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Tonneau M, Phan K, Manem VSK, Low-Kam C, Dutil F, Kazandjian S, Vanderweyen D, Panasci J, Malo J, Coulombe F, Gagné A, Elkrief A, Belkaïd W, Di Jorio L, Orain M, Bouchard N, Muanza T, Rybicki FJ, Kafi K, Huntsman D, Joubert P, Chandelier F, Routy B. Generalization optimizing machine learning to improve CT scan radiomics and assess immune checkpoint inhibitors' response in non-small cell lung cancer: a multicenter cohort study. Front Oncol 2023; 13:1196414. [PMID: 37546399 PMCID: PMC10400292 DOI: 10.3389/fonc.2023.1196414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023] Open
Abstract
Background Recent developments in artificial intelligence suggest that radiomics may represent a promising non-invasive biomarker to predict response to immune checkpoint inhibitors (ICIs). Nevertheless, validation of radiomics algorithms in independent cohorts remains a challenge due to variations in image acquisition and reconstruction. Using radiomics, we investigated the importance of scan normalization as part of a broader machine learning framework to enable model external generalizability to predict ICI response in non-small cell lung cancer (NSCLC) patients across different centers. Methods Radiomics features were extracted and compared from 642 advanced NSCLC patients on pre-ICI scans using established open-source PyRadiomics and a proprietary DeepRadiomics deep learning technology. The population was separated into two groups: a discovery cohort of 512 NSCLC patients from three academic centers and a validation cohort that included 130 NSCLC patients from a fourth center. We harmonized images to account for variations in reconstruction kernel, slice thicknesses, and device manufacturers. Multivariable models, evaluated using cross-validation, were used to estimate the predictive value of clinical variables, PD-L1 expression, and PyRadiomics or DeepRadiomics for progression-free survival at 6 months (PFS-6). Results The best prognostic factor for PFS-6, excluding radiomics features, was obtained with the combination of Clinical + PD-L1 expression (AUC = 0.66 in the discovery and 0.62 in the validation cohort). Without image harmonization, combining Clinical + PyRadiomics or DeepRadiomics delivered an AUC = 0.69 and 0.69, respectively, in the discovery cohort, but dropped to 0.57 and 0.52, in the validation cohort. This lack of generalizability was consistent with observations in principal component analysis clustered by CT scan parameters. Subsequently, image harmonization eliminated these clusters. The combination of Clinical + DeepRadiomics reached an AUC = 0.67 and 0.63 in the discovery and validation cohort, respectively. Conversely, the combination of Clinical + PyRadiomics failed generalizability validations, with AUC = 0.66 and 0.59. Conclusion We demonstrated that a risk prediction model combining Clinical + DeepRadiomics was generalizable following CT scan harmonization and machine learning generalization methods. These results had similar performances to routine oncology practice using Clinical + PD-L1. This study supports the strong potential of radiomics as a future non-invasive strategy to predict ICI response in advanced NSCLC.
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Affiliation(s)
- Marion Tonneau
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Université de Médecine, Lille, France
| | - Kim Phan
- Imagia Canexia Health, Montreal, QC, Canada
| | - Venkata S. K. Manem
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
- Department of Mathematics and Computer Science, University of Quebec at Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Suzanne Kazandjian
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Davy Vanderweyen
- Department of Radiology, Centre Hospitalier de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Justin Panasci
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Julie Malo
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
| | - François Coulombe
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Andréanne Gagné
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Arielle Elkrief
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Hemato-Oncology Division, Centre Hospitalier de l’université de Montreal, Montreal, QC, Canada
| | - Wiam Belkaïd
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
| | | | - Michele Orain
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
| | - Nicole Bouchard
- Department of Oncology, Centre Hospitalier de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Thierry Muanza
- Department of Medical Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Radiation Oncology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | | | - Kam Kafi
- Imagia Canexia Health, Montreal, QC, Canada
| | | | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Québec City, QC, Canada
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
| | | | - Bertrand Routy
- Department of Cancer Research, Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, QC, Canada
- Hemato-Oncology Division, Centre Hospitalier de l’université de Montreal, Montreal, QC, Canada
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2
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Phan K, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Abenhaim HA, Rahme E, Daskalopoulou SS. Arterial stiffness for the early prediction of pre-eclampsia compared with blood pressure, uterine artery Doppler and angiogenic biomarkers: a prospective cohort study. BJOG 2023. [PMID: 36807704 DOI: 10.1111/1471-0528.17430] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Our aim was to evaluate the ability of arterial stiffness parameters to predict pre-eclampsia early compared with peripheral blood pressure, uterine artery Doppler and established angiogenic biomarkers. DESIGN Prospective cohort study. SETTING Tertiary care antenatal clinics in Montreal, Canada. POPULATION Women with singleton high-risk pregnancies. METHODS In the first trimester, arterial stiffness was measured by applanation tonometry, along with peripheral blood pressure and serum/plasma angiogenic biomarkers; uterine artery Doppler was measured in the second trimester. The predictive ability of different metrics was assessed through multivariate logistic regression. MAIN OUTCOME MEASURES Arterial stiffness (carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity) and wave reflection (augmentation index, reflected wave start time), peripheral blood pressure, ultrasound indices of velocimetry and circulating angiogenic biomarker concentrations. RESULTS In this prospective study, among 191 high-risk pregnant women, 14 (7.3%) developed pre-eclampsia. A first-trimester 1 m/s increase in carotid-femoral pulse wave velocity was associated with 64% increased odds (P < 0.05), and a 1-millisecond increase in time to wave reflection with 11% decreased odds for pre-eclampsia (P < 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices and angiogenic biomarkers was 0.83 (95% confidence interval [CI] 0.74-0.92), 0.71 (95% CI 0.57-0.86), 0.58 (95% CI 0.39-0.77), and 0.64 (95% CI 0.44-0.83), respectively. With a 5% false-positive rate, blood pressure had a sensitivity of 14% for pre-eclampsia and arterial stiffness a sensitivity of 36%. CONCLUSIONS Arterial stiffness predicted pre-eclampsia earlier and with greater ability than blood pressure, ultrasound indices or angiogenic biomarkers.
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Affiliation(s)
- K Phan
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Y H Gomez
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - J Gorgui
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - A El-Messidi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - R Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - H A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - E Rahme
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - S S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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3
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Moon KS, Gombatto SP, Phan K, Ozturk Y. Extraction of Lumbar Spine Motion Using a 3-IMU Wearable Cluster. Sensors (Basel) 2022; 23:182. [PMID: 36616780 PMCID: PMC9823955 DOI: 10.3390/s23010182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Spine movement is a daily activity that can indicate health status changes, including low back pain (LBP) problems. Repetitious and continuous movement on the spine and incorrect postures during daily functional activities may lead to the potential development and persistence of LBP problems. Therefore, monitoring of posture and movement is essential when designing LBP interventions. Typically, LBP diagnosis is facilitated by monitoring upper body posture and movement impairments, particularly during functional activities using body motion sensors. This study presents a fully wireless multi-sensor cluster system to monitor spine movements. The study suggests an attempt to develop a new method to monitor the lumbopelvic movements of interest selectively. In addition, the research employs a custom-designed robotic lumbar spine simulator to generate the ideal lumbopelvic posture and movements for reference sensor data. The mechanical motion templates provide an automated sensor pattern recognition mechanism for diagnosing the LBP.
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Affiliation(s)
- Kee S. Moon
- Mechanical Engineering, College of Engineering, San Diego State University, San Diego, CA 92182, USA
| | - Sara P. Gombatto
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA
| | - Kim Phan
- Electrical and Computer Engineering, College of Engineering, San Diego State University, San Diego, CA 92182, USA
| | - Yusuf Ozturk
- Electrical and Computer Engineering, College of Engineering, San Diego State University, San Diego, CA 92182, USA
