province, north-west of Iran. METHODS This cross-sectional study was carried out from Apr to Oct 2016 in North-western of Iran. Thirty-three areas of 10 cities which are border areas were selected randomly. The larvae were collected 2 times in each month during the seasonal activities of mosquitoes and the larvae were identified morphologically according to the appropriate identification keys. RESULTS Overall, 694 larvae were collected from four counties, from which only 7.2% were Aedes larvae. Three species of Aedes were identified which include Ae. caspius, Ae. vexans and Ae. flavescens. Aedes flavescens is reported from Ardabil Province for the first time. CONCLUSION Aedes species were a high density in borderline of Iran and Azerbaijan. Therefore, the north parts of Ardabil Province are a suitable habitat for Aedes species mosquitoes. Care should be taken for vector control in the case of occurrence of any arboviruses transmitted by Aedes mosquitoes.
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Affiliation(s)
- Eslam Moradi-Asl
- Department of Public Health, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Vatandoost
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Department of Environmental Chemical Pollutants and Pesticides, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: Prof Hassan Vatandoost, E-mail:
| | - Davod Adham
- Department of Public Health, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Daryosh Emdadi
- Center for Disease Control, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Moosa-Kazemi
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Bas-Esteve E, Pérez-Arguedas M, Guarda-Muratori GA, Acién M, Acién P. Endometriosis and ovarian cancer: Their association and relationship. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100053. [PMID: 31404281 DOI: 10.1016/j.eurox.2019.100053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives To study endometriosis-associated borderline or malignant ovarian epithelial tumors by analyzing their differential clinical features, as well as the histological pattern, survival and immunohistochemical data compared with those without associated endometriosis. Study design Setting: Hospital Marina Baixa and San Juan University Hospital, Alicante, Spain. This retrospective study included clinical and pathological data from 36 operated cases with endometriosis-associated ovarian epithelial tumors and 305 cases of ovarian epithelial tumors without endometriosis, including borderline and invasive tumors. We also studied hormonal receptors and p53 protein expression in 13 cases with endometriosis-associated endometrioid and clear cell tumors, and report two cases with histologically-confirmed previous endometriosis. Results Associated endometriosis was observed in 10.5% of patients with borderline or invasive ovarian epithelial tumor, 53% of those with endometrioid, and 22% with clear cell tumors. Patients with endometriosis-associated ovarian epithelial tumors were younger, had lower parity, were more frequently premenopausal, had a lower tumor stage or were borderline, and in general had better prognosis and longer survival, although they also more frequently had an associated endometrial carcinoma. Associated endometriosis and endometrioid tumors were generally estrogen-receptor positive, whereas they were negative in the clear cell tumor component. p53 protein positivity was generally observed in clear cell tumors and in associated endometriosis. Two reported cases with previous, known endometriosis were followed in their evolution to borderline endometrioid carcinoma and clear cell carcinoma, respectively. Conclusions Our results and review of the literature suggest that the association of ovarian epithelial tumors and endometriosis is a factor for good prognosis for ovarian cancer and that this association might correspond in many cases to an intermediate stage in the development of endometriosis to endometrioid, clear cell, or other invasive carcinomas.
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Jbir I, Ghalleb M, Triki A, Zemni I, Hechiche M, Ben Hassouna J, Rahal K. Tumors of low malignant potential a single institution experience. Int J Surg Case Rep 2019; 55:41-6. [PMID: 30684818 DOI: 10.1016/j.ijscr.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
The tumors of low malignant potential are an independent group of ovarian epithelial tumors. The overall survival at 5 and 10 years was respectively of 96,9% and 92,8%. After a mean follow up of 10 years, we report 7 cases of locoregional relapse. After conservative surgery two patients achieved full term pregnancies. More studies are required for a higher grade of recommendation.
