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Carr NR, Bahr TM, Ohls RK, Tweddell SM, Morris DS, Rees T, Ilstrup SJ, Kelley WE, Christensen RD. Low-Titer Type O Whole Blood for Transfusing Perinatal Patients after Acute Hemorrhage: A Case Series. AJP Rep 2024; 14:e129-e132. [PMID: 38707262 PMCID: PMC11068431 DOI: 10.1055/s-0044-1786712] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Acute and massive blood loss is fortunately a rare occurrence in perinatal/neonatal practice. When it occurs, typical transfusion paradigms utilize sequential administration of blood components. However, an alternative approach, transfusing type O whole blood with low anti-A and anti-B titers, (LTOWB) has recently been approved and utilized in trauma surgery. Study Design Retrospective analysis of all perinatal patients who have received LTOWB after acute massive hemorrhage at the Intermountain Medical Center. Results LTOWB was the initial transfusion product we used to resuscitate/treat 25 women with acute and massive postpartum hemorrhage and five infants with acute hemorrhage in the first hours/days after birth. We encountered no problems obtaining or transfusing this product and we recognized no adverse effects of this treatment. Conclusion Transfusing LTOWB to perinatal patients after acute blood loss is feasible and appears at least as safe a serial component transfusion. Its use has subsequently been expanded to multiple hospitals in our region as first-line transfusion treatment for acute perinatal hemorrhage. Key Points Low-titer type O whole blood (LTOWB) was our initial transfusion product for 30 perinatal patients with acute hemorrhage. Twenty-five of these were obstetrical patients and five were neonatal patients. We encountered no problems with, or adverse effects from LTOWB in any of these patients. LTOWB transfusions to women were ten days since donor draw (interquartile range, 8-13) and to neonates was six days (5-8).
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Affiliation(s)
- Nicholas R. Carr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Timothy M. Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
- Obstetric and Neonatal Operations, Intermountain Healthcare, Murray, Utah
| | - Robin K. Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Sarah M. Tweddell
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - David S. Morris
- Division of Trauma, Intermountain Medical Center Murray, UT and Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Terry Rees
- Intermountain Healthcare Transfusion Services and Department of Pathology, Intermountain Medical Center, Murray, Salt Lake City, Utah
| | - Sarah J. Ilstrup
- Intermountain Healthcare Transfusion Services and Department of Pathology, Intermountain Medical Center, Murray, Salt Lake City, Utah
| | - Walter E. Kelley
- American National Red Cross, Salt Lake City, Utah
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Robert D. Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
- Obstetric and Neonatal Operations, Intermountain Healthcare, Murray, Utah
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Gore JL, Follmer K, Reynolds J, Nash M, Anderson CB, Catto JWF, Chamie K, Daneshmand S, Dickstein R, Garg T, Gilbert SM, Guzzo TJ, Kamat AM, Kates MR, Lane BR, Lotan Y, Mansour AM, Master VA, Montgomery JS, Morris DS, Nepple KG, O'Neil BB, Patel S, Pohar K, Porten SP, Riggs SB, Sankin A, Scarpato KR, Shore ND, Steinberg GD, Strope SA, Taylor JM, Comstock BA, Kessler LG, Wolff EM, Smith AB. Interruptions in bladder cancer care during the COVID-19 public health emergency. Urol Oncol 2024; 42:116.e17-116.e21. [PMID: 38087711 DOI: 10.1016/j.urolonc.2023.11.010] [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: 07/25/2023] [Revised: 10/19/2023] [Accepted: 11/10/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Academic and community urology centers participating in a pragmatic clinical trial in non-muscle-invasive bladder cancer completed monthly surveys assessing restrictions in aspects of bladder cancer care due to the COVID-19 Public Health Emergency. Our objective was to describe pandemic-related restrictions on bladder cancer care. METHODS We invited 32 sites participating in a multicenter pragmatic bladder cancer trial to complete monthly surveys distributed through REDCap beginning in May 2020. These surveys queried sites on whether they were experiencing restrictions in the use of elective surgery, transurethral resection of bladder tumors (TURBT), radical cystectomy, office cystoscopy, and intravesical bacillus Calmette-Guerin (BCG) availability. Responses were collated with descriptive statistics. RESULTS Of 32 eligible sites, 21 sites had at least a 50% monthly response rate over the study period and were included in the analysis. Elective surgery was paused at 76% of sites in May 2020, 48% of sites in January 2021, and 52% of sites in January 2022. Over those same periods, coinciding with COVID-19 incidence waves, TURBT was restricted at 10%, 14%, and 14% of sites, respectively, radical cystectomy was restricted at 10%, 14%, and 19% of sites, respectively, and cystoscopy was restricted at 33%, 0%, and 10% of sites, respectively. CONCLUSIONS Bladder cancer care was minimally restricted compared with more pronounced restrictions seen in general elective surgeries during the COVID-19 pandemic.
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Affiliation(s)
- John L Gore
- Department of Urology, University of Washington, Seattle, WA.
| | - Kristin Follmer
- Department of Urology, University of Washington, Seattle, WA
| | - Jason Reynolds
- Department of Urology, University of Washington, Seattle, WA
| | - Michael Nash
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - James W F Catto
- Department of Urology, Sheffield Teaching Hospitals NHS (National Health Service) Foundation Trust, Sheffield, United Kingdom
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Siamak Daneshmand
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rian Dickstein
- University of Maryland Medical Center, Baltimore Washington Medical Center, Glen Burnie, MD; Chesapeake Urology, Baltimore, MD
| | - Tullika Garg
- Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Scott M Gilbert
- Division of Genitourinary Oncology, H.Lee Moffitt Cancer Center and Research Institute, Tampa FL
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Max R Kates
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Brian R Lane
- Division of Urology, Spectrum Health, Grand Rapids, MI
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX
| | - Viraj A Master
- Department of Urology and Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | | | - Brock B O'Neil
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sanjay Patel
- Department of Urology, University of Oklahoma, Oklahoma City, OK
| | - Kamal Pohar
- Department of Urology, The Ohio State University, Columbus, OH
| | - Sima P Porten
- Department of Urology, UCSF School of Medicine, San Francisco, CA
| | - Stephen B Riggs
- Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
| | - Gary D Steinberg
- Department of Urology, Rush University Medical Center, Chicago, IL
| | | | - Jennifer M Taylor
- Michael E. DeBakey VAMC, Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Larry G Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Erika M Wolff
- Department of Urology, University of Washington, Seattle, WA
| | - Angela B Smith
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Van Neste L, Henao R, Wojno KJ, Signes J, DeHart J, Busta A, Marriott E, Willing M, Argentini A, Hurley PM, Korman H, Hafron J, Putzi M, Pieczonka CM, Karsh LI, Morris DS, Kassis AI, Kantoff PW. Development and Optimization of a Subtraction-Normalized Immunocyte Profiling Signature for Prostate Cancer Active Surveillance Risk Stratification. J Urol 2024; 211:415-425. [PMID: 38147400 DOI: 10.1097/ju.0000000000003824] [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: 02/14/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Less invasive decision support tools are desperately needed to identify occult high-risk disease in men with prostate cancer (PCa) on active surveillance (AS). For a variety of reasons, many men on AS with low- or intermediate-risk disease forgo the necessary repeat surveillance biopsies needed to identify potentially higher-risk PCa. Here, we describe the development of a blood-based immunocyte transcriptomic signature to identify men harboring occult aggressive PCa. We then validate it on a biopsy-positive population with the goal of identifying men who should not be on AS and confirm those men with indolent disease who can safely remain on AS. This model uses subtraction-normalized immunocyte transcriptomic profiles to risk-stratify men with PCa who could be candidates for AS. MATERIALS AND METHODS Men were eligible for enrollment in the study if they were determined by their physician to have a risk profile that warranted prostate biopsy. Both training (n = 1017) and validation cohort (n = 1198) populations had blood samples drawn coincident to their prostate biopsy. Purified CD2+ and CD14+ immune cells were obtained from peripheral blood mononuclear cells, and RNA was extracted and sequenced. To avoid overfitting and unnecessary complexity, a regularized regression model was built on the training cohort to predict PCa aggressiveness based on the National Comprehensive Cancer Network PCa guidelines. This model was then validated on an independent cohort of biopsy-positive men only, using National Comprehensive Cancer Network unfavorable intermediate risk and worse as an aggressiveness outcome, identifying patients who were not appropriate for AS. RESULTS The best final model for the AS setting was obtained by combining an immunocyte transcriptomic profile based on 2 cell types with PSA density and age, reaching an AUC of 0.73 (95% CI: 0.69-0.77). The model significantly outperforms (P < .001) PSA density as a biomarker, which has an AUC of 0.69 (95% CI: 0.65-0.73). This model yields an individualized patient risk score with 90% negative predictive value and 50% positive predictive value. CONCLUSIONS While further validation in an intended-use cohort is needed, the immunocyte transcriptomic model offers a promising tool for risk stratification of individual patients who are being considered for AS.
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Affiliation(s)
| | | | | | - Jorge Signes
- David H. Murdock Research Institute, Kannapolis, North Carolina
| | | | | | | | | | | | | | - Howard Korman
- Comprehensive Urology, Royal Oak, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
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Kay AB, Morris DS, Woller SC, Collingridge DS, Majercik S. Below the knee, let it be: Management of calf DVT in hospitalized trauma patients. Am J Surg 2023; 226:891-895. [PMID: 37574336 DOI: 10.1016/j.amjsurg.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Management of below-knee DVT (BKDVT) in trauma patients is uncertain. We hypothesized that BKDVT can be managed with observation only. METHODS Secondary analysis on trauma inpatients March 2017-September 2019 with risk assessment profile ≥5. Management of BKDVT included observation with ultrasound. BKDVT was compared to above-knee DVT (AKDVT), and BKDVT with progression to AKDVT/PE compared to no progression. RESULTS Of 1988 patients, 136 (6.8%) BKDVT and 23 (1.2%) AKDVT. 7 (6.9%) BKDVT progressed to AKDVT/PE. 6.9% had BKDVT progression, associated with higher ISS (36.7 vs 21.6, p = 0.005), longer prophylaxis delay (121 vs 45 h, p = 0.02) and longer hospital LOS (25.6 vs 7.8, p = 0.01). None experienced post-thrombotic syndrome. CONCLUSION Majority of BKDVT in hospitalized trauma patients did not progress to AKDVT. Observation for progression, rather than treatment, was not associated with increased PE risk or thrombotic sequelae. Observation with serial ultrasound may serve as a practical alternative to anticoagulation in trauma patients with BKDVT.