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Sidhu K, Kim D, Lebel D, Alshammari A, Photopoulos G, Duarte MP, Provost M, Nielsen C, Oitment C, Cowley R, Dumas E, Dea N, Versteeg A, Eltit F, Rampersaud YR, Dandurand C, Grassner L, Alduwaisan A, Kennedy C, Christie S, Toobaie A, Algarni N, El-Mughayyar D, Pahuta M, Grassner L, Pelletier-Roy R, Bak AB, Singh S, Abbas A, Abbas A, Abbas A, Ajisebutu A, Aldahamsheh O, Martin S, Baron N, Basiratzadeh S, Beresford-Cleary N, Good C, Thomson A, Bhatt F, Bhatt F, Good C, Thomson A, Blake N, Briand MM, Shah V, Chen T, Cherry A, Rocos B, Cherry A, Chua R, Chua R, Cotter T, Coyle MJ, Dandurand C, Dandurand C, Dandurand C, Dauphinee E, Dionne A, El Bojairami I, Duarte MP, Duarte MP, Elahi MT, Ellingwood N, Ells B, Fallah N, Fernandes R, Fernandes R, Fleury C, Flórez-Jiménez S, Li P, Gennari A, Georgiopoulos M, Greene R, Yu C, Werthmann N, Hakimjavadi R, Hakimjavadi R, Heard B, Hutchison C, Kemna C, Kennedy C, Laflamme M, Laskin J, MacLean M, Mac-Thiong JM, Manson N, Manson N, Manson N, Urquhart J, Kuepper E, Pahuta M, Pahuta M, Parker E, Persad A, Phan K, Rachevitz M, Ridha B, Dhaliwal P, Sakoto S, Sarraj M, Sarraj M, Hache P, Singh S, Slosar P, Sun M, Sundararajan K, Sundararajan K, Thornley P, Thornley P, Thornley P, Thornley P, Thorogood N, Toobaie A, Belhouari S, Olotu O, Du JT, Saleh I, Varga A, Varshney V, Versteeg A, Visnjevac O, Wang Z, Wasim A, Wasim A, Wu J, Filezio M, Singh V, Ferri-de-Barros F, Dermott J, Lebel D, Machida M, Bath N, Levin D, Campbell F, Koyle M, Isaac L, Ruskin D, Brennenstuh S, Stinson J, Navarro-Ramirez R, Rabau O, Ouellet JA, Hurry J, Brooks J, Fitzgerald R, Louer C, Murphy J, Shaw KA, Smit K, El-Hawary R, Joncas J, Parent S, Duval M, Chèmaly O, Brassard F, Mac-Thiong JM, Barchi S, Labelle H, Beauséjour M, Ishimo MC, Joncas J, Labelle H, Le May S, Lewis L, Arnold K, Oitment C, Jentzsch T, Lewis S, Rienmuller A, Jentzsch T, Yashuv HS, Martin A, Nielsen C, Berven S, Ludwig T, Coyle M, Asmussen M, Edwards B, Nicholls F, Bigney E, Fleury C, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, Lebel K, LaRue B, Investigators CSORN, Gal R, Verlaan JJ, Charest-Morin R, Fisher CG, Wessels H, Verkooijen L, Ng T, Gokaslan Z, Fisher C, Dea N, Charest-Morin R, Urquhart J, Glennie A, Fisher C, Bailey C, Mcintosh G, Fisher C, Paquet J, Abraham E, Bailey C, Weber M, Johnson M, Nataraj A, Glennie A, Attabib N, Kelly A, Hall H, Rampersaud R, Manson N, Phan P, Thomas K, Dea N, Thomé C, Kögl N, Vo AK, Kramer JLK, Petr O, Visva S, Phan K, Nguyen-Luu T, Stratton A, Kingwell S, Wai E, Phan P, Puskas D, Pahuta M, Marion T, Greene R, Kehler S, Rockwood K, Urquhart J, Thornley P, Rasoulinejad P, Glennie A, Rampersaud R, Manson N, Abraham E, Fisher C, Charest-Morin R, Paquette S, Gélinas-Phaneuf N, Thomas K, Dea N, Dvorak M, Kwon B, Street J, Ailon T, Christie S, Bailey C, McIntosh G, Dea N, Charest-Morin R, Adams T, Bigney E, Cunningham E, Richardson E, Vandewint A, Attabib N, Abraham E, Manson N, Small C, LeRoux A, Kolyvas G, Investigators CSORN, Hebert J, Jiang E, Fisk F, Taliaferro K, Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dvorak MF, Wellington C, Kwon BK, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau É, Mac-Thiong JM, Moghaddamjou A, Fehlings MG, Nadeau M, Fisher C, Toor J, Larouche J, Finkelstein J, Whyne C, Yee A, Toor J, Du JT, Versteeg A, Yee N, Finkelstein J, Abouali J, Nousiainen MT, Kreder H, Whyne C, Larouche J, Toor J, Lewis S, Finkelstein J, Larouche J, Yee A, Whyne C, Dhaliwal P, Hasan M, Berrington N, Johnson M, Burger L, Nicholls F, Evaniew N, Cobetto N, Aubin CE, Larson AN, Cheng Y, Fourney D, Hakimjavadi R, Michalowski W, Viktor H, Baddour N, Wai E, Stratton A, Kingwell S, Phan P, Dandurand C, Mawhinney G, Reynolds J, Orosz L, Thomson A, Bhatt F, Guth M, Allen B, Boyd D, Grigorian J, Schuler T, Jazini E, Haines C, Orosz L, Bhatt F, Allen B, Sabet A, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Namian S, Bharara N, Jazini E, Good C, Schuler T, Haines C, Orosz L, Tewari A, Roy R, Good C, Schuler T, Haines C, Jazini E, Orosz L, Thomson A, Bhatt F, Grigorian J, Schuler T, Haines C, Merril J, Roy R, Jazini E, Wang M, Orosz L, Haines C, Jazini E, Bhatt F, Sabet A, Roy R, Schuler T, Good C, Greene R, Schmidt M, Christie S, Richard-Denis A, Le MT, Lim V, Mac-Thiong JM, Gallagher M, Cheung A, Brown J, Chaudhry H, Yee C, McIntosh G, Christie S, Fisher C, Jarzem P, Roy JF, Bouchard J, Yee A, Eseonu K, Ahn H, Cherry A, Rampersaud R, Davidson B, Rabinovitch L, Nielsen C, Jiang F, Vaisman A, Lewis S, Canizares M, Rampersaud R, Investigators CSORN, Avila M, Burket A, Aguilar-Salinas P, Mongrain R, Ouellet J, Driscoll M, Schmidt-Braekling T, Dobransky J, Kreviazuk C, Gofton W, Phan P, Beaule P, Grammatopoulos G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Wilson J, Hall H, Bailey CS, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, Mcintosh G, Rasoulinejad P, Charest-Morin R, Hindi M, Farimani PL, Mashayekhi MS, Ailon T, Boyd M, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Urquhart J, Ailon T, Bailey C, Boyd M, Charest-Morin R, Dea N, Dvorak M, Glennie A, Kwon B, Paquette S, Rampersaud R, Street J, Fisher C, Vandewint A, Bigney E, El-Mughayyar D, Richardson E, Edward A, Manson N, Attabib N, Kolyvas G, Small C, Investigators CSORN, Mac-Thiong JM, Barthélémy D, Lim V, Richard-Denis A, Driscoll M, Aubin CE, Cobetto N, Roy-Beaudry M, Bellefleur C, Turgeon I, Labelle H, Barchi S, Parent S, Joncas J, Parent S, Labelle H, Barchi S, Mac-Thiong JM, Lee W, Phan P, Bigney E, Richardson E, El-Mughayyar D, Vandewint A, Abraham E, Manson N, Small C, Alugo T, Leroux A, Kolyvas G, Investigators CSORN, Attabib N, McIntosh G, Oxner W, Dunning PC, Glennie A, Wang D, Humphreys S, Noonan V, Urquhart J, Siddiqi F, Rasoulinejad P, Bailey C, Urquhart J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Fisher C, Bailey C, Investigators CSORN, Bigney E, Dumas E, El-Mughayyar D, Cherry A, Vanderwint A, Richardson E, Kerr J, McPhee R, Abraham E, Manson N, Attabib N, Small C, Couture J, Goulet J, Bédard S, LaRue B, Investigators CSORN, Macthiong JM, Bourassa-Moreau E, Ogden C, Gallagher M, Cheung A, Huong VT, Tarabay B, Al-Shakfa F, Yuh SJ, Shedid D, Boubez G, Wang Z, Gueziri HE, Santaguida C, Collins DL, Hall A, Alant J, Barry S, Weise L, Glennie A, Oxner B, Etchegary H, Christie S, Carreon L, Glassman S, Brown M, Daniels C, Polly D, Gum J, Gum J, Glassman S, Brown M, Daniels C, Carreon L, Hong HA, Fallah N, Humphreys S, Walden K, Noonan VK, Phan P, Basiratzadeh S, Wai EK, Phan P, Salo P, Krawetz R, Hart D, Bains I, Swamy G, Yang Q, Godoy A, Smith S, Lin C, Nataraj A, Puskas D, Pahuta M, Marion T, Dea N, Waheed Z, Thorogood N, Nightingale T, Noonan V, Touchette C, Duda T, Almojuela A, Bergeron D, Aljoghaiman M, Sader N, Kameda-Smith M, Alant J, Christie S, Hresko MT, Alzakri A, Parent S, Sucato DJ, Lenke LG, Marks M, Labelle H, Pereira P, Charles YP, Krutko A, Santos C, Park Y, Arzoglou V, Park SW, Franke J, Fuentes S, He S, Hosszu T, Varanda P, Mlyavykh S, Vanhauwaert D, Senker W, Franke J, Park Y, Charles YP, Santos C, Arzoglou V, Song Y, He S, Bhagat S, Hong JY, Vanhauwaert D, Senker W, Pereira P, Senker W, Charles YP, Pereira P, Santos C, Park Y, Arzoglou V, Park SW, Bordon G, Fuentes S, Song Y, Vialle E, Bhagat S, Krutko A, Franke J, Thornley P, Rampersaud R, Glennie A, Rasoulinejad P, Abraham E, Ailon T, Charest-Morin R, Dea N, Dvorak M, Gélinas-Phaneuf N, Kwon B, Manson N, Paquette S, Street J, Thomas K, Fisher C, Bailey C, Mishreky A, Hurry J, El-Hawary R, Jiang E, Fisk F, Taliaferro K, Dea N, Investigators CSORN, Al Anazi M, El-Hawary R, Kindrachuk M, Noyes E, Wu A, Fourney D, Pratt M, Wai E, Stratton A, Kingwell S, Wang Z, Phan P, Robarts S, Razmjou H, Yee A, Larouche J, Finkelstein J, Persad A, Huschi Z, Cheng Y, Fourney D, Rossong H, Zhang H, Johnson M, Goytan M, Zarrabian M, Berrington N, Zeiler F, Charles A, Roy-Beaudy, Parent S, Duong L, Marion T, Guha D, Pahuta M, Hache P, Oitment C, Guha D, Pahuta M, Sarraj M, Oitment C, Guha D, Pahuta M, Miyanji F, McAnany S, Cheung A, Dewitt D, Street J, Jurisica I, Perruccio AV, Rampersaud YR, Niu Y, Perruccio AV, Jurisica I, Rampersaud YR, Glennie A, Alahmari A, Al-Jahdali F, Fisher C, Rampersaud R, Urquhart J, Bailey C, Urquhart J, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Urquhart J, Rampersaud R, Glennie A, Fisher C, Bailey C, Harback K, Akpinar I, Adjetey C, Tindall D, Chernesky J, Noonan V, Fernandes RJR, Bailey C, Siddiqi F, Rasoulinejad P, Toor J, Abbas A, Brooks H, Larouche J, Abbas A, Bhatia A, Selimovic D, Larouche J, Yee A, Lewis S, Finkelstein J, Toor J, Abbas A, Toor J, Versteeg A, Finkelstein J, Toor J, Abbas A, Ahn H, Larouche J, Finkelstein J, Whyne C, Yee A, Slomp F, Thiessen E, Lastivnyak N, Maclean LS, Ritchie V, Hockley A, Osborn J, Paquette S, Sahjpaul R, Gal R, Charest-Morin R, Verlaan JJ, Wessels H, Fisher CG, Verkooijen L, Pastrak M, Truong VT, Liberman M, Al-Shakfa F, Yuh SJ, Soder SA, Wu J, Sunna T, Renaud-Charest É, Boubez G, Shedid D, Balasuberamaniam P, Shrikumar M, Chen T, Anthony T, Phillips A, Nathens A, Chapman M, Crawford E, Stark R, Schwartz C, Finkelstein J, Small C, Rampersaud R. Canadian Spine SocietyAbstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments?Abstract 74. How useful is prereferral spine imaging? A quality improvement projectAbstract 82. Early recovery after surgery, predictors of shorter length of stayAbstract 68. Gliding screws on early-onset scoliosis: a 5-year experienceAbstract 66. Reliability of radiographic assessment of growth modulation from anterior vertebral body tethering surgery in pediatric scoliosisAbstract 16. A dangerous curve: impact of the COVID-19 pandemic on brace treatment in adolescent idiopathic scoliosisAbstract 24. Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosisAbstract 94. Recognizing the importance of self-image in adult spinal deformity: results from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS)Abstract 25. Assessing pain as a primary factor in the surgical treatment of adult spinal deformity surgery in patients over 60 years of ageAbstract 72. Application of the Ames-International Spine Study Group (AMES) radiographic modifiers to an asymptomatic population. Are the thresholds for “normal” appropriate?Abstract 109. Exploring the relationship between cannabis and narcotic use on preoperative health considerations in Canadian thoracolumbar patients: a CSORN studyAbstract 36. Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyAbstract 91. What do patients expect of palliative treatment for symptomatic spinal metastases? A qualitative studyAbstract 44. Denosumab for giant cell tumours of the spine: molecular predictors of clinical response — a pilot studyAbstract 89. Surgical management and outcomes from “stable” degenerative spondylolisthesis (DS) from the CSORN prospective DS study: What the @#$ % are we doing?Abstract 33. Economic consequences of waiting for lumbar disc herniation surgeryAbstract 108. Motor recovery depends on timing of surgery in patients with lumbar disc herniationAbstract 106. Outcomes following revision decompression for lumbar spinal stenosis when compared to primary decompression: a matched cohort analysis using the Canadian Spine Outcomes and Research Network registryAbstract 64. Patient engagement, remote monitoring and virtual care — a pilot project in rural and remote patients undergoing elective lumbar surgeryAbstract 84. Development of a frailty index from the Canadian Spine Outcomes and Research Network (CSORN) to predict long-term success of surgery for patients with degenerative pathologies of the spineAbstract 102. Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis: analysis from the CSORN prospective LDS propensity score matched studyAbstract 31. Impact on patient-reported outcomes of ending the posterior construct proximally at C2 versus C3 in degenerative cervical myelopathy patientsAbstract 42. Perioperative factors predict 2-year trajectories of pain and disability following anterior cervical discectomy and fusionAbstract 61. Calculating utilities from the modified Japanese Orthopaedic Association score: a prerequisite for quantifying the value of care for cervical myelopathyAbstract 119. Serum neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP) biomarkers and their association with MRI findings in human acute traumatic spinal cord injuryAbstract 95. The Montreal Acute Classification of Spinal Cord Injury (MAC-SCI): a new tool to detect and characterize spinal cord injury in the trauma patientAbstract 118. Mechanism of injury is associated with neurologic outcomes after cervical sensorimotor complete acute traumatic spinal cord injuryAbstract 13. Patient perspective: diagnosis and prognosis of acute spinal cord injuriesAbstract 136. Predictive analytics to improve dedicated spine trauma operating room resource allocationAbstract 138. Machine learning models to predict surgical resident workload at a level 1 trauma centreAbstract 139. Machine learning to predict duration of surgery and length of stay for single-level discectomy proceduresAbstract 9. Outpatient spinal surgery in ManitobaAbstract 131. Unexpected positive culture in presumed aseptic revision spine surgery: a systematic review and meta-analysisAbstract 50. Lumbar anterior vertebral body tethering: biomechanical assessment of the surgical decision factors influencing the immediate and 2 years postoperative correctionAbstract 145. Does prolonged symptom duration influence surgical outcomes for cervical radiculopathy?Abstract 147. A data-driven cluster analysis approach to create homogenous subgroups for traumatic spine injury: toward improving traditional classificationAbstract 41. The use of neo-adjuvant denosumab in treatment of giant cell tumours of the spineAbstract 5. Complications, revision rates and accuracy of robotic-guided S2 alar-iliac screw placementAbstract 6. Opioid use after spine surgery: How much are we over-prescribing?Abstract 7. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at 1 yearAbstract 8. Augmented reality–assisted spine surgery: an early experience demonstrating safety and accuracy with 218 screwsAbstract 22. Comparison of complications, revision rates and fluoroscopy time using the latest technology in robotic-guided surgery with historical fluoroscopic-guided controlsAbstract 23. Robotic-guided thoracolumbar fusion experience: a multi-surgeon, single-centre study of 628 patients and 3874 robotic-guided screws from 2012 to 2020Abstract 86. A province-wide assessment of the appropriateness of lumbar spine MRIAbstract 134. Concomitant traumatic spinal cord injury and brain injury diagnoses are more frequent and impactful than expectedAbstract 45. Spatial and depth mapping of nascent mineralization on Ti6Al4V surfaces demonstrating hierarchical macro-micro-nanoscale surface featuresAbstract 111. Propensity-matched outcomes comparing lumbar interbody fusion and total disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyAbstract 30. A Canadian-based pilot study of current surgical practice and implant preferences in lumbar fusion surgeryAbstract 32. Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusionsAbstract 99. Comparing patient preoperative expectations and postoperative expectation fulfillment between minimally invasive versus open fusion surgeryAbstract 146. Outpatient robotic-assisted lumbar spinal fusion using the Mazor X Stealth EditionAbstract 149. Lessons learned from my first 100 robotic-assisted lumbar fusions using the Mazor X Stealth Edition: surgical synergy with MIS, surgical navigation and roboticsAbstract 151. Freehand biomechanical testing for use in lumbar discectomy trainingAbstract 48. Spinal pathology and outcome post-THA: Does segment of arthrodesis matter?Abstract 27. Patient, surgical and institutional factors associated with length of stay in degenerative lumbar spine surgery: national multicentre cohort analysis from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 28. The impact of the increasing proportion of degenerative spine emergency admissionsAbstract 51. Patient’s expectations of surgery for degenerative spondylolisthesis: analysis by site and type of surgery from the Canadian Spine Outcomes and Research Network (CSORN)Abstract 60. The impact of sex on thoracolumbar surgery outcomes in patients with diabetes — a CSORN studyAbstract 81. The impact of older age on rehabilitation outcomes following functional motor-incomplete traumatic spinal cord injuryAbstract 47. Devise and investigate a novel, intramuscular pressure based, muscle activation strategy in a spine stability modelAbstract 17. 3D radiologic outcomes for patients with moderate idiopathic scoliosis curves treated with internal (anterior vertebral growth modulation) versus external bracing: a 2-year observational studyAbstract 18. Is quality of life affected by concomitant isthmic spondylolisthesis when undergoing surgery for adolescent idiopathic scoliosis and nonsurgical management of the spondylolisthesis?Abstract 128. Toward macrostructural and microstructural investigation of the cervical spinal cord through quantitative analysis of T2-weighted and diffusion-weighted imagingAbstract 26. Minimally invasive versus open thoracolumbar spine surgery for patients who have lumbar spinal stenosis and an ASA score of 3 or above: a CSORN studyAbstract 101. Association between surgeon age and outcomes of spine surgery: a population-based retrospective cohort studyAbstract 77. Utilizing machine learning methodology to create a short form of the Multi-Morbidity Index in spinal cord injuryAbstract 70. Ten-year reoperation rate and clinical outcome in patients treated surgically for lumbar spinal stenosisAbstract 105. Assessing the importance of radiographic and clinical parameters when choosing decompression without fusion for LDS: results from the CSORN prospective DS studyAbstract 104. Preoperative cannabis use in Canadian thoracolumbar spine surgery patients: a CSORN studyAbstract 142. Post-traumatic ascending myelitis, about 2 cases, etiologic analysis and treatmentAbstract 55. NanoLOCK surfaces enhance osteoblast activities at the cellular levelAbstract 76. Which scoring system is the most accurate for predicting survival in patients undergoing surgery for spinal metastases from lung cancer?Abstract 11. Pedicle screw insertion using ultrasound-based navigation without intraoperative radiation: feasibility study on porcine cadaversAbstract 85. What barriers prevent patients being discharged from hospital following elective spine surgery?Abstract 15. Propensity-matched comparison of 90-day complications in robotic-assisted versus non-robotic-assisted lumbar fusionAbstract 56. No-tap (2-step) robotic-assisted cortical bone trajectory (RA-CBT) screw insertion is safe and efficient: comparative analysis of 179 patients and 924 RA-CBT screwsAbstract 124. Developing a Web-based application to promote the adoption of a clinical prediction model for independent walking in people with traumatic spinal cord injury — a protocolAbstract 125. Multivariable prediction models for prognostication after traumatic spinal cord injury — a systematic reviewAbstract 148. Expression of blood serum cytokines in the presentation of acute sciaticaAbstract 150. Do patient-reported outcome scores (PROs) correlate with bundled payment plan performance for elective spine surgeries?Abstract 46. Effects of delayed neurosurgery on anxiety, depression and economic burdenAbstract 69. Care close to home — a retrospective analysis of patients undergoing elective lumbar surgery in a rural satellite hospitalAbstract 110. Surgical adverse events for primary tumours of the spine and their impact on prognosis and outcomes: a PTRON studyAbstract 80. Spinal cord stimulation research in the restoration of function for individuals living with spinal cord injuries: a scoping reviewAbstract 132. Workup and management of asymptomatic extracranial traumatic vertebral artery injury: a Canadian Neurosurgery Resident Research Collaborative studyAbstract 12. A surgical treatment algorithm for restoring pelvic balance and health-related quality of life in high-grade lumbosacral spondylolisthesisAbstract 38. Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre studyAbstract 39. Clinical outcomes and fusion success in patients with degenerative lumbar disease without spondylolisthesis: comparing anterolateral to posterior MIS approaches from a global multicentre studyAbstract 40. Anterolateral versus posterior approaches to minimally invasive interbody fusion for patients with spondylolisthesis: results at 1-year follow-up from a global multicentre studyAbstract 73. Benefit of minimally invasive lumbar interbody fusion versus traditional interbody fusion versus posterolateral spinal fusion in lumbar degenerative spondylolisthesis: a propensity-matched analysis from the CSORN prospective LDS studyAbstract 67. The effect of fusionless pediatric scoliosis surgery on 3D radiographic spinopelvic alignmentAbstract 62. Calculating utilities from the Neck Disability Index: a prerequisite for quantifying the value of cervical spine careAbstract 63. The psychometric properties of the mJOA for quality-of-life assessments in cervical myelopathyAbstract 59. Low radius of curvature growth friendly implants increases the risk of developing clinically significant proximal junctional kyphosisAbstract 144. Very long–term outcome of single-level minimally invasive lumbar microdiscectomy with a tubular retractorAbstract 112. Metal implant hypersensitivity in patients undergoing spinal surgery: a literature review and case reportAbstract 43. Diagnostic value of the lumbar spinal stenosis (SSHQ) survey in virtual care provided at a tertiary spine programAbstract 54. Is the Calgary Postoperative Pain After Spine Surgery (CAPPS) score correlated with long-term outcomes after lumbar fusion?Abstract 4. Development of a single-entry referral pathway for patients with spinal conditions in Manitoba: a cross-sectional review of impact and potential way forward for Canadian spine programsAbstract 113. Automatization of bone age calculationAbstract 123. An effectiveness and quality-of-life analysis of conservative care versus surgery for moderate and severe cervical myelopathyAbstract 133. Long-term survivorship of cervical spine procedures: a survivorship meta-analysis and meta-regressionAbstract 137. Natural history of degenerative cervical myelopathy: a meta-analysis and neurologic deterioration survival curve synthesisAbstract 14. Does intraoperative vancomycin powder affect postoperative infections in adolescent idiopathic scoliosis?Abstract 37. The clinical impact of nano-surface technology on postoperative opioid consumption in patients undergoing anterior lumbar interbody fusionAbstract 130. Design and implementation of a comprehensive perioperative complex spine communication toolAbstract 87. Stratifying low back pain patients in an inter-professional education and self-management model of care: results of a latent class analysisAbstract 88. Cohort accuracy versus confidence at the patient level: clinical challenges for AI-based prediction of low back pain outcomesAbstract 96. Preoperative disc angle is an important predictor of segmental lordosis after degenerative spondylolisthesis fusionAbstract 97. Preoperative depression, functional and radiographic outcomes after surgery for degenerative lumbar spondylolisthesisAbstract 116. A CSORN study of functional outcomes after surgery for lumbar degenerative spondylolisthesisAbstract 121. A CSORN study of the effect on radiographic alignment outcomes with different surgery type for degenerative lumbar spondylolisthesisAbstract 79. Spinal cord stimulation to restore neurological function: a costing analysisAbstract 107. Biomechanical properties of a novel morselized bone graft cageAbstract 93. Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating roomAbstract 103. Machine learning models can predict subsequent publication of North American Spine Society Annual General Meeting abstractsAbstract 117. The use of primary sacroiliac joint fusion for lower back pain due to sacroiliac joint pathology: a systematic review and meta-analysisAbstract 141. How to make the most of your operative time by optimizing surgical schedulingAbstract 126. Altering physician referral practices remains a challenge: a spine assessment clinic quality improvement studyAbstract 152. Outcomes of workers’ compensation patients undergoing neuromodulation for persistent neuropathic pain conditionsAbstract 90. Expectations of treatment outcomes in patients with spinal metastases: What do we tell our patients? A qualitative studyAbstract 52. Fluoroscopically guided radiofrequency ablation of the superior cluneal nerve: preliminary outcomes data for a minimally invasive approach for treating superior cluneal neuralgiaAbstract 21. Single-stage posterior approach for en bloc resection and spinal reconstruction of T4 Pancoast tumour invading spineAbstract 34. Predictors of sacral ulcers in patients with complete spinal cord injuryAbstract 135. Targeting geographic wait time disparities in Canada: a rapid review of domestic and international strategies to reduce orthopedic wait times in the MaritimesAbstract 143. The influence of coronal plane parameters on patient-reported outcome measures in patients undergoing decompression for lumbar spinal stenosis. Can J Surg 2022. [DOI: 10.1503/cjs.011622] [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: 12/13/2022] Open