Background The tumors of low malignant potential are an independent group of the ovarian epithelial tumors. They represents 10–20% of all ovarian epithelial tumors. Our aim through this study to determine how to treat this disease in the most suitable way. Methods A retrospective study involving 73 patients diagnosed with TLMP and treated at our Institute between September 1975 and June 2010. Results The median age was 49 years. In 33% of the cases, the patients were younger than 40 years. Our study included 38 mucinous tumors, 30 serous and 5 mixed. The tumors were stage I in 69% of the cases, stage II in 11% and stage III in 20%. All patients had surgery as a primary treatment. The surgery was radical in 77% of the cases. Five patients had an adjuvant chemotherapy. After a mean follow up of 10 years, we reported 7 cases of local relapses. The prognostic factors for a disease free survival were: the stage of the tumor and the presence of invasive implants. The overall survival at 5 and 10 years was respectively of 96.9% and 92.8%. The prognostic factors for overall survival were: the age, the stage, the existence of a residual tumor, the presence of pseudomyxoma or peritoneal implants. After having a conservative surgery two patients achieved full term pregnancies. Conclusion Randomized studies are required to back-up our findings and give a higher grade of recommendation to the actual standard of care.
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Ritzl A, Csukly G, Balázs K, Égerházi A. Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Res 2018; 270:154-159. [PMID: 30248486 DOI: 10.1016/j.psychres.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
Abstract
Previous studies that aimed to support emotion recognition deficits and alexithymia in B cluster personality disorders have mainly focused on borderline personality disorder (BPD), and resulted in mixed findings. In our study we examine emotion recognition and alexithymia in patients with histrionic (HPD), narcissistic (NPD) and borderline (BPD) personality disorders compared to each other and healthy controls. Furthermore, the possibility is investigated that it is not the type of PD but the severity of psychopathology which predicts the severity of emotion recognition deficits and alexithymia. Patients with HPD, NPD, BPD and healthy controls (N = 20 for each group) were examined by using the Ekman 60 Faces Test (FEEST) and the Toronto Alexithymia Scale (TAS-20). To measure the extent and severity of psychopathology, the Symptom-Checklist-90 Revised (SCL-90-R) was used. Patient groups performed significantly worse compared to healthy controls on the Ekman test and TAS-20, while we found no significant differences among patient groups in emotion recognition and alexithymia. Furthermore, higher scores on the SCL-90-R predicted poorer emotion recognition performance and higher alexithymic features. The empirical data supports the conclusion that the severity of psychopathology plays an important role in predicting emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders.
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Affiliation(s)
- Andrea Ritzl
- Department of Psychiatry, Medical Center, University of Debrecen, Hungary.
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Katalin Balázs
- Institute of Psychology, University of Debrecen, Hungary
| | - Anikó Égerházi
- Department of Psychiatry, Medical Center, University of Debrecen, Hungary
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Abstract
The authors describe an object-relations based model drawing on the work of Kernberg and colleagues for the assessment of borderline pathology. The substrate of internal object relations that constitutes borderline pathology internally or structurally is described and a model for assessing such pathology in a clinical interview format focusing on identity, defensive style, and quality of object relations is presented. Two clinical examples illustrate how these data can be compiled for purposes of psychodynamic case formulation and decisions about psychodynamic treatment.
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Affiliation(s)
- Barry L Stern
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA.
