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Nieves JW, Cosman F, McMahon D, Redko M, Hentschel I, Bartolotta R, Loftus M, Kazam JJ, Rotman J, Lane J. Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Osteoporos Int 2022; 33:239-250. [PMID: 34383100 PMCID: PMC8758515 DOI: 10.1007/s00198-021-06065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED Pelvic fracture patients were randomized to blinded daily subcutaneous teriparatide (TPTD) or placebo to assess healing and functional outcomes over 3 months. With TPTD, there was no evidence of improved healing by CT or pain reduction; however, physical performance improved with TPTD but not placebo (group difference p < 0.03). INTRODUCTION To determine if teriparatide (20 μg/day; TPTD) results in improved radiologic healing, reduced pain, and improved functional outcome vs placebo over 3 months in pelvic fracture patients. METHODS This randomized, placebo-controlled study enrolled 35 patients (women and men >50 years old) within 4 weeks of pelvic fracture and evaluated the effect of blinded TPTD vs placebo over 3 months on fracture healing. Fracture healing from CT images at 0 and 3 months was assessed as cortical bridging using a 5-point scale. The numeric rating scale (NRS) for pain was administered monthly. Physical performance was assessed monthly by Continuous Summary Physical Performance Score (based on 4 m walk speed, timed repeated chair stands, and balance) and the Timed Up and Go (TUG) test. RESULTS The mean age was 82, and >80% were female. The intention to treat analysis showed no group difference in cortical bridging score, and 50% of fractures in TPTD-treated and 53% of fractures in placebo-treated patients were healed at 3 months, unchanged after adjustment for age, sacral fracture, and fracture displacement. Median pain score dropped significantly in both groups with no group differences. Both CSPPS and TUG improved in the teriparatide group, whereas there was no improvement in the placebo group (group difference p < 0.03 for CSPPS at 2 and 3 months). CONCLUSION In this small randomized, blinded study, there was no improvement in radiographic healing (CT at 3 months) or pain with TPTD vs placebo; however, there was improved physical performance in TPTD-treated subjects that was not evident in the placebo group.
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Affiliation(s)
- J W Nieves
- Hospital for Special Surgery, New York, NY, USA.
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - D McMahon
- Hospital for Special Surgery, New York, NY, USA
| | - M Redko
- Hospital for Special Surgery, New York, NY, USA
| | - I Hentschel
- Hospital for Special Surgery, New York, NY, USA
| | - R Bartolotta
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - M Loftus
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J J Kazam
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Lane
- Hospital for Special Surgery, New York, NY, USA
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du Plessis LM, Daniels LC, Koornhof HE, Solomon ZL, Loftus M, Babajee LC, Ronquest C, Kleingeld B, Greener CM, Burn KJ. Field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines amongst mothers/caregivers of children aged 0–12 months in the Breede Valley sub-district, Western Cape province, South Africa. South African Journal of Clinical Nutrition 2021. [DOI: 10.1080/16070658.2020.1769335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- LM du Plessis
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - LC Daniels
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - HE Koornhof
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - ZL Solomon
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - M Loftus
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - LC Babajee
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - C Ronquest
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - B Kleingeld
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - CM Greener
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - KJ Burn
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Chagpar AB, Longley PB, Horowitz NR, Killelea BK, Tsangaris TN, Li F, Butler M, Stavris K, Yao X, Harigopal M, Bossuyt V, Lannin DR, Pusztai L, Loftus M, Davidoff AJ, Gross CP. Abstract P3-13-01: Impact of routine cavity shave margins on time and money: Results from the SHAVE trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-13-01] [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
INTRODUCTION: Taking routine cavity shave margins (CSM) reduces positive margin and re-excision rates by 50%, but the impact of this technique on operative time and overall costs have not been well-elucidated.
METHODS: The SHAVE trial randomized 235 Stage 0-3 breast cancer patients undergoing partial mastectomy 1:1 to either have further cavity shave margins resected ("shave") or not ("no shave"). Randomization occurred intraoperatively after surgeons had completed standard partial mastectomy. Intraoperative time as well as actual direct costs incurred by the hospital were measured, for both the index case as well as any surgeries over the subsequent 90 days.
RESULTS: Median patient age was 61 (range; 33-94). 54 patients (23%) had invasive cancer, 45 (19%) had DCIS, and 125 (53%) had both. Median invasive tumor size was 1.1 cm (range; 0-6.5), and median DCIS size was 1.0 cm (range; 0-9.3). The "shave" and "no shave" groups were well-matched in terms of baseline characteristics, including the proportion having a sentinel node biopsy (75.6% vs. 69.8%, p=0.32) and/or axillary node dissection (9.2% vs. 7.8%, p=0.68) at the time of the initial surgery. The median number of additional CSM in the "shave" group was 4 (range; 3-6). At the initial surgery, those in the "shave" group had a longer operative time (median 76 vs. 66 minutes, p=0.005), and higher OR, pathology and total costs (see table). 48 patients required a subsequent surgery; 45 (93.8%) for margin clearance, 3 for sentinel lymph node biopsy alone (2 in the "shave" and 1 in the "no shave" group, p=1.00). There was a significantly lower re-excision rate for margins in the "shave" group (10.9% vs. 27.6%, p=0.001). Median time to re-excision was 22 days (range; 10-62). The mean cost of additional surgeries for those who required them was no different between the "shave" and "no shave" groups ($2636 vs. $3453, p=0.12); however, given the overall lower reoperation rate in the "shave" group (12.6% vs. 28.4%, p=0.003), the mean cost per patient for additional surgeries was significantly lower in the "shave" vs. "no shave" group. Taking into account all surgeries (including the index case and any additional surgeries within 90 days), there was no significant difference in cost (from a hospital perspective) between the two groups.