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Affiliation(s)
- Annika Bickford Kay
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - David S Morris
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Scott C Woller
- Department of Medicine, Intermountain Medical Center, Murray, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | | | - Sarah Majercik
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
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5
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Kay AB, Malone SA, Bledsoe JR, Majercik S, Morris DS. First steps toward a BIG change: A pilot study to implement the Brain Injury Guidelines across a 24-hospital system. Am J Surg 2023; 226:845-850. [PMID: 37517901 DOI: 10.1016/j.amjsurg.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/10/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The modified Brain Injury Guidelines (mBIG) support a subset of low-risk patients to be managed without repeat head computed tomography (RHCT), neurosurgical consult (NSC), or hospital transfer/admission. This pilot aimed to assess mBIG implementation at a single facility to inform future systemwide implementation. METHODS Single cohort pilot trial at a level I trauma center, December 2021-August 2022. Adult patients included if tICH meeting BIG 1 or 2 criteria. BIG 3 patients excluded. RESULTS No patients required neurosurgical intervention. 72 RHCT and 83 NSC were prevented. 21 isolated BIG 1 were safely discharged home from the ED. No hospital readmissions for tICH. Protocol adherence rate was 92%. CONCLUSION Implementation of the mBIG at a single trauma center is feasible and optimizes resource utilization. This pilot study will inform an implementation trial of the mBIG across a 24-hospital integrated health system.
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Affiliation(s)
- Annika Bickford Kay
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Samantha A Malone
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center, Murray, UT, USA.
| | - Sarah Majercik
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - David S Morris
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
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Simpkins C, Morris DS, Normando EM. Eyes in skies: ocular ultrasound performed by a low-experience operator at high altitude. BMJ Mil Health 2023:e002473. [PMID: 37336579 DOI: 10.1136/military-2023-002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Ciaran Simpkins
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D S Morris
- Cardiff Eye Unit, University of Wales Hospital, Cardiff, UK
| | - E M Normando
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- Imperial College Ophthalmology Research Group (ICORG), Imperial College London, London, UK
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Osterman J, Kay AB, Morris DS, Evertson S, Brunt T, Majercik S. Prehospital decompression of tension pneumothorax: Have we moved the needle? Am J Surg 2022; 224:1460-1463. [PMID: 36210204 DOI: 10.1016/j.amjsurg.2022.09.014] [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: 03/26/2022] [Revised: 07/31/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure. METHODS This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT. RESULTS Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%. CONCLUSIONS Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated.
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Affiliation(s)
- Jordan Osterman
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Annika Bickford Kay
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - David S Morris
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Shawn Evertson
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Teresa Brunt
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
| | - Sarah Majercik
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA.
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Abstract
Inherited genetic mutations can significantly increase the risk for prostate cancer (PC), may be associated with aggressive disease and poorer outcomes, and can have hereditary cancer implications for men and their families. Germline genetic testing (hereditary cancer genetic testing) is now strongly recommended for patients with advanced/metastatic PC, particularly given the impact on targeted therapy selection or clinical trial options, with expanded National Comprehensive Cancer Network guidelines and endorsement from multiple professional societies. Furthermore, National Comprehensive Cancer Network guidelines recommend genetic testing for men with PC across the stage and risk spectrum and for unaffected men at high risk for PC based on family history to identify hereditary cancer risk. Primary care is a critical field in which providers evaluate men at an elevated risk for PC, men living with PC, and PC survivors for whom germline testing may be indicated. Therefore, there is a critical need to engage and educate primary care providers regarding the role of genetic testing and the impact of results on PC screening, treatment, and cascade testing for family members of affected men. This review highlights key aspects of genetic testing in PC, the role of clinicians, with a focus on primary care, the importance of obtaining a comprehensive family history, current germline testing guidelines, and the impact on precision PC care. With emerging evidence and guidelines, clinical pathways are needed to facilitate integrated genetic education, testing, and counseling services in appropriately selected patients. There is also a need for providers to understand the field of genetic counseling and how best to collaborate to enhance multidisciplinary patient care.
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Affiliation(s)
- Veda N Giri
- Department of Medical Oncology, Cancer Biology, and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Todd M Morgan
- Department of Urology, University of Michigan Urology Cancer Center, Ann Arbor, Michigan
| | | | - Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Colette Hyatt
- Familial Cancer Program, University of Vermont Medical Center, Burlington, Vermont
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Sweeney CJ, Percent IJ, Babu S, Cultrera JL, Mehlhaff BA, Goodman OB, Morris DS, Schnadig ID, Albany C, Shore ND, Sieber PR, Guba SC, Zhang W, Wacheck V, Donoho GP, Szpurka AM, Callies S, Lin BK, Bendell JC. Phase Ib/II Study of Enzalutamide with Samotolisib (LY3023414) or Placebo in Patients with Metastatic Castration-Resistant Prostate Cancer. Clin Cancer Res 2022; 28:2237-2247. [PMID: 35363301 PMCID: PMC9662871 DOI: 10.1158/1078-0432.ccr-21-2326] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 03/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To report efficacy and safety of samotolisib (LY3023414; PI3K/mTOR dual kinase and DNA-dependent protein kinase inhibitor) plus enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) following cancer progression on abiraterone. PATIENTS AND METHODS In this double-blind, placebo-controlled phase Ib/II study (NCT02407054), following a lead-in segment for evaluating safety and pharmacokinetics of samotolisib and enzalutamide combination, patients with advanced castration-resistant prostate cancer with progression on prior abiraterone were randomized to receive enzalutamide (160 mg daily)/samotolisib (200 mg twice daily) or placebo. Primary endpoint was progression-free survival (PFS) assessed by Prostate Cancer Clinical Trials Working Group criteria (PCWG2). Secondary and exploratory endpoints included radiographic PFS (rPFS) and biomarkers, respectively. Log-rank tests assessed treatment group differences. RESULTS Overall, 13 and 129 patients were enrolled in phase Ib and II, respectively. Dose-limiting toxicity was not reported in patients during phase Ib and mean samotolisib exposures remained in the targeted range despite a 35% decrease when administered with enzalutamide. In phase II, median PCWG2-PFS and rPFS was significantly longer in the samotolisib/enzalutamide versus placebo/enzalutamide arm (3.8 vs. 2.8 months; P = 0.003 and 10.2 vs. 5.5 months; P = 0.03), respectively. Patients without androgen receptor splice variant 7 showed a significant and clinically meaningful rPFS benefit in the samotolisib/enzalutamide versus placebo/enzalutamide arm (13.2 months vs. 5.3 months; P = 0.03). CONCLUSIONS Samotolisib/enzalutamide has tolerable side effects and significantly improved PFS in patients with mCRPC with cancer progression on abiraterone, and this may be enriched in patients with PTEN intact and no androgen receptor splice variant 7.
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Affiliation(s)
- Christopher J. Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Corresponding Author: Christopher J. Sweeney, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215. Phone: 617-582-7221; Fax: 617-632-2165; E-mail:
| | - Ivor J. Percent
- Florida Cancer Specialists and Research Institute/Sarah Cannon Research Institute, Port Charlotte, Florida
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, Indiana
| | | | | | | | | | | | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Neal D. Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina
| | | | | | - Wei Zhang
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | | | | | - Johanna C. Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
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Labadie BW, Morris DS, Bryce AH, Given R, Zhang J, Abida W, Chowdhury S, Patnaik A. Guidelines for Management of Treatment-Emergent Adverse Events During Rucaparib Treatment of Patients with Metastatic Castration-Resistant Prostate Cancer. Cancer Manag Res 2022; 14:673-686. [PMID: 35210863 PMCID: PMC8860352 DOI: 10.2147/cmar.s335962] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The US Food and Drug Administration has recently granted accelerated approval of the poly(ADP-ribose) polymerase (PARP) inhibitor rucaparib as treatment for men with metastatic castration-resistant prostate cancer (mCRPC) associated with a deleterious germline or somatic BRCA1 or BRCA2 (BRCA) alteration. As the safety profile of this new addition to the mCRPC treatment landscape may be unfamiliar to clinicians and patients, we summarize the data from the literature and provide practical guidelines for the management of treatment-emergent adverse events (TEAEs) that may occur during rucaparib treatment. Materials and Methods Safety data were identified from PubMed and congress publications of trials involving men with mCRPC treated with oral rucaparib monotherapy (600 mg twice daily). Management guidelines for TEAEs were developed based on trial protocols, prescribing information, oncology association guidance, and the authors’ clinical experience. Results In clinical trials of men with mCRPC who received rucaparib (n = 193), TEAEs observed were consistent with that of other PARP inhibitors. The most frequent any-grade TEAEs included gastrointestinal events, asthenia/fatigue, anemia, increased alanine/aspartate aminotransferase, rash, and thrombocytopenia; the most frequent grade ≥3 TEAE was anemia. The majority of TEAEs were self-limiting and did not require treatment modification or interruption. Here, we provide recommendations on management of the most common TEAEs reported with rucaparib as well as other TEAEs of interest. Conclusion Rucaparib’s recent approval for treatment of BRCA-mutant mCRPC is practice changing. Proper management of TEAEs will allow maximum treatment benefit for patients receiving rucaparib.