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Phan K, Budiansky A, Miller E, Phan P, Dubois D. Novel use of transesophageal echocardiography to optimize hemodynamics and patient positioning during prone scoliosis surgery and safety considerations in the setting of intraoperative neuromonitoring: a case report. Can J Anaesth 2022; 69:1556-1561. [PMID: 36198993 DOI: 10.1007/s12630-022-02334-w] [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: 04/19/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prone position can lead to anatomical compression of the thoracic cavity resulting in reduced cardiac output, especially in the context of chest wall deformities commonly present in patients with scoliosis. There are no protocols for using transesophageal echocardiography (TEE) to optimize prone positioning and for safe use of TEE during cases requiring neuromonitoring. CLINICAL FEATURES We present a case of a 23-yr-old male with Cornelia de Lange syndrome undergoing elective posterior spinal fusion for syndromic scoliosis who developed severe refractory hypotension and cardiac arrest in the prone position. After hemodynamic stabilization in the intensive care unit, the patient returned to the operating room on postoperative day 2 for completion of his spinal fusion. Transesophageal echocardiography determined the optimal position of longitudinal bolster placements associated with minimal left ventricular compression in the supine position. The patient was then proned and intraoperative hemodynamics during the second surgery remained stable. Owing to the special considerations of using TEE in the prone position with neuromonitoring, we describe technical aspects to consider to protect the equipment and patient. CONCLUSION Patients with compliant chest walls or thoracic deformities are at risk of hemodynamic instability in the prone position. Intraoperative TEE can be used in the supine patient prior to proning to determine optimal longitudinal bolster positioning to minimize cardiac compression. Transesophageal echocardiography used during spine surgery in the prone position with neuromonitoring and motor-evoked potentials requires special considerations for patient safety.
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Affiliation(s)
- Kim Phan
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adele Budiansky
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Miller
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Philippe Phan
- Department of Orthopedics, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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Raiker R, Pakhchanian H, Phan K. 271 The association between primary focal hyperhidrosis and psychiatric illnesses. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.278] [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: 10/17/2022]
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Phan K, Pamidi S, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Kimoff RJ, Abenhaim HA, Daskalopoulou SS. Sleep-disordered breathing in high-risk pregnancies is associated with elevated arterial stiffness and increased risk for preeclampsia. Am J Obstet Gynecol 2022; 226:833.e1-833.e20. [PMID: 34863697 DOI: 10.1016/j.ajog.2021.11.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Impaired vascular function is a central feature of pathologic processes preceding the onset of preeclampsia. Arterial stiffness, a composite indicator of vascular health and an important vascular biomarker, has been found to be increased throughout pregnancy in those who develop preeclampsia and at the time of preeclampsia diagnosis. Although sleep-disordered breathing in pregnancy has been associated with increased risk for preeclampsia, it is unknown if sleep-disordered breathing is associated with elevated arterial stiffness in pregnancy. OBJECTIVE This prospective observational cohort study aimed to evaluate arterial stiffness in pregnant women, with and without sleep-disordered breathing and assess the interaction between arterial stiffness, sleep-disordered breathing, and preeclampsia risk. STUDY DESIGN Women with high-risk singleton pregnancies were enrolled at 10 to 13 weeks' gestation and completed the Epworth Sleepiness Score, Pittsburgh Sleep Quality Index, and Restless Legs Syndrome questionnaires at each trimester. Sleep-disordered breathing was defined as loud snoring or witnessed apneas (≥3 times per week). Central arterial stiffness (carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness), peripheral arterial stiffness (carotid-radial pulse wave velocity), wave reflection (augmentation index, time to wave reflection), and hemodynamics (central blood pressures, pulse pressure amplification) were assessed noninvasively using applanation tonometry at recruitment and every 4 weeks from recruitment until delivery. RESULTS High-risk pregnant women (n=181) were included in the study. Women with sleep-disordered breathing (n=41; 23%) had increased carotid-femoral pulse wave velocity throughout gestation independent of blood pressure and body mass index (P=.042). Differences observed in other vascular measures were not maintained after adjustment for confounders. Excessive daytime sleepiness, defined by Epworth Sleepiness Score >10, was associated with increased carotid-femoral pulse wave velocity only in women with sleep-disordered breathing (Pinteraction=.001). Midgestation (first or second trimester) sleep-disordered breathing was associated with an odds ratio of 3.4 (0.9-12.9) for preeclampsia, which increased to 5.7 (1.1-26.0) in women with sleep-disordered breathing and hypersomnolence, whereas late (third-trimester) sleep-disordered breathing was associated with an odds ratio of 8.2 (1.5-39.5) for preeclampsia. CONCLUSION High-risk pregnant women with midgestational sleep-disordered breathing had greater arterial stiffness throughout gestation than those without. Sleep-disordered breathing at any time during pregnancy was also associated with increased preeclampsia risk, and this effect was amplified by hypersomnolence.
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Phan K, Eipe N, Phan P. Neurogenic shock in a patient with cervical myelopathy from severe cervical kyphoscoliosis. Can J Anaesth 2022; 69:674-675. [DOI: 10.1007/s12630-022-02198-0] [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] [Received: 12/10/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
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Phan K, Den Broeck EV, Raes K, De Clerck K, Speybroeck VV, De Meester S. A comparative theoretical study on the solvent dependency of anthocyanin extraction profiles. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.118606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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Lai B, Phan K, Lewis N, Shumack S. A rare case of vernal keratoconjunctivitis in a patient with atopic dermatitis treated with tralokinumab. J Eur Acad Dermatol Venereol 2021; 36:e343-e345. [PMID: 34807480 DOI: 10.1111/jdv.17824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/03/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Affiliation(s)
- B Lai
- St George Dermatology and Skin Cancer Centre, Kogarah, NSW, Australia
| | - K Phan
- St George Dermatology and Skin Cancer Centre, Kogarah, NSW, Australia
| | - N Lewis
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,University of Sydney Medical School, Sydney, NSW, Australia
| | - S Shumack
- St George Dermatology and Skin Cancer Centre, Kogarah, NSW, Australia.,University of Sydney Medical School, Sydney, NSW, Australia.,Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Ong CS, Oh L, Ghozy S, Dmytriw A, Mobbs R, Phan K, Dibas M, Faulkner H. 846 Dysphagia Rates in Single- And Multiple-Level Anterior Cervical Discectomy and Fusion Surgery: A Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To conduct a meta-analysis to assess dysphagia complicating single-level and multiple-level (≥2) anterior cervical discectomy and fusion (ACDF) surgery.
Method
Electronic searches were performed using four electronic databases from their inception to December 2017. Relevant studies reporting the rate of dysphagia as an endpoint for patients undergoing ACDF for degenerative disease, myelopathy, cervical canal stenosis or ossification of the posterior longitudinal ligament were identified according to prior inclusion and exclusion criteria. Statistical analysis was performed using a fixed effect model. P-scores were used to rank the levels of ACDF based on the rate of dysphagia. I2 was used to explore heterogeneity.
Results
Ten studies were identified and included in the systematic review and meta-analysis, with a total of 4,018 patients identified; 2,362 patients underwent single-level ACDF, while 1,656 underwent multiple level (≥2 ACDF). The mean age ranged from 49.45 to 57.77 years. Mean follow-up time ranged from 2 days to 27.3 months. Overall, meta-analysis demonstrated a statistically significant higher dysphagia rate for multiple-level ACDF (6.6%) than for single-level ACDF (4%) (P heterogeneity =0.151, OR = 1.42, 95% CI: 1.05–1.91, I2=32%).
Conclusions
Dysphagia is a relatively common complication in the early postoperative period following ACDF and may cause patients significant discomfort and distress. This meta-analysis demonstrates a higher rate of dysphagia with multiple-level ACDF than with single-level ACDF at a period of 12–24 months.
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Affiliation(s)
- C S Ong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - L Oh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - S Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - A Dmytriw
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - R Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - K Phan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - M Dibas
- Sulaiman Al Rajhi Colleges, College of Medicine, Al Bukayriyah, Saudi Arabia
| | - H Faulkner
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Ong CS, Choy WJ, Phan K, Diwan A, Mobbs R. 843 Annular Closure Device for Disc Herniation: Meta-Analysis of Clinical Outcome and Complications. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assist surgeons to determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications.
Method
Four electronic full-text databases were systematically searched through September 2017. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics.
Results
Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P < 0.0001). Durotomies were lower among the ACD/AR patients with only 3 reported cases compared to 7 in the control group (OR: 0.54; 95% CI: 0.13, 2.23; I2 = 11%; P = 0.39). Similar outcomes for post-operative Oswestry Disability Index and visual analogue scale were obtained when both groups were compared.
Conclusions
Early results showed the use of Barricaid and Anulex devices are beneficial for short term outcomes demonstrating a reduction in symptomatic disc reherniation with low post-operative complication rates. Long-term studies are required to further investigate the efficacy of such devices.