Mean (± SE) Costs per patient"Shave" (n=119)"No Shave" (n=116)p-valueIndex surgery: OR costs$1315 (± $69)$1138 (± $52)0.042Pathology costs$1195 (± $43)$795 (± $48)< 0.001Total costs$4758 (± $123)$4133 (± $119)< 0.001Additional surgery: OR costs$94 (± $24)$247 (± $44)0.003Pathology costs$51 (± $18)$112 (± $21)0.031Total costs$332 (± $88)$983 (± $189)0.002Total 90 day surgery costs: OR costs$1409 (± $76)$1385 (± $64)0.808Pathology costs$1247 (± $49)$909 (± $52)< 0.001Total costs$5090 (± $166)$5116 (± $214)0.925
CONCLUSIONS: Taking routine CSM is associated with increased time and cost for the index surgery, but this is offset by the cost savings of reduced re-excision rates. While the strategies of "shave" and "no shave" are similar in terms of 90 day hospital-related costs, taking CSM is associated with a lower need for reoperative surgery, thereby reducing patient angst and improving utilization of surgeon and OR time.
Citation Format: Chagpar AB, Longley PB, Horowitz NR, Killelea BK, Tsangaris TN, Li F, Butler M, Stavris K, Yao X, Harigopal M, Bossuyt V, Lannin DR, Pusztai L, Loftus M, Davidoff AJ, Gross CP. Impact of routine cavity shave margins on time and money: Results from the SHAVE trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-01.
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Affiliation(s)
- AB Chagpar
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - PB Longley
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - NR Horowitz
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - BK Killelea
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - TN Tsangaris
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - F Li
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - M Butler
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - K Stavris
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - X Yao
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - M Harigopal
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - V Bossuyt
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - DR Lannin
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - L Pusztai
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - M Loftus
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - AJ Davidoff
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - CP Gross
- Yale University School of Medicine, New Haven, CT; Yale-New Haven Hospital, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Yale Center for Analytical Sciences, New Haven, CT; Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
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Jodari M, Loftus M, Gleghorn J, Gakhar G, Pratt E, Tagawa ST, Bander NH, Giannakakou P, Kirby B, Nanus DM. Capture and analysis of prostate cancer circulating tumor cells (CTCS) using geometrically enhanced differential immunocapture (GEDI). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.53] [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: 11/20/2022] Open
Abstract
53 Background: EpCAM-based immunocapture of prostate cancer (PC) CTCs yields relatively low purity and specificity. We developed a geometrically enhanced differential immunocapture (GEDI) microfluidic device that incorporates flow dynamics and utilizes a mAb to prostate-specific membrane antigen (PSMA) to optimize isolation and analysis of CTCs from PC patients. Methods: GEDI microfluidic silicon chips, fabricated using standard photolithography techniques, were functionalized by chemical cross-linking ending with a neutravidin terminated surface to which anti-PSMA biotinylated-mAb J591 was bound. C4-2 (PSMA+) and PC-3 (PSMA-) cells were used for chip optimization. 1 mL of peripheral blood from PC patients was flowed (1mL/hour) over functionalized chips. Captured cells were washed with PBS × 30 min, fixed with 3.7% formaldehyde, immunofluorescently stained for DAPI, androgen receptor (AR), tubulin and EpCAM and analyzed by high resolution point-scanning confocal microscopy. PSMA+, DAPI+, and CD45- cells were manually scored. RNA was extracted from unfixed captured CTCs using lysis buffer flowed thru the chip. Results: ∼80% capture efficiency was achieved from 26 PSMA positive C4-2 cells spiked into 1 mL blood flowed through the GEDI chip. RNA extracted from 50 C4-2 cells in 1 mL blood flowed thru the chip detected a known AR point mutation by RT-PCR and Sanger sequencing. Immunofluorescence staining of PSMA+ cells captured on the chip detected changes in AR subcellular localization and microtubule structure following treatment with DHT or paclitaxel, respectively. 10 patients with metastatic PC were analyzed by CellSearch (range 0-201 cells/7.5 mL) and GEDI chip (range 35->1200 cells/mL) yielding a 7->350 fold enrichment using GEDI. Captured PC cells isolated from PC patient incubated in 50 nm paclitaxel (ex vivo) overnight demonstrated microtubule bundling, indicative of drug-target engagement. Conclusions: PSMA based GEDI microfluidic CTC capture is highly specific and sensitive in capturing PSMA positive PC CTCs; and allows detailed CTC analysis including protein expression and subcellular localization, mutational analysis and drug sensitivity assessment. [Table: see text]
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Affiliation(s)
- M. Jodari
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - M. Loftus
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - J. Gleghorn
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - G. Gakhar
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - E. Pratt
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - S. T. Tagawa
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - N. H. Bander
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - P. Giannakakou
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - B. Kirby
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
| | - D. M. Nanus
- Weill Cornell Medical College, New York, NY; Cornell University, Ithaca, NY
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