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Affiliation(s)
- Brian W Labadie
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Alan H Bryce
- Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Robert Given
- Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA
- Urology of Virginia, Virginia Beach, VA, USA
| | - Jingsong Zhang
- Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Wassim Abida
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simon Chowdhury
- Medical Oncology, Guy’s Hospital, London, UK
- Sarah Cannon Research Institute, London, UK
| | - Akash Patnaik
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
- Correspondence: Akash Patnaik Knapp Center for Biomedical Discovery, Room 7152, University of Chicago, 900 E. 57th Street, Chicago, IL, 60637Tel +773-834-3519Fax +773-834-0778 Email
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11
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Kay AB, Morris DS, Gardner S, Majercik S, White TW. Readmission for pleural space complications after chest wall injury: Who is at risk? J Trauma Acute Care Surg 2021; 91:981-987. [PMID: 34538827 DOI: 10.1097/ta.0000000000003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about patient characteristics predicting postdischarge pleural space complications (PDPSCs) after thoracic trauma. We sought to analyze the patient population who required unplanned hospital readmission for PDPSC. METHODS Retrospective review of adult patients admitted to a Level I Trauma Center with a chest Abbreviated Injury Scale (AIS) score of 2 or greater between January 2015 and August 2020. Those readmitted within 30 days of index hospitalization discharge for PDPSC were compared with those not readmitted. Demographics, injury characteristics, surgical procedures, imaging, and readmission data were retrieved. RESULTS Out of 17,192 trauma evaluations, 3,412 (19.8%) suffered a chest AIS score of 2 or greater injury and 155 experienced an unplanned 30-day hospital readmission. Of those, 49 (1.4%) were readmitted for the management of PDPSC (readmit PDPSC) and were compared with patients who were not readmitted (no readmit, n = 3,257). The readmit PDPSC group was significantly older age, heavier, comprised of fewer men, and suffered a higher mean chest AIS score. The readmit PDPSC group had a significantly higher incidence of rib fractures, flail chest, pneumothorax, hemothorax, scapula fractures, and a higher rate of tube thoracostomy placement during index admission. The discharge chest X-ray in the readmit PDPSC group demonstrated a pleural space abnormality in 36 (73%) of patients. Mean time to readmission was 10.2 (7.2) days, and hospital length of stay on readmission was 5.8 (3.7) days. Pleural effusion was the most common readmission diagnosis (44 [90%]), and 42 (86%) required tube thoracostomy. CONCLUSION We describe the subset of chest wall injury patients who require hospital readmission for PDPSC. Characteristics from index hospitalization associated with PDPSC include older age, female sex, heavier weight, presence of rib fractures, pleural space abnormality, scapular fracture, and chest tube placement. Further studies are needed to characterize this at-risk chest wall injury population, and to determine what interventions can facilitate outpatient management of postdischarge pleural space complications and mitigate readmission risk. LEVEL OF EVIDENCE Prognostic and epidemiologic, Level IV; Care management, Level V.
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Affiliation(s)
- Annika B Kay
- From the Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, Utah
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Morris DS. Polarization, partisanship, and pandemic: The relationship between county-level support for Donald Trump and the spread of Covid-19 during the spring and summer of 2020. Soc Sci Q 2021; 102:2412-2431. [PMID: 34908615 PMCID: PMC8662106 DOI: 10.1111/ssqu.13053] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Republicans and Democrats have displayed widely divergent beliefs and behaviors related to COVID-19, creating the possibility that geographic areas with more Donald Trump supporters may be more likely to suffer from the disease. METHODS I use 2016 election data, COVID-19 case and mortality data, and multilevel linear growth models with state fixed effects to estimate the relationship between county-level support for Donald Trump and the trajectory of cumulative COVID-19 cases and deaths per 100,000 county residents between March 17, 2020 and August 31, 2020. RESULTS Counties more supportive of Trump had fewer COVID-19 cases and deaths in the early months of the pandemic. However, as the summer moved into July and August, counties less supportive of Trump stopped growth rates of COVID-19 cases and deaths, while counties more supportive of Trump saw a trajectory of increased cases and deaths in July and August. This is likely due to the widely divergent beliefs and behaviors displayed by Republicans and Democrats toward COVID-19. CONCLUSION This study underscores the power of polarization and partisanship in the public sphere, even when it comes to a public health issue.
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Affiliation(s)
- David S. Morris
- Department of Sociology & AnthropologyCollege of CharlestonCharlestonSouth CarolinaUSA
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Santos A, Morris DS, Rattan R, Zakrison T. Double-blinded manuscript review: Avoiding peer review bias. J Trauma Acute Care Surg 2021; 91:e39-e42. [PMID: 33901050 DOI: 10.1097/ta.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ariel Santos
- From the Division of Trauma, Acute Care Surgery and Surgical Critical Care (A.S.), Texas Tech University Health Sciences Center, Lubbock, Texas; Division of Trauma, Intermountain Medical Center (D.S.M.), Murray, Utah; Division of Trauma Surgery and Critical Care (R.R.), University of Miami Miller School of Medicine, Miami, Florida; and Division of Trauma (T.Z.), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
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Kay AB, Morris DS, Woller SC, Stevens SM, Bledsoe JR, Lloyd JF, Collingridge DS, Majercik S. Trauma patients at risk for venous thromboembolism who undergo routine duplex ultrasound screening experience fewer pulmonary emboli: A prospective randomized trial. J Trauma Acute Care Surg 2021; 90:787-796. [PMID: 33560104 DOI: 10.1097/ta.0000000000003104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although guidelines are established for the prevention and management of venous thromboembolism (VTE) in trauma, no consensus exists regarding protocols for the diagnostic approach. We hypothesized that at-risk trauma patients who undergo duplex ultrasound (DUS) surveillance for lower extremity deep venous thrombosis (DVT) will have a lower rate of symptomatic or fatal pulmonary embolism (PE) than those who do not undergo routine surveillance. METHODS Prospective, randomized trial between March 2017 and September 2019 of trauma patients admitted to a single, level 1 trauma center, with a risk assessment profile score of ≥5. Patients were randomized to receive either bilateral lower extremity DUS surveillance on days 1, 3, and 7 and weekly during hospitalization ultrasound group (US) or no surveillance no ultrasound group (NoUS). Rates of in-hospital and 90-day DVT and PE were reported as was DVT propagation and all-cause mortality. Standard care for the prevention and management of VTE per established institutional protocols was provided to all patients. RESULTS A total of 3,236 trauma service admissions were screened, and 1,989 moderate- and high-risk patients were randomized (US, 995; NoUS, 994). The mean ± SD age was 62 ± 20.1 years, Injury Severity Score was 14 ± 9.7, risk assessment profile was 7.1 ± 2.4, and 97% suffered blunt trauma. There was no difference in demographics or VTE risk factors between the groups. There were significantly fewer in-hospital PE in the US group than the NoUS group (1 [0.1%] vs. 9 [0.9%], p = 0.01). The US group experienced more in-hospital below-knee DVTs (124 [12.5%] vs. 8 [0.8%], p < 0.001) and above-knee DVTs (19 [1.9%] vs. 8 [0.8%], p = 0.05). There was no difference in 90-day PE or DVT, or overall mortality. CONCLUSION The implementation of a selective routine DUS protocol was associated with significantly fewer in-hospital PE. More DVTs were identified with routine screening; however, surveillance bias appears to exist primarily with distal DVT. Larger trials are needed to further characterize the relationship between routine DUS screening and VTE outcomes in the high-risk trauma population. LEVEL OF EVIDENCE Therapeutic/care management, level II.
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Affiliation(s)
- Annika B Kay
- From the Division of Trauma Services and Surgical Critical Care (A.B.K., D.S.M., S.M.), Department of Medicine (S.C.W., S.M.S.), Intermountain Medical Center, Murray; Department of Medicine (S.C.W., S.M.S.), University of Utah School of Medicine, Salt Lake City; Department of Emergency Medicine (J.R.B.), Intermountain Medical Center, Murray; Medical Informatics (J.F.L.), Intermountain Medical Center; and Office of Research (D.S.C.), Intermountain Medical Center, Murray, Utah
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15
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Perros P, Žarković MP, Panagiotou GC, Azzolini C, Ayvaz G, Baldeschi L, Bartalena L, Boschi AM, Nardi M, Brix TH, Covelli D, Daumerie C, Eckstein AK, Fichter N, Ćirić S, Hegedüs L, Kahaly GJ, Konuk O, Lareida JJ, Okosieme OE, Leo M, Mathiopoulou L, Clarke L, Menconi F, Morris DS, Orgiazzi J, Pitz S, Salvi M, Muller I, Knežević M, Wiersinga WM, Currò N, Dayan CM, Marcocci C, Marinò M, Möller L, Pearce SH, Törüner F, Bernard M. Asymmetry indicates more severe and active disease in Graves' orbitopathy: results from a prospective cross-sectional multicentre study. J Endocrinol Invest 2020; 43:1717-1722. [PMID: 32474767 PMCID: PMC7652741 DOI: 10.1007/s40618-020-01258-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Patients with Graves' orbitopathy can present with asymmetric disease. The aim of this study was to identify clinical characteristics that distinguish asymmetric from unilateral and symmetric Graves' orbitopathy. METHODS This was a multi-centre study of new referrals to 13 European Group on Graves' Orbitopathy (EUGOGO) tertiary centres. New patients presenting over a 4 month period with a diagnosis of Graves' orbitopathy were included. Patient demographics were collected and a clinical examination was performed based on a previously published protocol. Patients were categorized as having asymmetric, symmetric, and unilateral Graves' orbitopathy. The distribution of clinical characteristics among the three groups was documented. RESULTS The asymmetric group (n = 83), was older than the symmetric (n = 157) group [mean age 50.9 years (SD 13.9) vs 45.8 (SD 13.5), p = 0.019], had a lower female to male ratio than the symmetric and unilateral (n = 29) groups (1.6 vs 5.0 vs 8.7, p < 0.001), had more active disease than the symmetric and unilateral groups [mean linical Activity Score 3.0 (SD 1.6) vs 1.7 (SD 1.7), p < 0.001 vs 1.3 (SD 1.4), p < 0.001] and significantly more severe disease than the symmetric and unilateral groups, as measured by the Total Eye Score [mean 8.8 (SD 6.6) vs 5.3 (SD 4.4), p < 0.001, vs 2.7 (SD 2.1), p < 0.001]. CONCLUSION Older age, lower female to male ratio, more severe, and more active disease cluster around asymmetric Graves' orbitopathy. Asymmetry appears to be a marker of more severe and more active disease than other presentations. This simple clinical parameter present at first presentation to tertiary centres may be valuable to clinicians who manage such patients.