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Affiliation(s)
- C S Ong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - W J Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - K Phan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - A Diwan
- Department of Orthopaedic Surgery, St. George & Sutherland Clinical School, University of New South Wales, New South Wales, Australia
| | - R Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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Raiker R, Pakhchanian H, Phan K. LB751 COVID-19 complications in patients with Hidradenitis Suppurativa: A multicenter study. J Invest Dermatol 2021. [PMCID: PMC8374138 DOI: 10.1016/j.jid.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Tonneau M, Phan K, Kazandjian S, Elkrief A, Panasci J, Richard C, Nolin-Lapalme A, El Sayed R, Ding L, Nair T, Malo J, Chandelier F, Kafi K, O'Brien J, Di Jorio L, Muanza T, Routy B. 1357P A deep radiomics approach to assess PD-L1 expression and clinical outcomes in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors: A multicentric study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Soares A, Nguyen T, Phan K, Gabelli S, Kreitler D. A simple technique to classify diffraction data from dynamic proteins according to individual polymorphs. Acta Crystallogr A Found Adv 2021. [DOI: 10.1107/s0108767321097361] [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: 11/11/2022] Open
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Phan K, Bessman M, Rodríguez J, Gabelli S. Structural basis of inhibition of the NUDIX family ORF141. Acta Crystallogr A Found Adv 2021. [DOI: 10.1107/s010876732109718x] [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: 11/10/2022] Open
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DeVries Z, Locke E, Hoda M, Moravek D, Phan K, Stratton A, Kingwell S, Wai EK, Phan P. Using a national surgical database to predict complications following posterior lumbar surgery and comparing the area under the curve and F1-score for the assessment of prognostic capability. Spine J 2021; 21:1135-1142. [PMID: 33601012 DOI: 10.1016/j.spinee.2021.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/11/2021] [Accepted: 02/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND With spinal surgery rates increasing in North America, models that are able to accurately predict which patients are at greater risk of developing complications are highly warranted. However, the previously published methods which have used large, multi-centre databases to develop their prediction models have relied on the receiver operator characteristics curve with the associated area under the curve (AUC) to assess their model's performance. Recently, it has been found that a precision-recall curve with the associated F1-score could provide a more realistic analysis for these models. PURPOSE To develop a logistic regression (LR) model for the prediction of complications following posterior lumbar spine surgery and to then assess for any difference in performance of the model when using the AUC versus the F1-score. STUDY DESIGN Retrospective review of a prospective cohort. PATIENT SAMPLE The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) registry was used. All patients that underwent posterior lumbar spine surgery between 2005 to 2016 with appropriate data were included. OUTCOME MEASURES Both the AUC and F1-score were utilized to assess the prognostic performance of the prediction model. METHODS In order to develop the LR model used to predict a complication during or following spine surgery, 19 variables were selected by three orthopedic spine surgeons from the NSQIP registry. Two datasets were developed for this analysis: (1) an imbalanced dataset, which was taken directly from the NSQIP registry, and (2) a down-sampled set. The purpose of the down-sampled set was to balance the data in order to evaluate whether balancing the data had an effect on model performance. The AUC and F1-score were applied to both of these datasets. RESULTS Within the NSQIP database, 52,787 spine surgery cases were identified of which only 10% of these cases had complications during surgery. Applying the LR model showed a large difference between the AUC (0.69) and the F1 score (0.075) on the imbalanced dataset. However, no major differences existed between the AUC and F1-score when the data was balanced and the LR model was reapplied (0.69 and 0.62, AUC and F1-score, respectively). CONCLUSIONS The F1-score detected a drastically lower performance for the prediction of complications when using the imbalanced data, but detected a performance similar to the AUC level when balancing techniques were utilized for the dataset. This difference is due to a low precision score when many false positive classifications are present, which is not identified when using the AUC value. This lowers the utility of the AUC score, as many of the datasets used in medicine are imbalanced. Therefore, we recommend using the F1-score on large, prospective databases when the data is imbalanced with a large amount of true negative classifications.
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Affiliation(s)
- Zachary DeVries
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
| | - Eric Locke
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
| | - Mohamad Hoda
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
| | - Dita Moravek
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9; Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9
| | - Kim Phan
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
| | - Alexandra Stratton
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9
| | - Stephen Kingwell
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9
| | - Eugene K Wai
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9
| | - Philippe Phan
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9; Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada K1Y 4E9.
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Phan K, Schiller I, Dendukuri N, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Daskalopoulou SS. A longitudinal analysis of arterial stiffness and wave reflection in preeclampsia: Identification of changepoints. Metabolism 2021; 120:154794. [PMID: 33971204 DOI: 10.1016/j.metabol.2021.154794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Preeclampsia (PrE) is a leading complication of pregnancy characterized by vascular dysfunction. Characterizing the longitudinal changes in vascular function prior to PrE onset is critical to the identification of optimal timepoints for vascular assessment and the development of effective early screening strategies. METHODS In this prospective longitudinal study of women with singleton high-risk pregnancies, arterial stiffness and wave reflection parameters were assessed using applanation tonometry at 10-13 weeks' gestation and repeated every 4 weeks throughout pregnancy. Changepoints in carotid-femoral pulse wave velocity (cfPWV), carotid-radial PWV (crPWV), augmentation index (AIx), time to wave reflection (T1R), pulse pressure amplification (PPA), and subendocardial viability ratio (SEVR) were compared between women who did and did not subsequently develop PrE. RESULTS A changepoint in cfPWV and crPWV was detected at 14-17 weeks' gestation. cfPWV then increased in women who went on to develop PrE but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22-25 weeks' gestation. Conversely, crPWV converged in the two groups from a baseline difference of 1.05 m/s (95% credible interval: 0.37, 1.72). Women who subsequently developed PrE demonstrated an increase in AIx at 18-21 weeks' gestation that was not seen in women who did not develop PrE until 30-33 weeks. No differences in T1R, PPA, or SEVR were observed between the groups. CONCLUSIONS Altered vascular adaptations were detected using measures of arterial stiffness and wave reflection in the early second trimester of pregnant women who developed PrE compared to those who did not. These findings demonstrate the potential clinical utility of arterial stiffness and wave reflection parameters as an early screening tool for PrE, which can be used to inform clinical management of high-risk pregnancies.
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Affiliation(s)
- Kim Phan
- Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Ian Schiller
- Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Nandini Dendukuri
- Division of Clinical Epidemiology, McGill University Health Centre - Research Institute, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Yessica-Haydee Gomez
- Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Jessica Gorgui
- Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Amira El-Messidi
- Department of Obstetrics and Gynecology, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada; Division of Internal Medicine, Department of Medicine, McGill University, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
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Grover P, Phan K, Magge T, Chou A, Naffouje R, Jandarov R, Grate L, Hinrichs BH, Charif M. Association of tumor infiltrating lymphocytes with pathological response after neoadjuvant therapy in breast cancer: A retrospective study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12621 Background: Tumor infiltrating lymphocytes (TILs) are thought to represent favorable host anti-tumor immunity and play an important role in mediating response to chemotherapy in breast cancer. TILs are heterogenous across breast cancer subtypes and are increasingly being studied as prognostic and predictive biomarkers. We undertook a retrospective study to establish the relationship between pre-treatment density of TILs and subsequent quality of response to neoadjuvant chemotherapy in patients with early-stage breast cancer. Methods: We retrospectively identified women with breast cancer who had received neoadjuvant therapy (NAT) at the University of Cincinnati from 2012-2018. Clinical and pathological variables were extracted from medical records. Pre-treatment core biopsies were assessed for intra-tumoral TILs through independent pathology review and were graded as mild (grade 1), moderate (grade 2) or severe (grade 3). Post-treatment resection samples were assessed for pathological complete response (pathCR). Univariate analysis was done to determine the association between TILs and pathCR. Results: We identified 148 patients with breast cancer who received NAT, median age 53 years (25-90), 77 were Caucasian. 32 patients had stage I disease at diagnosis, 87 stage II and 29 stage III. Most patients had tumor grade 2 (n=50) or 3 (n=91). 50 patients were HER2+, 65 ER/PR+ HER2- (HR+) and 33 had triple negative breast cancer (TNBC). 69 patients received anthracycline based NAT, 29 non-anthracycline based NAT and all HER2+ patients received anti-HER2 therapy. 72 patients had TILs grade 1, 54 grade 2 and 22 had grade 3. 50 patients achieved pathCR. On univariate analysis grade 2 and 3 TILs were associated with higher likelihood of pathCR compared to grade 1 (42.1% vs 25%, OR 2.18, [1.08 – 4.4], p = 0.029). There was no difference in pathCR between grade 2 and grade 3 TILs (40.7% vs 45.5%, OR 1.21 [0.45-3.29], p=0.12). Tumor grade 3 was associated with higher pathCR than grade 1 or 2 (41.8 vs 21.1%, OR 2.69 [1.26-5.75], p=0.01). Amongst breast cancer subtypes, pathCR was lower in HR+(13.8%) compared to TNBC (45.5%) or HER2+ (52%) with OR 0.15 (0.06-0.36), p<0.01. Age, race, stage and type of chemotherapy were not associated with pathCR. On multivariate analysis, none of the variables retained significance. Conclusions: Our analysis shows that increased TILs density (grade 2 or 3) and higher tumor grade are associated with pathCR whereas HR+ breast cancer have a lower rate of pathCR after NAT. Immune characterization of TILs might be helpful in further refining the prognostic impact of TILs.[Table: see text]
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Affiliation(s)
- Punita Grover
- University of Cincinnati Medical Center, Cincinnati, OH
| | - Kim Phan
- Desert Regional Medical Center, Palm Springs, CA
| | - Tara Magge
- University of Cincinnati, Cincinnati, OH
| | | | | | | | - Lisa Grate
- UC Health-University of Cincinnati Medical Center, Cincinnati, OH
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Landry MJ, Phan K, McGuirt JT, Ostrander A, Ademu L, Seibold M, McCallops K, Tracy T, Fleischhacker SE, Karpyn A. USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Vendor Criteria: An Examination of US Administrative Agency Variations. Int J Environ Res Public Health 2021; 18:ijerph18073545. [PMID: 33805495 PMCID: PMC8037245 DOI: 10.3390/ijerph18073545] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/09/2023]
Abstract
The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.
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Affiliation(s)
- Matthew J. Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA 94305, USA;
| | - Kim Phan
- Harvard College, Harvard University, Cambridge, MA 02138, USA;
| | - Jared T. McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC 27412, USA;
| | - Alek Ostrander
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lilian Ademu
- College of Liberal Arts and Sciences, University of North Carolina Charlotte, Charlotte, NC 28223, USA;
| | - Mia Seibold
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | - Kathleen McCallops
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | - Tara Tracy
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
| | | | - Allison Karpyn
- Center for Research in Education & Social Policy, College of Education & Human Development, University of Delaware, Newark, DE 19716, USA; (M.S.); (K.M.); (T.T.)