| | - Eve Caligor
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA
| | - Susanne Hörz-Sagstetter
- Psychologische Hochschule Berlin, Clinical Psychology and Psychotherapy, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - John F Clarkin
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA
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Yousif HMA, Mohammed RAA. Alteration of BRCA-1 tumor suppressor gene expression in serous and mucinous ovarian neoplasms in the benign- borderline-malignant pathway. Curr Probl Cancer 2018; 43:377-385. [PMID: 30446260 DOI: 10.1016/j.currproblcancer.2018.10.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
Alteration of expression of the tumor suppressor gene BRCA-1 has been widely studied in breast and ovarian carcinoma. However, pattern of this alteration in the benign-borderline-carcinoma sequence in serous and mucinous ovarian neoplasms have not yet fully described. Tissue sections from 214 formalin-fixed paraffin-embedded ovarian specimens were stained immunohistochemically with BRCA-1 antibody. Specimens were 10 normal ovarian surface epithelium, 10 fallopian tube epithelium, 70 benign adenoma (50 serous and 20 mucinous), 28 borderline (13 serous and 15 mucinous), 78 carcinoma (58 serous and 20 mucinous), and 18 metastatic deposit (13 serous and 5 mucinous). Expression was evaluated into 0, +1, +2, and +3. Score +3 staining similar to normal tissues was considered normal and other scores were considered altered expression. Strong expression was seen in all normal epithelium specimens. Altered expression was seen in 34 serous neoplasms; 17 of 50 (34%) of benign cystadenomas, 6 of 13 (46%) of borderline tumors, 43 of 58 (74%) of primary carcinoma, and in 8 of 13 (62%) of metastatic carcinoma. This alteration was significantly associated with higher histopathologic grade (P = 0.049), presence of necrosis (P = 0.0001), and higher proliferation rate (P = 0.001). In mucinous neoplasms; altered BRCA-1 was detected in 25 specimens; 7 of 20 (41%) of benign cystadenomas, 5 of 15 (33%) of borderline neoplasms, 9 of 20 (45%) of primary carcinoma, and 4 of 5 (80%) of the metastatic deposits. This alteration was not associated with any of the clinicopathologic tumor characteristics. In conclusion, alteration of BRCA-1 expression is more frequent in serous than in mucinous carcinomas and is associated with tumors of higher grades and high proliferation rate.
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Affiliation(s)
- Hala Mohammad Ali Yousif
- Department of Pathology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Rabab Ahmed Ahmed Mohammed
- Department of Pathology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia; Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Vasudevan G, Jaiprakash P, Guruvare S, Samanta N. Ovarian borderline mucinous tumor with squamous overgrowth: An unusual finding with review of literature. INDIAN J PATHOL MICR 2018; 61:261-263. [PMID: 29676373 DOI: 10.4103/ijpm.ijpm_30_17] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Borderline mucinous tumor (BMT) is often associated with other entities such as dermoid cyst, Brenner tumor, and endometriosis. Squamous areas are often associated which may be a part of BMT or its associated conditions. Here, we describe squamous overgrowth in a case of intestinal type of mucinous borderline tumor in a 29-year-old uniparous female and discuss the diagnostic difficulties.
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Affiliation(s)
- Geetha Vasudevan
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Padmapriya Jaiprakash
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Shyamala Guruvare
- Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Nivedita Samanta
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
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Adam MJ, Bendifallah S, Kalhorpour N, Cohen-Steiner C, Ropars L, Mahmood A, Rousseau C, Leveque J, Nyangoh Timoh K, Der Some A, Ouldamer L, Legendre G, Ballester M, Daraï E, Canlorbe G, Lavoue V. Time to revise classification of phyllodes tumors of breast? Results of a French multicentric study. Eur J Surg Oncol 2018; 44:1743-1749. [PMID: 30195948 DOI: 10.1016/j.ejso.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/03/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To assess prognostic factors of recurrence of phyllodes tumors (PT) of the breast. METHODS We performed a retrospective, multicentric cohort study, including all patients who underwent breast surgery for grade 1 (benign), 2 (borderline) or 3 (malignant) PT between 2000 and 2016 in five tertiary University hospitals, diagnosed according to World Health Organisation classification. RESULTS 230 patients were included: 144 (63%), 60 (26%) and 26 (11%) with grade 1, 2 and 3 PT, respectively. Recurrence occurred in 10 (7%), 7 (12%) and 5 (19%) patients with grade 1, 2 and 3 PT, respectively. In univariate analysis, moderate to severe nuclear stromal pleomorphism (HR 8.00 [95% CI: 1.65-38.73], p < 0.009) was correlated with recurrence in all groups including grade 1 (HR 14.3 [95% CI: 1.29-160], p = 0.031). In multivariate analysis, surgical margin >5 mm, (HR 0.20 [95% CI: 0.06-0.63], p = 0.013) were significantly correlated with less recurrence in all PT grades. For grade 1 PT, there was also significantly less recurrence with surgical margin >5 mm, (HR 0.09 [95% CI: 0.01-0.85], p = 0.047) in multivariate analysis. CONCLUSION The surgical margin should be at least 5 mm whatever the grade of PT. Moderate to severe nuclear stromal pleomorphism identified a subgroup of grade 1 PT with a higher rate of recurrence. This suggests that the WHO classification could be revised with the introduction of nuclear stromal pleomorphism to tailor PT management.