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Affiliation(s)
- P Perros
- Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK.
| | - M P Žarković
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia
| | - G C Panagiotou
- Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK
| | - C Azzolini
- Department of Medicine and Surgery, Section of Ophthalmology, School of Medicine, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - G Ayvaz
- Department of Endocrinology, Yüksek Ihtisas University Ankara Koru Hastanesi, 1450. Sk. No:13, Kızılırmak, 06510, Çankaya, Ankara, Turkey
| | - L Baldeschi
- Department of Ophthalmology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - L Bartalena
- Endocrine Unit, University of Insubria, Ospedale di Circolo, Viale Borri, 57 21100, Varese, Italy
| | - A M Boschi
- Department of Ophthalmology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - M Nardi
- Dipartimento di Patologia Chirurgica Medica, Molecolare e Dell'Area Critica, Università di Pisa, Pisa, Italy
| | - T H Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000, Odense, Denmark
| | - D Covelli
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, University of Milan, via Sforza, 35 - I-20122, Milan, Italy
| | - C Daumerie
- Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - A K Eckstein
- Department of Ophthalmology, University of Duisburg-Essen, 45122, Essen, Germany
| | - N Fichter
- Interdisciplinary Centre for Graves' Orbitopathy, 4600, Olten, Switzerland
| | - S Ćirić
- Clinic of Endocrinology, Clinical Centre of Serbia, Belgrade, Serbia
| | - L Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, 5000, Odense, Denmark
| | - G J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, 55101, Mainz, Germany
| | - O Konuk
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Besevler, Ankara, 06500, Turkey
| | - J J Lareida
- Interdisciplinary Centre for Graves' Orbitopathy, 4600, Olten, Switzerland
| | - O E Okosieme
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - M Leo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Mathiopoulou
- Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK
| | - L Clarke
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - F Menconi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - D S Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
| | - J Orgiazzi
- Department of Endocrinology, Centre Hospitalier Lyon-Sud, Lyon, France
| | - S Pitz
- Orbital Center, Ophthalmic Clinic, Bürger Hospital, Frankfurt, Germany
| | - M Salvi
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, University of Milan, via Sforza, 35 - I-20122, Milan, Italy
| | - I Muller
- Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, University of Milan, via Sforza, 35 - I-20122, Milan, Italy
| | - M Knežević
- Medical School, Clinic for Ophthalmology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - W M Wiersinga
- Department of Endocrinology, Academic Medical Center, Amsterdam, Netherlands
| | - N Currò
- Department of Surgery, Ophthalmology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C M Dayan
- Thyroid Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - L Möller
- Interdisciplinary Centre for Graves' Orbitopathy, 4600, Olten, Switzerland
| | - S H Pearce
- Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK
| | - F Törüner
- Department of Endocrinology, Faculty of Medicine, Gazi University, Besevler, Ankara, 06500, Turkey
| | - M Bernard
- Neuro-Ophthalmology Outpatient Clinics, GHE-Hospices Civils de Lyon and Lyon 1 University, Lyon, France
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Dickinson GE, Morris DS. End-of-Life Issues in US Child Life Specialist Programs: 2009–2019. Child Youth Care Forum 2020. [DOI: 10.1007/s10566-020-09579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hulse W, Bahr TM, Morris DS, Richards DS, Ilstrup SJ, Christensen RD. Emergency-release blood transfusions after postpartum hemorrhage at the Intermountain Healthcare hospitals. Transfusion 2020; 60:1418-1423. [PMID: 32529673 DOI: 10.1111/trf.15903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most low-risk obstetric patients do not have crossmatched blood available to treat unexpected postpartum hemorrhage. An emergency-release blood transfusion (ERBT) program is critical for hospitals with obstetrical services. We performed a retrospective analysis of obstetrical ERBTs administered in our multihospital system. DESIGN AND METHODS We collected data from the past 8 years at all Intermountain Healthcare hospitals on every ERBT after postpartum hemorrhage; logging circumstances, number and type of transfused products, and outcomes. RESULTS Eighty-nine women received ERBT following 224,035 live births, for an incidence of 3.97 transfused women/10,000 births. The most common causally-associated conditions were: uterine atony (40%), placental abruption/placenta previa (16%), retained placenta (11%), and uterine rupture (5%). The mean number of total units transfused was 7.9 (range 1-76). The mean number of red blood cells (RBCs) transfused was 4.8, the median 4, and SD was ±4.4. Massive transfusion protocols (MTPs) for trauma recommend using a ratio of 1:1:1 or 2:1:1 of RBC:FFP:Platelets, however the ratios varied widely for postpartum hemorrhage. Only 1.5% received a 1:1:1 ratio and 7.5% received a 2:1:1 ratio. Nineteen percent (17/89) of women underwent hysterectomy, 7% (6/89) had uterine artery embolization, 36% (32/89) had an intensive care unit admission, and 1% (1/89) died. CONCLUSION Emergency transfusion for postpartum hemorrhage occurred after 1/2500 births. Most women received less FFP and platelets than recommended for traumatic hemorrhage. A potentially better practice for postpartum hemorrhage would be a balanced ratio of blood products, transfusion of low-titer, group O, cold-stored, whole blood, or inclusion in a MTP.
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Affiliation(s)
- Whitley Hulse
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - David S Morris
- Trauma and General Surgery, Intermountain Medical Center, Murray, Utah, USA
| | - Douglas S Richards
- Division of Maternal/Fetal Medicine, University of Utah Health and Intermountain Medical Center, Murray, Utah, USA.,Women and Newborn's Clinical Program, Intermountain Healthcare, Murray, Utah, USA
| | - Sarah J Ilstrup
- Department of Pathology, Intermountain Healthcare Transfusion Services and Intermountain Medical Center, Murray, Utah, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA.,Division of Maternal/Fetal Medicine, University of Utah Health and Intermountain Medical Center, Murray, Utah, USA.,Division of Hematology-Oncology, University of Utah Health, Salt Lake City, Utah, USA
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Morris DS, Braverman MA, Corean J, Myers JC, Xenakis E, Ireland K, Greebon L, Ilstrup S, Jenkins DH. Whole blood for postpartum hemorrhage: early experience at two institutions. Transfusion 2020; 60 Suppl 3:S31-S35. [PMID: 32478935 DOI: 10.1111/trf.15731] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Death from postpartum hemorrhage (PPH) remains a significant preventable problem worldwide. Cold-stored, low-titer, type-O whole blood (LTOWB) is increasingly being used for resuscitation of injured patients, but it is uncommon in PPH patients, and it is unclear what its role may be in this population. STUDY DESIGN AND METHODS Brief report of the early experience of WB use for PPH in two institutions, one university hospital and one private hospital. RESULTS Different approaches have been implemented at the two institutions, one designed for emergency release, uncrossmatched transfusion of LTOWB as part of a massive transfusion protocol (MTP) and one for high-risk obstetric patients with known placental abnormalities. A total of 7 PPH patients have received a total of 17 units of LTOWB between the two institutions. No severe adverse transfusion reactions were observed clinically in either institution and the clinical outcomes were favorable in all cases. CONCLUSION In our early experience, LTOWB can be implemented for two different PPH clinical scenarios. Larger studies are needed to compare outcomes between LTOWB and traditional component resuscitation strategies.
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Affiliation(s)
- David S Morris
- Division of Trauma, Intermountain Medical Center, Murray, Utah
| | - Maxwell A Braverman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Jessica Corean
- Division of Pathology, University of Utah, Salt Lake City, Utah
| | - John C Myers
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Elly Xenakis
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Kayla Ireland
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Leslie Greebon
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Sarah Ilstrup
- Division of Transfusion Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Donald H Jenkins
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
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Bahr TM, DuPont TL, Morris DS, Pierson SE, Esplin MS, Brown SM, O'Brien EA, Ilstrup SJ, Christensen RD. First report of using low‐titer cold‐stored type O whole blood in massive postpartum hemorrhage. Transfusion 2019; 59:3089-3092. [DOI: 10.1111/trf.15492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Timothy M. Bahr
- Division of Neonatology, Department of PediatricsUniversity of Utah Health Salt Lake City Utah
| | - Tara L. DuPont
- Division of Neonatology, Department of PediatricsUniversity of Utah Health Salt Lake City Utah
| | - David S. Morris
- Trauma and General SurgeryIntermountain Medical Center Salt Lake City Utah
| | - Spencer E. Pierson
- Department of Obstetrics and GynecologyIntermountain Medical Center Salt Lake City Utah
| | - Michael Sean Esplin
- Department of Obstetrics and GynecologyIntermountain Medical Center Salt Lake City Utah
- Women and Newborn's Clinical ProgramIntermountain Healthcare Salt Lake City Utah
- Department of Obstetrics and GynecologyUniversity of Utah Health Salt Lake City Utah
| | - Samuel M. Brown
- Divsion of Pulmonology, Department of Internal MedicineUniversity of Utah Health, and Shock/Trauma ICU, Intermountain Medical Center Salt Lake City Utah
| | - Elizabeth A. O'Brien
- Division of Neonatology, Department of PediatricsUniversity of Utah Health Salt Lake City Utah
- Women and Newborn's Clinical ProgramIntermountain Healthcare Salt Lake City Utah
| | - Sarah J. Ilstrup
- Intermountain Healthcare Transfusion Medicine Service and Department of Pathology Intermountain Medical Center Salt Lake City Utah
| | - Robert D. Christensen
- Division of Neonatology, Department of PediatricsUniversity of Utah Health Salt Lake City Utah
- Women and Newborn's Clinical ProgramIntermountain Healthcare Salt Lake City Utah
- Division of Hematology‐Oncology, Department of PediatricsUniversity of Utah Health Salt Lake City Utah
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Cullinane DC, Jawa RS, Como JJ, Moore AE, Morris DS, Cheriyan J, Guillamondegui OD, Goldberg SR, Petrey L, Schaefer GP, Khwaja KA, Rowell SE, Barbosa RR, Bass GA, Kasotakis G, Robinson BRH. Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2019; 86:505-515. [PMID: 30789470 DOI: 10.1097/ta.0000000000002146] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons. METHODS Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications. RESULTS Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data. CONCLUSIONS In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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Affiliation(s)
- Daniel C Cullinane
- From the Department of Surgery, Marshfield Clinic, Marshfield, Wisconsin (D.C.C.); Division of Trauma, Stony Brook University School of Medicine, Stony Brook, New York (R.S.J.); Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio (J.J.C.); Department of Surgery, Holmes Medical Center, Melbourne, Florida (A.M.); Department of Surgery, Intermountain Health Care, Murray, Utah (D.S.M.); Department of Surgery, Kern Medical Center, Bakersfield, California (J.C.); Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (O.D.G.); Department of Surgery, Virginia Commonwealth University, Richmond, Virginia (S.R.G.); Department of Surgery, Baylor University Medical Center, Dallas, Texas (L.P.); Department of Surgery, West Virginia University Medical Center, Morgantown, West Virginia (G.S.); Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada (K.A.K.); Department of Surgery, Oregon Health & Science University, Portland, Oregon (S.E.R.); Department of Surgery, Legacy Emmanuel Medical Center, Portland, Oregon (R.R.B.); Department of Surgery, St. Vincent's Hospital, Dublin, Ireland (G.A.B.); Department of Surgery, Boston Medical Center, Boston, Massachusetts (G.K.); and Department of Surgery, University of Washington, Seattle, Washington (B.R.H.R.)