- Correspondence:
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21
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Phan K, De Meester S, Raes K, De Clerck K, Van Speybroeck V. A Comparative Study on the Photophysical Properties of Anthocyanins and Pyranoanthocyanins. Chemistry 2021; 27:5956-5971. [PMID: 33453093 DOI: 10.1002/chem.202004639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/21/2020] [Indexed: 11/09/2022]
Abstract
Anthocyanins and pyranoanthocyanins are flavonoids that are present in various food products (e.g., fruit, vegetables, wine, etc.). The large chemical diversity amongst these molecules leads to compound-specific properties such as color and stability towards external conditions. These properties are also attractive for food and non-food applications. The photophysical experimental characterization is not easy as this generally demands advanced analytical techniques along with optimized separation procedures. Molecular modeling can provide insights into the fundamental understanding of the photophysical properties of these compounds in a uniform way for a broad set of compounds. However, the current literature is quite fragmented on this topic. Herein, a large set of 140 naturally derived anthocyanins was evaluated in a systematic way with three functionals (B3LYP, PBE0, and CAM-B3LYP). The accuracy of these functionals was determined with experimental literature λmax,vis values. In addition to λmax,vis values, time-dependent (TD)-DFT calculations also provided oscillator strengths, molar absorption coefficients, and orbital energies, which define whether specific natural anthocyanin-based compounds can be deployed in food and non-food applications such as food additives/colorants, textile dyeing, analytical standards, and dye-sensitized solar cells (DSSCs).
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Affiliation(s)
- Kim Phan
- Laboratory for Circular Process Engineering (LCPE), Department of Green Chemistry and Technology, Ghent University, Campus Kortrijk, Graaf Karel de Goedelaan 5, 8500, Kortrijk, Belgium
| | - Steven De Meester
- Laboratory for Circular Process Engineering (LCPE), Department of Green Chemistry and Technology, Ghent University, Campus Kortrijk, Graaf Karel de Goedelaan 5, 8500, Kortrijk, Belgium
| | - Katleen Raes
- Research Unit VEG-i-TEC, Department of Food Technology, Safety and Health, Ghent University Campus Kortrijk, Graaf Karel de Goedelaan 5, 8500, Kortrijk, Belgium
| | - Karen De Clerck
- Department of Materials, Textiles and Chemical Engineering (MaTCh), Ghent University, Technologiepark 70A, 9052, Zwijnaarde, Belgium
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Phan K, Dehle F, Spiteri C, Toomeh E, Taylor C, Bohensky M. PCN85 Comparison of Observed LONG-TERM Overall Survival with Extrapolated Overall Survival for Pembrolizumab Monotherapy Assessed By Australian Reimbursement Authorities. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.135] [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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23
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Elkrief A, Phan K, Di Jorio L, Simpson R, Chassé M, Malo J, Richard C, Kosyakov M, Chandelier F, Kafi K, Routy B. 1394P Deep learning model to predict clinical outcomes in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1708] [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] Open
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24
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Phan K, Shi W, Chang TH, Aytenfisu T, Soares A, Jakoncic J, Hernandez de la Peña A, Amzel LM, Gabelli S. Native SAD data collection using microbeam at NSLSII. Acta Crystallogr A Found Adv 2020. [DOI: 10.1107/s0108767320099419] [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: 11/10/2022] Open
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25
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Phan K, Smith S. Lichen planopilaris and dyslipidaemia: systematic review and meta‐analysis. Clin Exp Dermatol 2020; 45:611-613. [DOI: 10.1111/ced.14190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- K. Phan
- Department of Dermatology Liverpool Hospital Liverpool Australia
| | - S.D. Smith
- Department of Dermatology Royal North Shore Hospital St Leonards Australia
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26
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Oh LJ, Phan K, Kim SW, Low TH, Gupta R, Clark JR. Elective neck dissection versus observation for early-stage oral squamous cell carcinoma: Systematic review and meta-analysis. Oral Oncol 2020; 105:104661. [PMID: 32244173 DOI: 10.1016/j.oraloncology.2020.104661] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) is the seventh most common cancer globally, and has been identified as a growing health concern. This study aims to evaluate the current literature comparing elective neck dissection to observation in the treatment of early-stage tongue SCC, focusing on nodal recurrence, overall survival, disease specific survival statistics from randomised controlled trials comparing the two interventions. METHODS Systematic review and meta-analysis was conducted according to PRISMA guidelines. The odds ratio (OR) was used as a summary statistic. RESULTS From 8 studies, there was a total of 372 cases of recurrence, 98 (15.1%) in END group and 274 (41.5%) in the Observation group. There was a significantly lower rate of recurrence in the END group compared to observation (OR 0.25, 95% CI 0.16-0.39, I2 = 54%, P < 0.00001). END was associated with higher overall survival rates when compared with observation (OR 1.95, 95% CI 1.40-2.73, I2 = 14%, P < 0.0001). END was also associated with higher disease-specific survival compared with observation (OR 1.88, 95% CI 1.21-2.93), I2 = 47%, P = 0.005), with no significant heterogeneity noted. CONCLUSIONS END was associated with significantly lower recurrence rates and higher overall and disease-specific survival compared to a conservative observation approach in early-stage oral SCC with clinically N0 neck.
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Affiliation(s)
- L J Oh
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia.
| | - K Phan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - S W Kim
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - T H Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia
| | - R Gupta
- Central Clinical School, University of Sydney, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - J R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia
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Phan K, Phan P, Stratton A, Kingwell S, Hoda M, Wai E. Impact of resident involvement on cervical and lumbar spine surgery outcomes. Spine J 2019; 19:1905-1910. [PMID: 31323330 DOI: 10.1016/j.spinee.2019.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Resident involvement in the operating room is a vital component of their medical education. Conflicting and limited research exists regarding the effects of surgical resident participation on spine surgery patient outcomes. PURPOSE To determine the effect of resident involvement on surgery duration, length of hospital stay and 30-day postoperative complication rates in common spinal surgery using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. STUDY DESIGN Multicenter retrospective cohort study. PATIENT SAMPLE A total of 1,441 patients met the inclusion criteria: 1,142 patients had surgeries with an attending physician alone and 299 patients had surgeries with trainee involvement. All anterior cervical or posterior lumbar surgery patients were identified. Patients who had missing trainee involvement information, surgery for cancer, preoperative infection or dirty wound classification, spine fractures, traumatic spinal cord injury, intradural surgery, thoracic surgery, and emergency surgery were excluded. OUTCOME MEASURES The main outcomes of interest analyzed from the ACS-NSQIP database included surgical complications, medical complications, length of hospital stay, and surgery duration. METHODS Propensity score for risk of any complication was calculated to account for baseline characteristic differences between the attending alone and trainee present group. Multivariate logistic regression was used to investigate the impact of resident involvement on surgery duration, length of hospital stay, and 30-day postoperative complication rates. RESULTS After adjusting using the calculated propensity score, the multivariate analysis demonstrated that there was no significant difference in any complication rates between surgeries involving trainees compared to surgeries with attending surgeons alone. Surgery times were found to be significantly longer for surgeries involving trainees. To further explore this relationship, separate analyses were performed for tertiles of predicted surgery duration, cervical or lumbar surgery, fusion or nonfusion, and inpatient or outpatient surgery. The effect of trainee involvement on increasing surgery time remained significant for medium predicted surgery duration, longer predicted surgery duration, cervical surgery, lumbar surgery, fusion surgery, and inpatient surgery. There were no significant differences reported for any other factors. CONCLUSIONS After adjusting for confounding, we demonstrated in a national database that resident involvement in surgeries did not increase complication rates. We demonstrated that surgeries with more complex features may lead to an increase in operative time when trainees are involved. Further study is required to determine how to efficiently integrate resident involvement in surgeries without affecting their medical education.
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Affiliation(s)
- Kim Phan
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Stratton
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stephen Kingwell
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mohamad Hoda
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eugene Wai
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Phan K, Sebaratnam DF. JAK inhibitors for alopecia areata: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:850-856. [PMID: 30762909 DOI: 10.1111/jdv.15489] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022]
Abstract
There have been a number of case reports and small clinical trials reporting promising outcomes of Janus Kinase (JAK) inhibitors tofacitinib, ruxolitinib and baricitinib for alopecia areata (AA). The majority of the literature to date is based on small volume data, with a lack of definitive evidence or guidelines. To determine the expected response of AA to JAK inhibitor therapy and factors which influence response and recurrence rates. A systematic review and meta-analysis was performed according to PRISMA guidelines. From 30 studies and 289 cases, there were 72.4% responders, good responders 45.7% and partial responders 21.4%. Mean time to initial hair growth was 2.2 ± 6.7 months, and time to complete hair regrowth was 6.7 ± 2.2 months. All 37 recurrences occurred when treatment was ceased after 2.7 months. Oral route was significantly associated with response to treatment compared to topical therapy. No difference was found between paediatric and adult cases in proportion of responses. There is promising low-quality evidence regarding the effectiveness of JAK inhibitors in AA. Future large-sized randomized studies are required to confirm findings.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - D F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Departments of Dermatology, Sydney Children's Hospitals' Network, Sydney, NSW, Australia
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Dmytriw AA, Phan K, Moore JM, Pereira VM, Krings T, Thomas AJ. On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management. AJNR Am J Neuroradiol 2019; 40:591-600. [PMID: 30894358 DOI: 10.3174/ajnr.a6006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/25/2019] [Indexed: 12/15/2022]
Abstract
Uptake of flow-diverting technology is rapidly outpacing the availability of clinical evidence. Most current usage is off-label, and the endovascular community is nearer the beginning than the end of the learning curve, given the number of devices in development. A comprehensive overview of technical specifications alongside key outcome data is essential both for clinical decision-making and to direct further investigations. Most-studied has been the Pipeline Embolization Device, which has undergone a transition to the Pipeline Flex for which outcome data are sparse or heterogeneous. Alternative endoluminal devices do not appear to be outperforming the Pipeline Embolization Device to date, though prospective studies and long-term data mostly are lacking, and between-study comparisons must be treated with caution. Nominal technical specifications may be unrelated to in situ performance, emphasizing the importance of correct radiologic sizing and device placement. Devices designed specifically for bifurcation aneurysms also lack long-term outcome data or have only recently become available for clinical use. There are no major studies directly comparing a flow-diverting device with standard coiling or microsurgical clipping. Data on flow-diverting stents are too limited in terms of long-term outcomes to reliably inform clinical decision-making. The best available evidence supports using a single endoluminal device for most indications. Recommendations on the suitability and choice of a device for bifurcation or ruptured aneurysms or for anatomically complex lesions cannot be made on the basis of current evidence. The appropriateness of flow-diverting treatment must be decided on a case-by-case basis, considering experience and the relative risks against standard approaches or observation.