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Affiliation(s)
- Marie-José Adam
- Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France
| | - Sofiane Bendifallah
- Service de Gynécologie, CHU de Tenon, Assistance Publique des Hôpitaux de Paris, 4 Rue de la Chine, 75020, Paris, France
| | - Négar Kalhorpour
- Service de Gynécologie, CHU de Tenon, Assistance Publique des Hôpitaux de Paris, 4 Rue de la Chine, 75020, Paris, France
| | - Camille Cohen-Steiner
- Service de Gynécologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Laetitia Ropars
- Service de Gynécologie, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Asma Mahmood
- Service de Gynécologie, CHU La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Chloé Rousseau
- Service de Pharmacologie Clinique, CIC Inserm 1414, CHU de Rennes, Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033, Rennes, France
| | - Jean Leveque
- Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Rennes, France
| | - Krystel Nyangoh Timoh
- Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France
| | - Adolphe Der Some
- Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France
| | - Lobna Ouldamer
- Service de Gynécologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Guillaume Legendre
- Service de Gynécologie, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Marcos Ballester
- Service de Gynécologie, CHU de Tenon, Assistance Publique des Hôpitaux de Paris, 4 Rue de la Chine, 75020, Paris, France
| | - Emile Daraï
- Service de Gynécologie, CHU de Tenon, Assistance Publique des Hôpitaux de Paris, 4 Rue de la Chine, 75020, Paris, France
| | - Geoffroy Canlorbe
- Service de Gynécologie, CHU La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Vincent Lavoue
- Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Rennes, France.
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Huguet F, Rivin Del Campo E, Antoni D, Vendrely V, Hammel P. [Role of radiation therapy in the management of pancreatic cancer]. Cancer Radiother 2018; 22:552-557. [PMID: 30100126 DOI: 10.1016/j.canrad.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, 4, rue de la Chine, 75020 Paris, France; Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France.
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, 4, rue de la Chine, 75020 Paris, France; Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - P Hammel
- Service d'oncologie digestive et médicale, hôpital Beaujon, AP-HP, 100, boulevard du Géneral-Leclerc, 92110 Clichy, France; Université Paris Diderot, 100, boulevard du Géneral-Leclerc, 92110 Clichy, France
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Sabater L, Muñoz E, Roselló S, Dorcaratto D, Garcés-Albir M, Huerta M, Roda D, Gómez-Mateo MC, Ferrández-Izquierdo A, Darder A, Cervantes A. Borderline resectable pancreatic cancer. Challenges and controversies. Cancer Treat Rev 2018; 68:124-135. [PMID: 29957372 DOI: 10.1016/j.ctrv.2018.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Pancreatic cancer is a dismal disease with an increasing incidence. Despite the majority of patients are not candidates for curative surgery, a subgroup of patients classified as borderline resectable pancreatic cancer can be selected in whom a sequential strategy of neoadjuvant therapy followed by surgery can provide better outcomes. Multidisciplinary approach and surgical pancreatic expertise are essential for successfully treating these patients. However, the lack of consensual definitions and therapies make the results of studies very difficult to interpret and hard to be implemented in some settings. In this article, we review the challenges of borderline resectable pancreatic cancer, the complexity of its management and controversies and point out where further research and international cooperation for a consensus strategy is urgently needed.