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Kay AB, Majercik S, Sorensen J, Woller SC, Stevens SM, White TW, Morris DS, Baldwin M, Bledsoe JR. Weight-based enoxaparin dosing and deep vein thrombosis in hospitalized trauma patients: A double-blind, randomized, pilot study. Surgery 2018; 164:S0039-6060(18)30094-1. [PMID: 29699807 DOI: 10.1016/j.surg.2018.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Venous thromboembolism is a cause of morbidity and mortality in trauma patients. Chemoprophylaxis with low-molecular-weight heparin at a standardized dose is recommended. Conventional chemoprophylaxis may be inadequate. We hypothesized that a weight-adjusted enoxaparin prophylaxis regimen would reduce the frequency of venous thromboembolism in hospitalized trauma patients and at 90-day follow-up. METHODS This prospective, randomized pilot study enrolled adult patients admitted to a level 1 trauma center between July 2013 and January 2015. Subjects were randomized to receive either standard (30 mg subcutaneously every 12 hours) or weight-based (0.5mg/kg subcutaneously every 12 hours) enoxaparin. Surveillance duplex ultrasound for lower extremity deep vein thrombosis was performed on hospital days 1, 3, and 7, and weekly thereafter. The primary outcome was deep vein thrombosis during hospitalization. Secondary outcomes included venous thromboembolism at 90 days and significant bleeding events. RESULTS Two hundred thirty-four (124 standard, 110 weight-based) subjects were enrolled. There was no difference between standard and weight-based regarding age, body mass index, percentage female gender, injury severity score, or percentage that had surgery. There was a trend toward less in-hospital deep vein thrombosis in weight-based (12 [9.7%] standard vs 4 [3.6%] weight-based, P = .075). At 90 days, there was no difference in venous thromboembolism (12 [9.7%] standard vs 6 [5.5%] weight-based, P =.34). There was 1 bleeding event, which occurred in a standard subject. CONCLUSION Weight-based enoxaparin dosing for venous thromboembolism chemoprophylaxis in trauma patients may provide better protection against venous thromboembolism than standard. A definitive study is necessary to determine whether weight-based dosing is superior to standard.
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Affiliation(s)
- Annika Bickford Kay
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Sarah Majercik
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT.
| | - Jeffrey Sorensen
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Scott C Woller
- Department of Internal Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott M Stevens
- Department of Internal Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Thomas W White
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - David S Morris
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Margaret Baldwin
- Division of Trauma Services and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Medical Center, Murray, UT
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Hernandez M, Murphy B, Aho JM, Haddad NN, Saleem H, Zeb M, Morris DS, Jenkins DH, Zielinski M. Validation of the AAST EGS acute cholecystitis grade and comparison with the Tokyo guidelines. Surgery 2018; 163:739-746. [PMID: 29325783 DOI: 10.1016/j.surg.2017.10.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Acute cholecystitis presents with heterogeneous severity. The Tokyo Guidelines 2013 is a validated method to assess cholecystitis severity, but the variables are multifactorial. The American Association for the Surgery of Trauma (AAST) developed an anatomically based severity grading system for surgical diseases, including cholecystitis. Because the Tokyo Guidelines represent the gold standard to estimate acute cholecystitis severity, we wished to validate the AAST emergency general surgery scoring system and compare the performance of both systems for several patient outcomes. METHODS Adults (≥18 years) with acute cholecystitis during 2013-2016 were identified. Baseline demographic characteristics, comorbidity severity as defined by Charlson Comorbidity Index score, procedure types, and AAST and Tokyo Guidelines 2013 grades were abstracted. Outcomes included duration of stay, 30-day mortality, and complications. Comparison of the Tokyo Guidelines and AAST grading system was performed using receiver operating characteristic (AUROC) curve C statistics. RESULTS There were 443 patients, with a mean (±standard deviation) age of 64.8 (±18) years, 59% male. The median (interquartile ratio) Charlson Comorbidity score was 3 (0-6). Management included laparoscopic (n = 307, 69.3%), open (n = 26, 6%), laparoscopy converted to laparotomy (n = 53, 12%), and cholecystostomy (n = 57, 12.7%). Comparison of AAST with Tokyo Guidelines AUROC C statistics indicated (P < .05) mortality (0.86 vs 0.73), complication (0.76 vs 0.63), and cholecystostomy tube utilization (0.80 vs 0.68). CONCLUSION Emergency general surgery grading systems improve disease severity assessment, may improve documentation, and guide management. Discrimination of disease severity using the AAST grading system outperforms the Tokyo Guidelines for key clinical outcomes. The AAST grading system requires prospective validation and further comparison.
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Affiliation(s)
- Matthew Hernandez
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Brittany Murphy
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Johnathan M Aho
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nadeem N Haddad
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Humza Saleem
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Zeb
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - David S Morris
- Division of General Surgery, Trauma, and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Donald H Jenkins
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Zielinski
- Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN, USA
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Hernandez MC, Zielinski MD, Morris DS. In reply: Trauma patients presenting with a King laryngeal tube in place can be safely intubated in the emergency department. Am J Emerg Med 2017; 36:504. [PMID: 29248271 DOI: 10.1016/j.ajem.2017.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Matthew C Hernandez
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
| | - Martin D Zielinski
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
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Laan DV, Pandian TK, Jenkins DH, Kim BD, Morris DS. Swallowing dysfunction in elderly trauma patients. J Crit Care 2017; 42:324-327. [PMID: 28843860 DOI: 10.1016/j.jcrc.2017.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 06/20/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Newly diagnosed swallowing dysfunction is rare, with an incidence <1% in hospitalized patients. The purpose of this study was to evaluate the incidence and clinical characteristics of dysphagia in elderly trauma patients specifically. METHODS Patients ≥75years who had newly diagnosed swallowing dysfunction were identified by retrospective review of our institutional trauma database from 2009-2012. A comparison group without dysphagia was also identified that was matched by age, gender, injury mechanism, and injury severity score (ISS). Relevant demographics, injury characteristics, and potential factors associated with dysphagia were collected. RESULTS 1323 patients met criteria. Of these, 56(4.2%) had newly identified dysphagia. Cases and controls were similar in regards to regional injury pattern (AIS). Patients with dysphagia had a mean Charlson Comorbidity Index (CCI) of 3.7 vs. 1.9 for patients without dysphagia (p<0.01). Patients with dysphagia also had longer hospital (11.4 vs. 5.8days, p<0.01) and ICU LOS (5.6 vs 1.9days, p<0.01). On multivariable regression, CCI greater than 3 (OR 7.2, p<0.001), in-hospital complications (OR 9.6, p<0.01), and ICU LOS greater than 2days (OR 1.5, p<0.05) were independently associated with the diagnosis of dysphagia. CONCLUSIONS Elderly trauma patients with a high comorbidity burden or with prolonged ICU lengths of stay should be screened for dysphagia.
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Affiliation(s)
- Danuel V Laan
- Department of Surgery, Mayo Clinic. Divisions of Trauma, Critical Care, and General Surgery. 200 First ST SW, Rochester, MN 55905, United States.
| | - T K Pandian
- Department of Surgery, Mayo Clinic. Divisions of Trauma, Critical Care, and General Surgery. 200 First ST SW, Rochester, MN 55905, United States.
| | - Donald H Jenkins
- Department of Surgery, Mayo Clinic. Divisions of Trauma, Critical Care, and General Surgery. 200 First ST SW, Rochester, MN 55905, United States.
| | - Brian D Kim
- Department of Surgery, Mayo Clinic. Divisions of Trauma, Critical Care, and General Surgery. 200 First ST SW, Rochester, MN 55905, United States.
| | - David S Morris
- Department of Surgery, Mayo Clinic. Divisions of Trauma, Critical Care, and General Surgery. 200 First ST SW, Rochester, MN 55905, United States
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Ruparel RK, Laack TA, Brahmbhatt RD, Rowse PG, Aho JM, AlJamal YN, Kim BD, Morris DS, Farley DR, Campbell RL. Securing a Chest Tube Properly: A Simple Framework for Teaching Emergency Medicine Residents and Assessing Their Technical Abilities. J Emerg Med 2017; 53:110-115. [PMID: 28408233 DOI: 10.1016/j.jemermed.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 02/22/2017] [Accepted: 02/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Quality-improvement efforts at our institution have identified chest tube dislodgement as a preventable complication of tube thoracostomy. Because proper fixation techniques are not well described in the literature and are seldom formally taught, techniques vary among residents. OBJECTIVE Our aim was to develop and test a framework for teaching and assessing chest tube securement. METHODS A repeated-measures study design was used. At baseline, 19 emergency medicine residents (program years 1-3) placed and secured a chest tube in a cadaver. After a 45-min proficiency-based teaching session using a low-cost chest tube simulator (approximate cost, $5), each resident again placed and secured a chest tube in a cadaver, followed by 3-month retention testing. All securements were evaluated by two raters using a four-point checklist and a five-point global assessment scale (GAS). The checklist addressed suture selection, tying knots down to the tube, wound approximation, and tube displacement relative to skin. RESULTS After the initial educational intervention, median scores for the group improved significantly over baseline for the GAS (p < 0.001), checklist (p < 0.001), and amount of displacement (p = 0.01). At 3 months, GAS, checklist, and displacement scores did not differ significantly from the immediate post-test scores. Inter-rater reliability was substantial, with weighted κ values of .77 for the GAS and .70 for the checklist. CONCLUSIONS Quality of chest tube securement by emergency medicine residents can be significantly improved with an inexpensive chest tube simulator and a brief workshop. The four-point checklist served as a reliable and effective means for teaching and assessing chest tube securement.