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Affiliation(s)
- A A Dmytriw
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada .,Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Phan
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,NeuroSpine Surgery Research Group (K.P.), Prince of Wales Private Hospital, Sydney, Australia
| | - J M Moore
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - V M Pereira
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - T Krings
- From the Department of Medical Imaging (A.A.D., V.M.P., T.K.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A J Thomas
- Neurosurgical Service (A.A.D., K.P., J.M.M., A.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and diabetes mellitus: updated systematic review and adjusted meta-analysis. Clin Exp Dermatol 2019; 44:e126-e132. [PMID: 30730068 DOI: 10.1111/ced.13922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating and distressing chronic inflammatory skin disease. There is also evolving evidence supporting the association between HS and cardiovascular risk factors, including smoking, obesity, hyperlipidaemia and metabolic syndrome. Notably, these are clinical features and risk factors that are closely associated with type 2 diabetes mellitus (DM). AIMS We performed a pooled adjusted meta-analysis of comparative studies to investigate the relationship between HS and DM. METHODS A systematic review and meta-analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OR was used as the summary effect size. RESULTS From pooled analysis of unadjusted data from 12 studies, we found a significantly higher proportion of DM in HS cases compared with non-HS healthy controls (16.1% vs. 15.7%; OR = 2.17; 95% CI 1.85-2.55; P < 0.001). Adjusted effect sizes from five studies were also pooled. A significantly higher proportion of DM was found for HS compared with healthy controls, although the effect size was attenuated compared with unadjusted analyses (OR 1.69; 95% CI 1.50-1.91; P < 0.001). CONCLUSIONS To our knowledge, our systematic review and meta-analysis is the first to pool adjusted effect sizes. We found that HS was associated with a 1.69-fold increased odds of diabetes; however, the absolute risk difference was small (16.1% vs. 15.7%) and is probably not clinically relevant. Treating clinicians should be aware of this association, but there may not be an urgent need to perform screening for impaired glucose tolerance or diabetes.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - O Charlton
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - S D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Gosford and St Leonards, Sydney, Australia
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Phan K, Kahlaee HR, Kim SH, Toh JWT. Laparoscopic vs. robotic rectal cancer surgery and the effect on conversion rates: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Tech Coloproctol 2019; 23:221-230. [PMID: 30623315 DOI: 10.1007/s10151-018-1920-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The usage of robotic surgery in rectal cancer is increasing, but there is an ongoing debate as to whether it provides any benefit. The aim of the present study was to determine if robotic surgery results in less conversion to an open operation than laparoscopic rectal cancer surgery. METHODS A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club and Database of Abstracts of Review of Effectiveness. Included were randomized controlled trials (RCTs) and propensity-score-matched (PSM) studies comparing a robotic vs. laparoscopic approach to rectal cancer surgery. The primary endpoint was conversion to open. All statistical analyses and data synthesis were conducted using STATA/IC version 14·2, Windows 64 bit (StataCorp LP, College Station, TX, USA) RESULTS: Six hundred and twenty-one studies were identified through electronic database search. After application of selection criteria as per PRISMA and MOOSE criteria, six RCTs and five PSM articles were analyzed. From the six RCTs, 512 robotic and 519 laparoscopic cases were evaluated. There was a significantly lower rate of conversion for the robotic surgery arm (4.1% vs. 8.1%, OR 0.28; 95% CI 0.00-0.57). Of the five PSM studies, 2097 robotic and 3053 laparoscopic cases were evaluated. There was a significantly lower conversion to open rate found in the robotic surgery cohort (7.4% vs. 15.6%; OR 0.39; 95% CI 0.30-0.47). Pooled RCT and PSM data demonstrated significantly lower conversion rates for robotic surgery (6.7% vs. 14.5%; OR 0.38; 95% CI 0.30-0.46). CONCLUSIONS Robotic surgery for rectal cancer is associated with reduced conversion to open surgery compared to a laparoscopic approach.
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Affiliation(s)
- K Phan
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia.,Division of Colorectal Surgery, Department of Surgery, Liverpool Hospital, Liverpool, Australia
| | - H R Kahlaee
- Department of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - S H Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - J W T Toh
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, NSW, Australia. .,The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia.
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Shepard P, Akagi K, Everett S, Hassan I, Osborne A, Tan M, Schroth C, Aase D, Passi H, Proescher E, Greenstein J, Walters R, Krage M, Phan K. A - 66The Polytrauma Triad: Impact of PTSD Symptom Clusters on Cognitive Complaints in Post-9/11 Veterans. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.66] [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: 11/12/2022] Open
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Choi J, Luc J, Escrivà EM, Phan K, Rizvi S, Patel S, Entwistle J, Morris R, Massey H, Tchantchaleishvili V. Impact of Concomitant Mitral Valve Surgery for Mitral Regurgitation During LVAD Implantation: Systematic Review and Meta-Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tchantchaleishvili V, Luc J, Phan K, Dunlay S, Maltais S, Stulak J. Management and Outcomes of LVAD Thrombosis: A Systematic Review and Meta-Analysis. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.281] [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: 10/19/2022] Open
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Yudi M, Clark D, Tsang D, Jelinek M, Kalten K, Joshi S, Phan K, Nasis A, Amerena J, MacIsaac A, Arunothayaraj S, Si S, Reid C, Farouque O. SMARTphone-based, Early Cardiac REHABilitation in Patients with Acute Coronary Syndromes [SMART-REHAB Trial]: A Randomised Controlled Trial. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Zentner D, Phan K, Gibson R, Sood S, Gorelik A, Grigg L, Nicoll A. Fontan-Associated Liver Disease (FALD)–Results from Shear Wave Elastography. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.651] [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: 11/26/2022]
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Bolea-Fernandez E, Phan K, Balcaen L, Resano M, Vanhaecke F. Determination of ultra-trace amounts of prosthesis-related metals in whole blood using volumetric absorptive micro-sampling and tandem ICP – Mass spectrometry. Anal Chim Acta 2016; 941:1-9. [DOI: 10.1016/j.aca.2016.08.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 12/20/2022]
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Veneziale B, Huang L, Li X, Zhao Q, Zhao C, Osgood R, Cowell J, Rosengren S, Parise J, Wei G, Phan K, Connor R, Rowe S, Keller G, Frost G, Maneval D, Thompson C, Shepard M, Thanos C. Abstract B32: A tumor microenvironment specific EGFR targeting antibody-drug conjugate promotes regression in KRAS or BRAF mutant tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.tme16-b32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The epidermal growth factor (EGF) signaling pathway relies on recognition by its receptor, EGFR, and subsequent downstream signaling by the KRAS and BRAF proteins to relay proper proliferative, migratory, and angiogenic functions. Cancers with activating KRAS or BRAF mutations are resistant to EGFR targeting agents and correspond to a significant unmet medical need. We hypothesized that an anti-EGFR antibody-drug conjugate (ADC) could be active against KRAS or BRAF mutated tumors, due to the cytotoxic mechanism of the ADC warhead. In an effort to eliminate the known dermal toxicity associated with anti-EGFR therapy, and to mitigate potential toxicities associated with treatment by an anti-EGFR ADC, we wished to engineer an antibody with enhanced specificity towards EGFR in the tumor microenvironment (TME) and attenuated binding to EGFR in normal tissue. This was achieved by screening a library of antibody variants (based on cetuximab) in a spatially addressed manner for binding to a recombinant version of the EGFR extracellular domain (EGFRECD) in two separate ELISA reaction conditions. High affinity binding to the EGFRECD was desired in the first condition, which approximated the physicochemical properties of the TME (acidic pH, high lactic acid concentration, 25% human serum). In the second assay condition, which approximated mAb binding to EGFRECD in normal tissue (neutral pH, low lactic acid concentration, 25% human serum), attenuated binding affinity was desired. We identified a lead mAb variant, cMab-1501, which possessed several fold reduced binding to EGFRECD in the neutral pH, low lactic acid condition, when compared to EGFRECD binding in the low-pH, high lactic acid, assay condition. To evaluate enhanced specificity for binding to EGFR in vivo, cMab-1501 was compared to cetuximab for binding to both human donor foreskin xenografts and human A431 tumor xenografts, using a DyLight 755 conjugated version of each antibody, and subsequent fluorescence detection with a Caliper IVIS system. cMab-1501 and cetuximab demonstrated relatively comparable binding towards human A431 tumor xenografts in vivo. In addition, cetuximab bound relatively equally between human tumor xenografts and human skin grafts. However, no binding to EGFR in the human skin graft was detected for cMab-1501 over all days measured; suggesting that cMab-1501 was highly specific for binding to EGFR in the TME. We next generated an cMab-1501 based ADC (antibody-drug conjugate), via maleimide chemistry carrying a protease cleavable valine-citrulline-p-aminobenzyloxycarbonyl monomethylauristatin E (vcPAB-MMAE) cytotoxic moiety, forming a cMab-1501-vcPAB-MMAE conjugate. Both the conjugated and un-conjugated versions of cMab-1501 were rapidly internalized by EGFR positive MDA-MB-231M tumor cells over several hours. In tumor xenograft models, the TME-specific anti-EGFR ADC demonstrated complete tumor regressions against two human EGFR overexpressing tumor types, MDA-MB-231M (TNBC, KRAS G13D) and HT-29 (CRC, BRAF V600E). In both in vivo models, tumors were resistant to treatment by cetuximab. These data suggest that it is possible to engineer a monoclonal antibody with enhanced specificity for its target within the TME and that an ADC-based approach could be utilized as potential treatment of EGFR overexpressing tumors with KRAS or BRAF mutations.
Citation Format: Bob Veneziale, Lei Huang, Xiaoming Li, Qiping Zhao, Chunmei Zhao, Ryan Osgood, Jessica Cowell, Sanna Rosengren, Jason Parise, Ge Wei, Kim Phan, Robert Connor, Steve Rowe, Gilbert Keller, Gregory Frost, Dan Maneval, Curtis Thompson, Michael Shepard, Christopher Thanos. A tumor microenvironment specific EGFR targeting antibody-drug conjugate promotes regression in KRAS or BRAF mutant tumors. [abstract]. In: Proceedings of the AACR Special Conference: Function of Tumor Microenvironment in Cancer Progression; 2016 Jan 7–10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2016;76(15 Suppl):Abstract nr B32.