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Affiliation(s)
- Luis Sabater
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Elena Muñoz
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Susana Roselló
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marisol Huerta
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Desamparados Roda
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | | | | | - Antonio Darder
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Andrés Cervantes
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
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Morrison C, Pabla S, Conroy JM, Nesline MK, Glenn ST, Dressman D, Papanicolau-Sengos A, Burgher B, Andreas J, Giamo V, Qin M, Wang Y, Lenzo FL, Omilian A, Bshara W, Zibelman M, Ghatalia P, Dragnev K, Shirai K, Madden KG, Tafe LJ, Shah N, Kasuganti D, de la Cruz-Merino L, Araujo I, Saenger Y, Bogardus M, Villalona-Calero M, Diaz Z, Day R, Eisenberg M, Anderson SM, Puzanov I, Galluzzi L, Gardner M, Ernstoff MS. Predicting response to checkpoint inhibitors in melanoma beyond PD-L1 and mutational burden. J Immunother Cancer 2018; 6:32. [PMID: 29743104 PMCID: PMC5944039 DOI: 10.1186/s40425-018-0344-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have changed the clinical management of melanoma. However, not all patients respond, and current biomarkers including PD-L1 and mutational burden show incomplete predictive performance. The clinical validity and utility of complex biomarkers have not been studied in melanoma. METHODS Cutaneous metastatic melanoma patients at eight institutions were evaluated for PD-L1 expression, CD8+ T-cell infiltration pattern, mutational burden, and 394 immune transcript expression. PD-L1 IHC and mutational burden were assessed for association with overall survival (OS) in 94 patients treated prior to ICI approval by the FDA (historical-controls), and in 137 patients treated with ICIs. Unsupervised analysis revealed distinct immune-clusters with separate response rates. This comprehensive immune profiling data were then integrated to generate a continuous Response Score (RS) based upon response criteria (RECIST v.1.1). RS was developed using a single institution training cohort (n = 48) and subsequently tested in a separate eight institution validation cohort (n = 29) to mimic a real-world clinical scenario. RESULTS PD-L1 positivity ≥1% correlated with response and OS in ICI-treated patients, but demonstrated limited predictive performance. High mutational burden was associated with response in ICI-treated patients, but not with OS. Comprehensive immune profiling using RS demonstrated higher sensitivity (72.2%) compared to PD-L1 IHC (34.25%) and tumor mutational burden (32.5%), but with similar specificity. CONCLUSIONS In this study, the response score derived from comprehensive immune profiling in a limited melanoma cohort showed improved predictive performance as compared to PD-L1 IHC and tumor mutational burden.
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Affiliation(s)
- Carl Morrison
- Center for Personalized Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- OmniSeq Inc., Buffalo, NY, 14203, USA.