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Affiliation(s)
- Raaj K Ruparel
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Torrey A Laack
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Brian D Kim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David S Morris
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
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Bruns BR, Morris DS, Zielinski M, Mowery NT, Miller PR, Arnold K, Phelan HA, Murry J, Turay D, Fam J, Oh JS, Gunter OL, Enniss T, Love JD, Skarupa D, Benns M, Fathalizadeh A, Leung PS, Carrick MM, Jewett B, Sakran J, O’Meara L, Herrera AV, Chen H, Scalea TM, Diaz JJ. Stapled versus hand-sewn. J Trauma Acute Care Surg 2017; 82:435-443. [DOI: 10.1097/ta.0000000000001354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Choudhry AJ, Haddad NN, Rivera M, Morris DS, Zietlow SP, Schiller HJ, Jenkins DH, Chowdhury NM, Zielinski MD. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law. Surgery 2016; 160:1017-1027. [DOI: 10.1016/j.surg.2016.06.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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Zietlow JM, Zietlow SP, Morris DS, Berns KS, Jenkins DH. Prehospital Use of Hemostatic Bandages and Tourniquets: Translation From Military Experience to Implementation in Civilian Trauma Care. J Spec Oper Med 2016; 15:48-53. [PMID: 26125164 DOI: 10.55460/1p70-3h9d] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the military use of tourniquets and hemostatic gauze is well established, few data exist regarding civilian emergency medical services (EMS) systems experience. METHODS A retrospective review was performed of consecutive patients with prehospital tourniquet and hemostatic gauze application in a single ground and rotor-wing rural medical transport service. Standard EMS registry data were reviewed for each case. RESULTS During the study period, which included 203,301 Gold Cross Ambulance and 8,987 Mayo One Transport records, 125 patients were treated with tourniquets and/or hemostatic gauze in the prehospital setting. Specifically, 77 tourniquets were used for 73 patients and 62 hemostatic dressings were applied to 52 patients. Seven patients required both interventions. Mechanisms of injury (MOIs) for tourniquet use were blunt trauma (50%), penetrating wounds (43%), and uncontrolled hemodialysis fistula bleeding (7%). Tourniquet placement was equitably distributed between upper and lower extremities, as well as proximal and distal locations. Mean tourniquet time was 27 minutes, with 98.7% success. Hemostatic bandage MOIs were blunt trauma (50%), penetrating wounds (35%), and other MOIs (15%). Hemostatic bandage application was head and neck (50%), extremities (36%), and torso (14%), with a 95% success rate. Training for both interventions was computer-based and hands-on, with maintained proficiency of %gt;95% after 2 years. CONCLUSION Civilian prehospital use of tourniquets and hemostatic gauze is feasible and effective at achieving hemostasis. Online and practical training programs result in proficiency of skills, which can be maintained despite infrequent use.
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Zeb MH, Pandian TK, El Khatib MM, Naik ND, Chandra A, Morris DS, Smoot RL, Farley DR. Risk factors for postoperative hematoma after inguinal hernia repair: an update. J Surg Res 2016; 205:33-7. [PMID: 27620996 DOI: 10.1016/j.jss.2016.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/19/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We recently sensed an increase in the frequency of groin hematoma after inguinal hernia repair (IHR) at our institution. The aim of this study was to provide a more updated assessment of the risk factors inherent to this complication. METHODS We performed a case-control study of all adult patients (age ≥ 18 y) who developed a groin hematoma after IHR at our institution between 2003 and 2015. Univariate and multivariable analyses were performed to assess for independent predictors for groin hematoma. RESULTS A total of 96 patients (among 6608 IHR) developed a groin hematoma, (60 were observed, 36 required intervention). The hematoma frequency increased from our previous study (1.4 % versus 0.9%, P < 0.01). Mean age was 64.6 y (range: 18-92), and 84.3% were men. There was no significant difference in the laterality, type, or technique of IHR between cases and controls. Univariate analysis (odds ratio [95% confidence interval], P) identified warfarin usage (3.5, [1.6-6.4], P < 0.01), valvular heart disease (11.6, [2.6-51.3], P < 0.01), atrial fibrillation (2.6, [1.2-5.5], P = 0.01), hypertension (2.03, [1.1-3.6], P = 0.02), recurrent hernia (3.7, [1.4-9.7], P < 0.01), and coronary artery disease (2.1, [1.0-4.4 ], P = 0.05) as significant preoperative factors. The proportion of patients on warfarin decreased since our prior report (31% versus 42%, P = 0.20). On multivariable regression, warfarin and recurrent hernia were independent predictors of hematoma development. CONCLUSIONS Independent risk factors for the development of groin hematoma after IHR included warfarin use and recurrent hernia. Careful consideration for anticoagulation and surgical hypervigilance remains prudent in all patients undergoing IHR and especially those with recurrence.
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Affiliation(s)
- Muhammad H Zeb
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - T K Pandian
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Moustafa M El Khatib
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nimesh D Naik
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Abhishek Chandra
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David S Morris
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rory L Smoot
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Farley
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Reisenauer JS, Kim BD, Cassivi SD, Cross WW, Morris DS, Schiller HJ. Repair of symptomatic non-union rib fractures: outcomes from a contemporary thoracic surgical series. J Cardiothorac Surg 2015. [PMCID: PMC4693821 DOI: 10.1186/1749-8090-10-s1-a205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Morris DS, Rohrbach J, Sundaram LMT, Sonnad S, Sarani B, Pascual J, Reilly P, Schwab CW, Sims C. Early hospital readmission in the trauma population: are the risk factors different? Injury 2014; 45:56-60. [PMID: 23726120 PMCID: PMC4149179 DOI: 10.1016/j.injury.2013.04.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/08/2013] [Accepted: 04/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hospital readmission rates will soon impact Medicare reimbursements. While risk factors for readmission have been described for medical and elective surgical patients, little is known about their predictive value specifically in trauma patients. PATIENTS AND METHODS We retrospectively identified all admissions after trauma resuscitation to our urban level 1 trauma centre from 1/1/2004 to 8/31/2010. All patients discharged alive were included. Data collected included demographics, Injury Severity Score (ISS), and length of stay (LOS). We analyzed these index admissions for the development of complications that have previously been shown to be associated with readmission. Readmissions that occurred within 30 days of index admission were identified. Univariable and multivariable analyses were performed. p<0.05 was considered significant. RESULTS We identified 10,306 index admissions, with 447 (4.3%) early (within 30 days) readmissions. Mean ISS was 11.1 (SD 10.4). On multivariable analysis, African-American race (OR 1.3, p=0.009), pre-existing chronic obstructive pulmonary disease (COPD) (OR 1.5, p=0.02), and diabetes mellitus (OR 1.8, p<0.001) were associated with readmission, along with higher ISS (OR 1.01, p<0.001), ICU admission (OR 2.1, p<0.001), and increased LOS (OR 1.01, p<0.001). Among many in-hospital complications examined, only the development of surgical site infection (SSI) (OR 1.9, p=0.02) was associated with increased risk of readmission. CONCLUSIONS Trauma patients have a low risk of readmission. In contrast to elective surgical patients, the only modifiable risk factor for readmission in our trauma population was SSI. Other risk factors may present clinicians with opportunities for targeted interventions, such as proactive follow up or early phone contact. With future changes to health care policy, clinicians may have even greater motivation to prevent readmission.
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Affiliation(s)
- David S. Morris
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Jeff Rohrbach
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Latha Mary Thanka Sundaram
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Seema Sonnad
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Babak Sarani
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Jose Pascual
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Patrick Reilly
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - C. William Schwab
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Carrie Sims
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
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Morris DS, Willis S, Minassian D, Foot B, Desai P, MacEwen CJ. The incidence of serious eye injury in Scotland: a prospective study. Eye (Lond) 2013; 28:34-40. [PMID: 24097120 DOI: 10.1038/eye.2013.213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 08/05/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ocular trauma remains an important cause of visual morbidity worldwide. A previous population-based study in Scotland reported a 1-year cumulative incidence of 8.14 per 100 000 population. The purpose of this study was to identify any change in the incidence and pattern of serious ocular trauma in Scotland. METHODS This study was a 1-year prospective observational study using the British Ophthalmological Surveillance Unit reporting scheme among Scottish ophthalmologists. Serious ocular trauma was defined as requiring hospital admission. Data were collected using two questionnaires for each patient 1 year apart. RESULTS The response rate from ophthalmologists was 77.1%. There were 102 patients reported with complete data giving an incidence of 1.96 per 100 000 population, four times less than in 1992. In patients younger than 65 years, the age-adjusted incidence ratio (males/females) indicated a ninefold higher risk of trauma in males. In 25 patients (27.2%), the injured eye was blind (final visual acuities (FVA) <6/60), 24 being attributable to the eye injury. Standardised morbidity ratios suggested a threefold decrease in risk of poor visual outcome in 2009 compared with 1992. CONCLUSIONS The incidence of serious ocular trauma has fallen; this study has shown hospital admission for serious eye injury in Scotland has decreased fourfold in 17 years. Young adult males continue to be at highest risk, which needs to be specifically addressed in future health-prevention strategies. This study also observed a reduction in visual loss from serious ocular injuries, although the reasons for this require further exploration.