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Affiliation(s)
| | - Lei Huang
- Halozyme Therapeutics, San Diego, CA
| | | | | | | | | | | | | | | | - Ge Wei
- Halozyme Therapeutics, San Diego, CA
| | - Kim Phan
- Halozyme Therapeutics, San Diego, CA
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Wang L, Cowell J, Rosengren S, Huang L, Li X, Zhao Q, Souratha J, Marella M, Blouw B, Cannon K, Zhao C, Phan K, Thompson C, Shepard M, Thanos C. Abstract 1472: Enzymatic depletion of adenosine by pegylated, engineered adenosine deaminase 2 (PEG-ADA2): A novel immunotherapeutic approach to treat solid tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Adenosine is an endogenous immunosuppressant that binds to adenosine receptor checkpoints and protects tissue from immune-mediated rejection. Abnormally high adenosine levels (up to 100-fold greater than other tissues) contribute to a highly immunosuppressive tumor microenvironment (TME). We hypothesized that adenosine deaminase 2 (ADA2), a human enzyme that catalyzes the deamination of adenosine, could be administered at therapeutic levels to deplete high levels of TME adenosine and stimulate anti-tumor immune activity. Recombinant wild-type ADA2 (wtADA2) was cleared extremely rapidly from circulation (t1/2 = 69 min, 7.5 mg/kg iv, n = 9 mice), rendering it unsuitable for therapeutic testing. Therefore, a series of variants was designed to attenuate the heparin binding properties of ADA2 to improve bio-distribution and conjugated with 20K PEG to improve pharmacokinetics (PK). The variant PEG-ADA2-K374D displayed 94% less binding to heparin compared to wtADA2, enzymatic activity comparable to wtADA2, and 33-fold improved PK (t1/2 = 2,256 min); and consistently induced at least 60% (p<0.0001) tumor growth inhibition (TGI) of established subcutaneous syngeneic CT26 tumors (b.i.w., 0.3mg/kg, n = 8). Treatment with PEG-ADA2-K374D resulted in a 5-fold increase in tumor infiltrating CD3+ T-cells (p<0.0001, 6 hours post dose), as assessed by histology. We hypothesized that CD73, which catalyzes the turnover of AMP to adenosine, could be used as a biomarker to identify tumors with elevated adenosine levels. Gene expression studies against a panel of syngeneic tumors revealed that lung KLN205 and pancreatic MH194/PSC4 tumors had high CD73 levels. PEG-ADA2-K374D inhibited the growth of established MH194/PSC4 and KLN205 tumors, with TGI reaching 47% (p<0.0001) and 78% (p<0.0001) after 2 weeks of treatment (b.i.w, 0.3 mg/kg, n = 8). A second series of variants was generated based on structure-based design to have significantly improved kcat/km for adenosine deaminase activity. ADA2-R222Q/S265N had the highest improvement, with a 15-fold greater kcat/km than wtADA2. After pegylation, the circulating half-life of PEG-ADA2-R222Q-S265N in mice was extended from 69 min to 2,790 min (>40-fold increase). This variant induced a maximum TGI of 69% (p<0.05) in the MH194/PSC4 model at 0.003 mg/kg, a 100-fold lower dose than PEG-ADA2-K374D (n = 8). A third variant, PEG-ADA2-E182T lacked detectable enzymatic activity and displayed no tumor growth inhibition, suggesting that ADA2 enzyme activity is required for efficacy. These data
suggest that engineered PEG-ADA2 variants induce significant tumor growth inhibition activity in several syngeneic solid tumor models, validating enzymatic depletion of high TME adenosine levels as novel immunotherapeutic approach to treat solid tumors.
Citation Format: Lin Wang, Jessica Cowell, Sanna Rosengren, Lei Huang, Xiaoming Li, Qiping Zhao, Jennifer Souratha, Mathieu Marella, Barbara Blouw, Keri Cannon, Chunmei Zhao, Kim Phan, Curtis Thompson, Michael Shepard, Christopher Thanos. Enzymatic depletion of adenosine by pegylated, engineered adenosine deaminase 2 (PEG-ADA2): A novel immunotherapeutic approach to treat solid tumors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1472.
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Affiliation(s)
- Lin Wang
- Halozyme Therapeutics, San Diego, CA
| | | | | | - Lei Huang
- Halozyme Therapeutics, San Diego, CA
| | | | | | | | | | | | | | | | - Kim Phan
- Halozyme Therapeutics, San Diego, CA
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Huang L, Veneziale B, Frigerio M, Badescu G, Li X, Zhao Q, Bahn J, Souratha J, Osgood R, Zhao C, Phan K, Cowell J, Rosengren S, Parise J, Pabst M, Bird M, McDowell W, Wei G, Thompson C, Godwin A, Shepard M, Thanos C. Abstract 1217: Preclinical evaluation of a next-generation, EGFR targeting ADC that promotes regression in KRAS or BRAF mutant tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancers with downstream activating KRAS or BRAF mutations in the EGFR pathway are resistant to EGFR targeting agents such as cetuximab and correspond to a significant unmet need. We hypothesized that an anti-EGFR ADC could be effective against KRAS or BRAF mutated tumors due to the cytotoxic mechanism of the ADC warhead. In an effort to eliminate the known dermal toxicity associated with anti-EGFR therapy, and to mitigate potential toxicities associated with treatment by an anti-EGFR ADC, a mAb was engineered with increased tumor microenvironment (TME) specificity for EGFR. The lead mAb demonstrated undetectable in vivo binding to human donor foreskins grafted onto nude mice, while binding to human A431 tumor xenografts with similar intensity to cetuximab (P < 0.005, detected using DyLight-755 conjugated versions of each mAb, measured with a Caliper IVIS system). The lead mAb was further optimized and conjugated to the potent cytotoxic drug MMAE using a novel bis-alkylating conjugation linker, which covalently re-bridged the inter-chain disulfide bonds, creating a stable and defined ADC. The resulting ADC, HTI-1511, incorporated a vc-PAB cleavable moiety and a short linear PEG (24 ethylene glycol units) in a side-chain configuration. Analytical HIC revealed that HTI-1511 possessed a nearly homogenous drug:antibody ratio (DAR) of 4 (>99.7%). Approximately 70% of this compound was rapidly internalized by human tumor cells grown in vitro over 4 hours, overlapping the internalization kinetics of the unconjugated mAb. HTI-1511 was evaluated for efficacy against two human EGFR overexpressing tumor models, MDA-MB-231M (triple-negative breast cancer, KRAS-G13D) and HT-29 (colorectal cancer, BRAF-V600E), and dosed at 5, 10, and 15 mg/kg, (qw, IV). A clear dose dependent anti-tumor response was observed with complete tumor regressions observed at the 15 mg/kg dose in both models, which were resistant to treatment by cetuximab. In addition, HTI-1511 was well-tolerated at 2 and 8 mg/kg in a cynomolgus monkey toxicity study (n = 3 per group), with limited dermal findings that were comparable with the vehicle control group. No adverse findings were observed at either dose. HTI-1511 showed a high degree of circulating stability in cynomolgus monkeys, and lacked in vivo degradation and instability that was observed in a control ADC conjugated using maleimide chemistry. HTI-1511 demonstrated significantly attenuated binding to FcγRIIa, FcγIIb, FcγIIIa 158V, and FcγIIIa 158F receptors, but not attenuated binding to FcγR1, in a FACS based assay format specific for each receptor, suggesting that HTI-1511 might have improved tolerability due to lack of binding by FcγRII-III receptors, possibly due steric hindrance from the PEG side chain. Thus, HTI-1511 holds promise as a potentially safe and effective treatment of EGFR overexpressing tumors with KRAS or BRAF mutations.
Citation Format: Lei Huang, Bob Veneziale, Mark Frigerio, George Badescu, Xiaoming Li, Qiping Zhao, Jesse Bahn, Jennifer Souratha, Ryan Osgood, Chunmei Zhao, Kim Phan, Jessica Cowell, Sanna Rosengren, Jason Parise, Martin Pabst, Mathew Bird, William McDowell, Gina Wei, Curtis Thompson, Antony Godwin, Michael Shepard, Christopher Thanos. Preclinical evaluation of a next-generation, EGFR targeting ADC that promotes regression in KRAS or BRAF mutant tumors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1217.
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Affiliation(s)
- Lei Huang
- 1Halozyme Therapeutics, San Diego, CA
| | | | - Mark Frigerio
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
| | - George Badescu
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Kim Phan
- 1Halozyme Therapeutics, San Diego, CA
| | | | | | | | - Martin Pabst
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
| | - Mathew Bird
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
| | - William McDowell
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
| | - Gina Wei
- 1Halozyme Therapeutics, San Diego, CA
| | | | - Antony Godwin
- 2Abzena, Antitope Limited & PolyTherics Limited, Cambridge, United Kingdom
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Huo Y, Phan K, Zhao D, Rao P, Phan S, Mortimer A. Endovascular therapy including thrombectomy for acute ischemic stroke: a systematic review and meta-analysis with trial sequential analysis. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Huo Y, Phan K, Jia F, Phan S, Mortimer A. A systematic review and meta-analysis of stent-assisted coiling versus coiling-only in treatment of intracranial aneurysm. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Phan K, Gomez YH, El-Messidi A, Gagnon R, Daskalopoulou SS. PO-30 EFFECT OF LOW-DOSE ACETYLSALICYLIC ACID ON ARTERIAL STIFFNESS IN HIGH-RISK PREGNANCIES: AN OBSERVATIONAL LONGITUDINAL STUDY. Artery Res 2016. [DOI: 10.1016/j.artres.2016.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Phan K, Haydee Gomez Y, Gorgui J, El-Messidi A, Gagnon R, Daskalopoulou S. 3.7 ARTERIAL STIFFNESS FOR THE EARLY PREDICTION OF PRE-ECLAMPSIA COMPARED WITH CLINICAL CHARACTERISTICS, UTERINE ARTERY DOPPLER INDICES, AND ANGIOGENIC BIOMARKERS. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Phan K, Gomez YH, Al-azzawi MS, El-Messidi A, Daskalopoulou SS. PO-31 EFFECT OF POOR GLYCEMIC CONTROL ON ARTERIAL STIFFNESS IN PREGNANCY. Artery Res 2016. [DOI: 10.1016/j.artres.2016.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shortt C, Phan K, Hill SA, Worster A, Kavsak PA. An approach to rule-out an acute cardiovascular event or death in emergency department patients using outcome-based cutoffs for high-sensitivity cardiac troponin assays and glucose. Clin Biochem 2015; 48:282-7. [DOI: 10.1016/j.clinbiochem.2014.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 01/04/2023]
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Phan K, Xie A, Tsai YC, Kumar N, La Meir M, Yan TD. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis. Europace 2015; 17:38-47. [PMID: 25336669 DOI: 10.1093/europace/euu220] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
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Phan K, Medi C, Yan T. Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation: systematic review and meta-analysis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.333] [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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Phan K, Gomez YH, Elbaz L, Daskalopoulou S. Statin Treatment Non-adherence and Discontinuation: Clinical Implications and Potential Solutions. Curr Pharm Des 2014; 20:6314-24. [DOI: 10.2174/1381612820666140620162629] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/16/2014] [Indexed: 11/22/2022]
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Kavsak PA, Worster A, You JJ, Oremus M, Shortt C, Phan K, Sohn KY, Veljkovic K, Devereaux PJ, Hill S, Bhanich-Supapol W, Jaffe AS. Ninety-minute vs 3-h performance of high-sensitivity cardiac troponin assays for predicting hospitalization for acute coronary syndrome. Clin Chem 2013; 59:1407-10. [PMID: 23842201 DOI: 10.1373/clinchem.2013.208595] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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