| | | | - Jeffrey M Conroy
- Center for Personalized Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- OmniSeq Inc., Buffalo, NY, 14203, USA
| | | | - Sean T Glenn
- Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- OmniSeq Inc., Buffalo, NY, 14203, USA
| | | | | | | | | | | | | | | | | | - Angela Omilian
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Wiam Bshara
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Matthew Zibelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Pooja Ghatalia
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Konstantin Dragnev
- Department of Hematology and Oncology, Dartmouth Hitchcock, Lebanon, NH, 03756, USA
| | - Keisuke Shirai
- Department of Hematology and Oncology, Dartmouth Hitchcock, Lebanon, NH, 03756, USA
| | - Katherine G Madden
- Department of Hematology and Oncology, Dartmouth Hitchcock, Lebanon, NH, 03756, USA
| | - Laura J Tafe
- Department of Hematology and Oncology, Dartmouth Hitchcock, Lebanon, NH, 03756, USA
- Department of Pathology, Dartmouth Hitchcock, Lebanon, NH, 03756, USA
| | - Neel Shah
- Department of Pathology, Community Hospital, Munster, IN, 46321, USA
| | - Deepa Kasuganti
- Department of Pathology, Community Hospital, Munster, IN, 46321, USA
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology Development, Hospital Universitario Virgen Macarena, 41009, Sevilla, Spain
| | - Isabel Araujo
- Department of Clinical Oncology Development, Hospital Universitario Virgen Macarena, 41009, Sevilla, Spain
| | - Yvonne Saenger
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - Margaret Bogardus
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | | | - Zuanel Diaz
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Roger Day
- Department of Biomedical Informatics and Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Marcia Eisenberg
- Laboratory Corporation of America Holdings, Burlington, NC, 27215, USA
| | - Steven M Anderson
- Laboratory Corporation of America Holdings, Burlington, NC, 27215, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, 10065, USA
- Sandra and Edward Meyer Cancer Center, New York, NY, 10065, USA
- Université Paris Descartes/Paris V, 75006, Paris, France
| | | | - Marc S Ernstoff
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
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Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail 2018; 5:685-694. [PMID: 29660263 PMCID: PMC6073025 DOI: 10.1002/ehf2.12283] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 12/28/2022] Open
Abstract
Aims This study aimed to assess by a meta‐analysis the clinical characteristics, all‐cause and cardiovascular mortality, and hospitalization of patients with heart failure (HF) with mid‐range ejection fraction (HFmrEF) compared with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Methods and results Data from 12 eligible observational studies including 109 257 patients were pooled. HFmrEF patients were significantly different and occupied a mid‐position between HFrEF and HFpEF: mean age 73.6 ± 9.8 vs. 72.6 ± 9.8 and 77.6 ± 7.2 years, male gender 59% vs. 68.5% and 40%, ischaemic heart disease 49% vs. 52.6% and 39.4%, hypertension 67.3% vs. 61.5% and 76.5%, atrial fibrillation 45.2% vs. 39.6% and 46%, chronic obstructive pulmonary disease 26.4% vs. 24.9% and 30.5%, estimated glomerular filtration rate 62 ± 30 vs. 63.3 ± 23 and 59 ± 22.5, use of renin–angiotensin system inhibitors 79.6% vs. 90.1% and 68.7%, beta‐blockers 82% vs. 89% and 73.5%, and aldosterone antagonists 20.3 vs. 31.5% and 26%, P‐values < 0.05. After a mean follow‐up of 31 ± 5 months, all‐cause mortality was significantly lower in HFmrEF than in HFrEF and HFpEF (26.8% vs. 29.5% and 31%): risk ratio (RR) 0.95 [0.93–0.98; 95% confidence interval (CI)], P < 0.001, and 0.97 (0.94–0.99; 95% CI), P = 0.014, respectively. Cardiovascular mortality was lowest in HFmrEF (9.7% vs. 13% and 12.8%): RR = 0.81 (0.73–0.91), P < 0.001, and 1.10 (0.97–1.24; 95% CI), P = 0.13, respectively. HF hospitalization in HFmrEF compared to that in HFrEF and HFpEF was 23.9% vs. 27.6% and 23.3% with RR = 0.89 (0.85–0.93), P < 0.001, and RR = 1.12 (1.07–1.17), P < 0.001, respectively. Conclusions The results of this study support that HFmrEF is a distinct category characterized by a mid‐position between HFrEF and HFpEF and with the lowest all‐cause and cardiovascular mortality.