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Affiliation(s)
- D S Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
| | - S Willis
- University of Cardiff Medical School, Cardiff, UK
| | - D Minassian
- The Institute of Ophthalmology, University College of London, London, UK
| | - B Foot
- British Ophthalmic Surveillance Unit, The Royal College of Ophthalmologists, London, UK
| | - P Desai
- Moorfields Eye Hospital, London, UK
| | - C J MacEwen
- University Department of Ophthalmology, Ninewells Hospital, Dundee, UK
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Barbara DW, Wetzel DR, Pulido JN, Pershing BS, Park SJ, Stulak JM, Zietlow SP, Morris DS, Boilson BA, Mauermann WJ. The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery. Mayo Clin Proc 2013; 88:674-82. [PMID: 23809318 DOI: 10.1016/j.mayocp.2013.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the perioperative management of patients with left ventricular assist devices (LVADs) who require general anesthesia while undergoing noncardiac surgery (NCS) at a single, large tertiary referral center. PATIENTS AND METHODS Electronic medical records from September 2, 2005, through May 31, 2012, were retrospectively reviewed to evaluate the perioperative management and outcomes in LVAD patients undergoing NCS. Patients were included only if they required a general anesthetic and had previously been discharged from the hospital after initial LVAD implantation. RESULTS Thirty-three patients with LVADs underwent general anesthesia for 67 noncardiac operations. The mean ± SD time from LVAD implantation to NCS was 317 ± 349 days. All but 1 patient had axial flow LVADs. Anticoagulation or antiplatelet agents were present within 7 days before NCS in 49 procedures (73%) and reversed in 32 of 49 (65%). No perioperative thrombotic complications related to anticoagulation or antiplatelet reversal were noted. Red blood cell, fresh frozen plasma, and platelet transfusions were administered during 10, 6, and 4 operations, respectively. The only intraoperative complication was surgical bleeding. Postoperative complications were present in 12 patients after NCS and were mainly composed of bleeding. Three patients died within 30 days of NCS, with the causes of death not attributed to NCS. CONCLUSION Patients with LVAD safely underwent NCS in a multidisciplinary setting that included preoperative optimization by cardiologists familiar with LVADs when feasible. Anticoagulation or antiplatelet agents were present preoperatively in most patients with LVADs and were safely reversed when necessary for NCS. The relatively high occurrence of postoperative bleeding is consistent with previous series.
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Culpepper BK, Morris DS, Prevelige PE, Bellis SL. Engineering nanocages with polyglutamate domains for coupling to hydroxyapatite biomaterials and allograft bone. Biomaterials 2013; 34:2455-62. [PMID: 23312905 DOI: 10.1016/j.biomaterials.2012.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/22/2012] [Indexed: 02/01/2023]
Abstract
Hydroxyapatite (HA) is the principal constituent of bone mineral, and synthetic HA is widely used as a biomaterial for bone repair. Previous work has shown that polyglutamate domains bind selectively to HA and that these domains can be utilized to couple bioactive peptides onto many different HA-containing materials. In the current study we have adapted this technology to engineer polyglutamate domains into cargo-loaded nanocage structures derived from the P22 bacteriophage. P22 nanocages have demonstrated significant potential as a drug delivery system due to their stability, large capacity for loading with a diversity of proteins and other types of cargo, and ability to resist degradation by proteases. Site-directed mutagenesis was used to modify the primary coding sequence of the P22 coat protein to incorporate glutamate-rich regions. Relative to wild-type P22, the polyglutamate-modified nanocages (E2-P22) exhibited increased binding to ceramic HA disks, particulate HA and allograft bone. Furthermore, E2-P22 binding was HA selective, as evidenced by negligible binding of the nanocages to non-HA materials including polystyrene, agarose, and polycaprolactone (PCL). Taken together these results establish a new mechanism for the directed coupling of nanocage drug delivery systems to a variety of HA-containing materials commonly used in diverse bone therapies.
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Affiliation(s)
- Bonnie K Culpepper
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Morris DS, Schweickert W, Holena D, Handzel R, Sims C, Pascual JL, Sarani B. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses. Resuscitation 2012; 83:1434-7. [PMID: 22841611 DOI: 10.1016/j.resuscitation.2012.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Although rapid response systems (RRS) have been shown to decrease the incidence of cardiac arrest (CA), there are no studies evaluating optimal staffing. We hypothesize that there are no outcome differences between ICU physician and senior resident led events. METHODS A retrospective study of the RRS database at a single, academic hospital was performed from July 1, 2006 to May 31, 2010. Surgical patients and those in the ICU were excluded. Daytime (D) was defined as 7 am-5 pm Monday through Friday, and weekends were defined as 5 pm on Friday to 6:59 am on Monday. The nurse to patient ratio is constant during all shifts. An ICU physician leads daytime events on weekdays whereas night/weekend (NW) events are led by residents. NW events were compared against D events using chi square or Fischer's exact test. Significance was defined as p<0.05. RESULTS A total of 1404 events were reviewed with 534 (38%) D and 870 (62%) NW events. Respiratory and staff concerns were more likely during NW compared to D (50% vs. 39% and 46% vs. 34%, p<0.001, respectively). Following RRS activation, no difference was noted between D and NW periods in the incidence of progression to CA, transfer to ICU, or hospital mortality. Invasive procedures were more common in the NW period. CONCLUSION Resident-led RRS may have similar outcomes to attending intensivist led events. Prospective studies are needed to determine the ideal team composition.
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Affiliation(s)
- David S Morris
- 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC 20037, United States
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Uchida M, Morris DS, Kang S, Jolley CC, Lucon J, Liepold LO, LaFrance B, Prevelige PE, Douglas T. Site-directed coordination chemistry with P22 virus-like particles. Langmuir 2012; 28:1998-2006. [PMID: 22166052 DOI: 10.1021/la203866c] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Protein cage nanoparticles (PCNs) are attractive platforms for developing functional nanomaterials using biomimetic approaches for functionalization and cargo encapsulation. Many strategies have been employed to direct the loading of molecular cargos inside a wide range of PCN architectures. Here we demonstrate the exploitation of a metal-ligand coordination bond with respect to the direct packing of guest molecules on the interior interface of a virus-like PCN derived from Salmonella typhimurium bacteriophage P22. The incorporation of these guest species was assessed using mass spectrometry, multiangle laser light scattering, and analytical ultracentrifugation. In addition to small-molecule encapsulation, this approach was also effective for the directed synthesis of a large macromolecular coordination polymer packed inside of the P22 capsid and initiated on the interior surface. A wide range of metals and ligands with different thermodynamic affinities and kinetic stabilities are potentially available for this approach, highlighting the potential for metal-ligand coordination chemistry to direct the site-specific incorporation of cargo molecules for a variety of applications.
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Affiliation(s)
- Masaki Uchida
- Department of Chemistry and Biochemistry, Montana State University, Bozeman, Montana, USA
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Morris DS, Rohrbach J, Rogers M, Thanka Sundaram LM, Sonnad S, Pascual J, Sarani B, Reilly P, Sims C. The Surgical Revolving Door: Risk Factors for Hospital Readmission. J Surg Res 2011; 170:297-301. [DOI: 10.1016/j.jss.2011.04.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/29/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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Affiliation(s)
- D S Morris
- Health Promotion and Chronic Disease Prevention, Oregon Public Health Division, 800 NE Oregon St, Suite 730, Portland, OR 97232, USA.
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Wang R, Morris DS, Tomlins SA, Lonigro RJ, Tsodikov A, Mehra R, Giordano TJ, Kunju LP, Lee CT, Weizer AZ, Chinnaiyan AM. Development of a multiplex quantitative PCR signature to predict progression in non-muscle-invasive bladder cancer. Cancer Res 2009; 69:3810-8. [PMID: 19383904 DOI: 10.1158/0008-5472.can-08-4405] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In bladder cancer, clinical grade and stage fail to capture outcome. We developed a clinically applicable quantitative PCR (QPCR) gene signature to predict progression in non-muscle-invasive bladder cancer. Comparative metaprofiling of 12 DNA microarray data sets (comprising 631 samples and 241,298 probe sets) identified 96 genes, which showed differential expression in seven clinical outcome categories, or were identified as outliers, historic markers, or housekeeping genes. QPCR was done to determine mRNA expression from 96 bladder tumors. Fifty-seven genes differentiated T2 from non-T2 tumors (P < 0.05). Principal components analysis and Cox regression models were used to predict probability of T2 progression for non-T2 patients, placing them into high- and low-risk groups based on their gene expression. At 2 years, high-risk patients exhibited greater T2 progression (45% for high-risk patients versus 12% for low-risk patients; P = 0.003, log-rank test). This difference remained significant within T1 tumors (61% for high-risk patients versus 22% for low-risk patients; P = 0.02) and Ta tumors (29% for high-risk patients versus 0% for low-risk patients; P = 0.03). The best multivariate Cox model included stage and gender, and this signature provided predictive improvement over both (P = 0.002, likelihood ratio test). Immunohistochemistry was done for two genes in the signature not previously described in bladder cancer, ACTN1 and CDC25B, corroborating their up-regulation at the protein level with disease progression. Thus, we identified a 57-gene QPCR panel to help predict progression of non-muscle-invasive bladder cancers and delineate a systematic, generalizable approach to converting microarray data into a multiplex assay for cancer progression.
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Affiliation(s)
- Rou Wang
- Department of Urology, Howard Hughes Medical Institute, University of Michigan, Ann Arbor, Michigan 48109-0944, USA
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Wang R, Faerber GJ, Roberts WW, Morris DS, Wolf JS. Single-center North American experience with wolf Piezolith 3000 in management of urinary calculi. Urology 2009; 73:958-63. [PMID: 19278719 DOI: 10.1016/j.urology.2008.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 04/23/2008] [Accepted: 06/02/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To review our experience with the newest generation piezoelectric lithotripter, the Piezolith 3000, in adult patients undergoing extracorporeal shock wave lithotripsy for solitary urinary calculi. METHODS We identified 139 shock wave lithotripsy procedures that had used the Piezolith 3000 from February 2005 to July 2007. All procedures were performed under intravenous sedation. Retrospective chart review was used to obtain the pertinent information. Stone-free status was defined as the absence of any fragments, and success as the absence of stone fragments >4 mm, on follow-up imaging after a single treatment. RESULTS The stone-free and success rate 1 month after a single shock wave lithotripsy session was 45% and 64%, respectively. Only stone size correlated with the overall success rate (P = .004). The overall complication rate was 15% and included a 5.8% major complication rate requiring intervention or admission. The median time in the procedure room was 33 minutes. The adjunctive procedure rate was 1.4%, and the secondary retreatment rate was 10%. CONCLUSIONS The Piezolith 3000 provides modest, but acceptable, single-treatment stone-free and success rates, with a reasonable safety profile, and offers rapid and convenient lithotripsy requiring only intravenous sedation.