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Affiliation(s)
- Josephine Lauritsen
- Division of Cardiology, Department of Internal Medicine, Copenhagen University Hospital of Glostrup, Glostrup, 2600, Denmark
| | - Finn Gustafsson
- Department of Cardiology B, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jawdat Abdulla
- Division of Cardiology, Department of Internal Medicine, Copenhagen University Hospital of Glostrup, Glostrup, 2600, Denmark
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Kang MJ, Jang JY, Kwon W, Kim SW. Clinical significance of defining borderline resectable pancreatic cancer. Pancreatology 2018; 18:139-145. [PMID: 29274720 DOI: 10.1016/j.pan.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
Since the introduction of the concept of borderline resectable pancreatic cancer (BRPC), various definitions of this disease entity have been suggested. However, there are several obstacles in defining this disease category. The current diagnostic criteria of BRPC mainly focuses on its expanded 'technical resectability'; however, they are difficult to interpret because of their ambiguity using potential subjective or arbitrary terminology, In addition, limitations in current imaging technology and a lack of evidence in radiological-pathological-clinical correlation make it difficult to refine the criteria. On the other hand, neoadjuvant treatment is usually applied to increase the R0 resection rate of BRPC focusing on the 'oncological curability'. However, evidence is needed concerning the effect of neoadjuvant treatment by quality-controlled prospective randomized clinical trials based on a standardized radiologic and pathologic reporting system. In conclusion, there are two aspects in the current concept of BRPC, which are technical resectability and oncological curability. Although the recent evolution of surgical techniques is expanding the scope of technical resectability, it should not be overlooked that the disease entity must be defined based on the evidence of oncological curability.
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Affiliation(s)
- Mee Joo Kang
- Korea International Cooperation Agency, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Smesny S, Große J, Gussew A, Langbein K, Schönfeld N, Wagner G, Valente M, Reichenbach JR. Prefrontal glutamatergic emotion regulation is disturbed in cluster B and C personality disorders - A combined 1H/ 31P-MR spectroscopic study. J Affect Disord 2018; 227:688-697. [PMID: 29174743 DOI: 10.1016/j.jad.2017.10.044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/27/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personality disorders (PD) belong to the most common and most serious mental disorders as regards social dysfunction, inability to work, occurrence of comorbidity and suicidal risk. PDs also crucially influence the incidence, clinical course and treatment response of mental disorders with high suicidal risk, such as depression or substance abuse. One key issue of PD concerns the regulation of emotions. METHODS Both 1H-/31P-Chemical Shift Imaging (CSI) was applied in a single session to assess neurochemical markers of glutamate function (NAA, Glu) and local energy metabolism (PCr, ATP) in two patient cohorts encompassing 22 cluster B (CB) and 21 cluster C (CC) PD patients, whereby 10 patients of each group were on low-dose antidepressants, and in 60 healthy controls (HC). Non-parametric statistical tests and correlation analyses were performed to assess disease effects on the metabolites and their relation to symptomatology as assessed by SCL-90R self-ratings. RESULTS Overall comparison including Bonferroni correction revealed significant differences of Glu across all groups in the dorsolateral prefrontal cortex (DLPFC). The following uncorrected results of pairwise tests were obtained: (i) Glu was bilaterally increased in the DLPFC in CB patients, whereas it was - together with NAA - bilaterally decreased in the DLPFC in CC patients and accompanied by increased PCr in the left DLPFC. (ii) NAA and Glu, accompanied by increased PCr, were significantly decreased in the dorsomedial prefrontal cortex (DMPFC) in CC patients. (iii) NAA was decreased in the right anterior cingulate cortex (ACC) in CB patients, and in the left ACC in CC patients with PCr being increased bilaterally. (iv) No associations were observed between metabolites and psychopathology measures. CONCLUSION The observations in the DLPFC may reflect a neurobiochemical correlate of disturbed cognitive control function in CB and CC PD. While the alterations in CB patients suggest increased basal activity, the observed patterns in CC patients likely reflect decreased or inhibited activity. The alterations of NAA and Glu levels in the ACC and DMPFC indirectly support the assumption of disturbed neuronal function in regions involved in social cognition and mentalizing abilities in both CB and CC PD. Further studies should include the investigation of metabolites of neuronal inhibition (GABA) and the examination of treatment effects.
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Affiliation(s)
- Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany.
| | - Johanna Große
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Alexander Gussew
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, D-07740 Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Nils Schönfeld
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Matias Valente
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum am Weissenhof, D-74189 Weinsberg, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, D-07740 Jena, Germany
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