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Affiliation(s)
- Rou Wang
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-0330, USA
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Morris DS, Elzaridi E, Clarke L, Dickinson AJ, Lawrence CM. Periocular basal cell carcinoma: 5-year outcome following Slow Mohs surgery with formalin-fixed paraffin-embedded sections and delayed closure. Br J Ophthalmol 2008; 93:474-6. [PMID: 19060015 DOI: 10.1136/bjo.2008.141325] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The aim of the study was to determine the 5-year outcome of periocular basal cell carcinoma (BCC) managed by Mohs surgery using formalin-fixed, paraffin-embedded sections (Slow Mohs). METHODS This was a prospective, non-comparative, interventional case series of all patients with periocular BCC treated by Slow Mohs in Newcastle upon Tyne, UK, between 1985 and 1999. Data collected included demographic information, indication for Slow Mohs, tumour site, histology, recurrence rate after 5 years and cosmetic outcome. RESULTS Of 287 BCCs in 278 patients, 5-year follow-up data were available for 173 (60.2%). Recurrence following Slow Mohs occurred in one patient: 0.34% of total and 0.58% of those with 5-year follow-up. The main indication for Slow Mohs was most frequently due to the tumour site. Cosmetic outcome was deemed excellent in 56%, good in 18%, adequate in 8%, unknown in 14% and revision advised in only 4%. CONCLUSION The low 5-year recurrence rate (0.58%) reported in this prospective series confirms the importance of margin-controlled removal of recurrent, poorly defined or critically sited BCCs, and illustrates that Slow Mohs is equivalent to standard Mohs. While delayed closure does not appear to compromise cosmetic outcome, this technique offers a histologically superior and cheaper alternative to frozen-section Mohs surgery.
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Affiliation(s)
- D S Morris
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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Abstract
Hemorrhage is a rare complication of acute cholecystitis. Patients who develop this complication often are receiving anticoagulation therapy or have a pathologic coagulopathy. We present a case of an elderly patient who developed hemorrhagic cholecystitis while taking aspirin and cilostazol, a phosphodiesterase inhibitor. The patient underwent an emergent abdominal exploration. A large, blood-filled gallbladder was found along with a large hematoma between the liver and gallbladder. We also briefly review the literature regarding hemorrhagic cholecystitis, hemorrhage into the biliary tree, and hemorrhage as a complication of aspirin and phosphodiesterase inhibitor therapy.
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Tomlins SA, Rhodes DR, Yu J, Varambally S, Mehra R, Perner S, Demichelis F, Helgeson BE, Laxman B, Morris DS, Cao Q, Cao X, Andrén O, Fall K, Johnson L, Wei JT, Shah RB, Al-Ahmadie H, Eastham JA, Eggener SE, Fine SW, Hotakainen K, Stenman UH, Tsodikov A, Gerald WL, Lilja H, Reuter VE, Kantoff PW, Scardino PT, Rubin MA, Bjartell AS, Chinnaiyan AM. The role of SPINK1 in ETS rearrangement-negative prostate cancers. Cancer Cell 2008; 13:519-28. [PMID: 18538735 PMCID: PMC2732022 DOI: 10.1016/j.ccr.2008.04.016] [Citation(s) in RCA: 247] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Revised: 04/01/2008] [Accepted: 04/29/2008] [Indexed: 01/28/2023]
Abstract
ETS gene fusions have been characterized in a majority of prostate cancers; however, the key molecular alterations in ETS-negative cancers are unclear. Here we used an outlier meta-analysis (meta-COPA) to identify SPINK1 outlier expression exclusively in a subset of ETS rearrangement-negative cancers ( approximately 10% of total cases). We validated the mutual exclusivity of SPINK1 expression and ETS fusion status, demonstrated that SPINK1 outlier expression can be detected noninvasively in urine, and observed that SPINK1 outlier expression is an independent predictor of biochemical recurrence after resection. We identified the aggressive 22RV1 cell line as a SPINK1 outlier expression model and demonstrate that SPINK1 knockdown in 22RV1 attenuates invasion, suggesting a functional role in ETS rearrangement-negative prostate cancers.
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Affiliation(s)
- Scott A. Tomlins
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Daniel R. Rhodes
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Biology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Jianjun Yu
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Biology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Sooryanarayana Varambally
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Rohit Mehra
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Sven Perner
- Department of Medicine, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
- Institute of Pathology, University, Hospitals Ulm, Ulm, Germany
| | - Francesca Demichelis
- Department of Pathology, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Beth E. Helgeson
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Bharathi Laxman
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - David S. Morris
- Center for Computational Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Qi Cao
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Ove Andrén
- Department of Urology, Örebro University Hospital, Örebro, Sweden
| | - Katja Fall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Johnson
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - John T. Wei
- Center for Computational Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Rajal B. Shah
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - James A. Eastham
- Department of Surgery /Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Scott E. Eggener
- Department of Surgery /Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kristina Hotakainen
- Department of Clinical Chemistry, Helsinki University Central Hospital, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, Helsinki University Central Hospital, Finland
| | - Alex Tsodikov
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Biology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Clinical Chemistry, Helsinki University Central Hospital, Finland
| | - William L. Gerald
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Hans Lilja
- Department of Surgery /Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY
- Clinical Laboratories and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Laboratory Medicine, University Hospital UMAS, Lund University, Malmö, Sweden
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Phillip W. Kantoff
- Department of Medicine, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Peter T. Scardino
- Department of Surgery /Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mark A. Rubin
- Department of Pathology, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Anders S. Bjartell
- Department of Surgery /Urology Services, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Urology, University Hospital UMAS, Lund University, Malmö, Sweden
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Howard Hughes Medical Institute, University of Michigan Medical School, Ann Arbor, MI 48109
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Biology, University of Michigan Medical School, Ann Arbor, MI 48109
- Center for Computational Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI 48109
- The Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109
- Address correspondence and requests for reprints to: Arul M. Chinnaiyan, M.D., Ph.D., Department of Pathology, University of Michigan Medical School, 1400 E. Medical Center Dr. 5316 CCGC, Ann Arbor, Michigan 48109-0602 Phone: (734) 615-4062 Fax: (734) 615-4498.
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Abstract
Chromosomal rearrangements play a causal role in haematological and mesenchymal malignancies. Importantly, the resulting gene fusions can serve as specific therapeutic targets, as exemplified by the development of imatinib (Gleevec), which specifically inhibits the BCR-ABL gene fusion product that defines chronic myeloid leukaemia. Recently, gene fusions involving the prostate-specific gene transmembrane protease, serine 2 (TMPRSS2) and members of the erythroblastosis virus E26 transforming sequence (ETS) family of transcription factors were identified in most of PSA-screened prostate cancers. In this review, we summarize the identification, characterization and detection of TMPRSS2:ETS gene fusions and their role in prostate cancer development. We also discuss the discovery of additional 5' partners that define distinct classes of ETS gene fusions based on the prostate specificity and androgen responsiveness of the 5' partner. Additionally, we also summarize conflicting reports about associations between gene fusion status and patient outcome. The specificity of ETS gene fusions in prostate cancer suggests that they may have causal roles in prostate cancer and suggest utility in prostate cancer detection, stratification and treatment.
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Affiliation(s)
- David S Morris
- Department of Urology, Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI 48109-0602, USA
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Morris DS, Tomlins SA, Rhodes DR, Yu J, Rubin MA, Bjartell AS, Chinnaiyan AM. OUTLIER EXPRESSION OF SPINK1 IDENTIFIES AN AGGRESSIVE MOLECULAR SUBTYPE IN PROSTATE CANCERS WITHOUT ETS GENE FUSIONS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wang R, Weizer AZ, Morris DS, Tomlins SA, Lonigro RJ, Tsodikov A, Lee CT, Chinnaiyan AM. DEVELOPMENT OF A MULTIPLEX QUANTITATIVE PCR SIGNATURE TO PREDICT POOR OUTCOME IN BLADDER CANCER. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morris DS, Tomlins SA, Rhodes DR, Wang R, Lonigro RJ, Lee CT, Weizer AZ, Chinnaiyan AM. INTEGRATIVE META-ANALYSIS OF MICROARRAY DATA TO IDENTIFY PROFILES THAT PREDICT BLADDER CANCER OUTCOMES AND PROGRESSION. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sutherland AI, Morris DS, Owen CG, Bron AJ, Roach RC. Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study. Br J Sports Med 2008; 42:183-8. [DOI: 10.1136/bjsm.2007.045286] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Laxman B, Morris DS, Yu J, Siddiqui J, Cao J, Mehra R, Lonigro RJ, Tsodikov A, Wei JT, Tomlins SA, Chinnaiyan AM. A first-generation multiplex biomarker analysis of urine for the early detection of prostate cancer. Cancer Res 2008; 68:645-9. [PMID: 18245462 DOI: 10.1158/0008-5472.can-07-3224] [Citation(s) in RCA: 332] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although prostate-specific antigen (PSA) serum level is currently the standard of care for prostate cancer screening in the United States, it lacks ideal specificity and additional biomarkers are needed to supplement or potentially replace serum PSA testing. Emerging evidence suggests that monitoring the noncoding RNA transcript PCA3 in urine may be useful in detecting prostate cancer in patients with elevated PSA levels. Here, we show that a multiplex panel of urine transcripts outperforms PCA3 transcript alone for the detection of prostate cancer. We measured the expression of seven putative prostate cancer biomarkers, including PCA3, in sedimented urine using quantitative PCR on a cohort of 234 patients presenting for biopsy or radical prostatectomy. By univariate analysis, we found that increased GOLPH2, SPINK1, and PCA3 transcript expression and TMPRSS2:ERG fusion status were significant predictors of prostate cancer. Multivariate regression analysis showed that a multiplexed model, including these biomarkers, outperformed serum PSA or PCA3 alone in detecting prostate cancer. The area under the receiver-operating characteristic curve was 0.758 for the multiplexed model versus 0.662 for PCA3 alone (P = 0.003). The sensitivity and specificity for the multiplexed model were 65.9% and 76.0%, respectively, and the positive and negative predictive values were 79.8% and 60.8%, respectively. Taken together, these results provide the framework for the development of highly optimized, multiplex urine biomarker tests for more accurate detection of prostate cancer.
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Affiliation(s)
- Bharathi Laxman
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109-0602, USA
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