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Goyal A, Crabtree CD, Lee BC, Harfi TT, Rajpal S, Yildiz VO, Simonetti OP, Tong MS. The impact of severe obesity on image quality and ventricular function assessment in echocardiography and cardiac MRI. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03078-y. [PMID: 38625629 DOI: 10.1007/s10554-024-03078-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
This study sought to evaluate the impact of severe obesity on image quality and ventricular function assessment in cardiovascular magnetic resonance (MRI) and trans-thoracic echocardiography (TTE). We studied 100 consecutive patients who underwent clinically indicated cardiac MRI and TTE studies within 12 months between July 2017 and December 2020; 50 (28 females and 22 males; 54.5 ± 18.7 years) with normal body mass index (BMI) (18.5-25 kg/m2) and 50 (21 females and 29 males; 47.2 ± 13.3 years) with severe obesity (BMI ≥ 40 kg/m2). MRI and TTE image quality scores were compared within and across cohorts using a linear mixed model. Categorical left (LVF) and right (RVF) ventricular function were compared using Cohens Kappa statistic. Mean BMI for normal weight and obese cohorts were 22.2 ± 1.7 kg/m2 and 50.3 ± 5.9 kg/m2, respectively. Out of a possible 93 points, mean MRI image quality score was 91.5 ± 2.5 for patients with normal BMI, and 88.4 ± 5.5 for patients with severe obesity; least square (LS) mean difference 3.1, p = 0.460. TTE scores were 64.2 ± 13.6 for patients with normal BMI and 46.0 ± 12.9 for patients with severe obesity, LS mean difference 18.2, p < 0.001. Ventricular function agreement between modalities was worse in the obese cohort for both LVF (72% vs 80% agreement; kappa 0.53 vs 0.70, obese vs. normal BMI), and RVF (58% vs 72% agreement, kappa 0.18 vs 0.34, obese vs. normal BMI). Severe obesity had limited impact on cardiac MRI image quality, while obesity significantly degraded TTE image quality and ventricular function agreement with MRI.
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Affiliation(s)
- Akash Goyal
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | | | - Bryan C Lee
- OhioHealth Systems, Heart and Vascular Institute, Columbus, OH, USA
| | - Thura T Harfi
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Saurabh Rajpal
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, OH, USA
- Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA
| | - Matthew S Tong
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 234 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA.
- Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH, USA.
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Jadcherla SR, Helmick R, Hasenstab KA, Njeh M, Yildiz VO, Wei L, Slaughter JL, Di Lorenzo C. Proton pump inhibitor therapy may alter the sensory motor characteristics of pharyngoesophageal motility in infants with suspected GERD. Neurogastroenterol Motil 2024; 36:e14730. [PMID: 38155406 DOI: 10.1111/nmo.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Acid reflux index (ARI) is a biomarker for gastroesophageal reflux disease (GERD). The effects of short-term proton pump inhibitor (PPI) therapy on pharyngoesophageal motility and clearance mechanisms in infants remain unknown. We hypothesized that pharyngoesophageal reflexes and response to PPI are distinct between infants with 3%-7% and >7% ARI. METHODS Secondary analysis was performed from a subset of infants who participated in a randomized controlled trial (NCT: 02486263). Infants (N = 36, 29.9 ± 4.3 weeks gestation) underwent 4 weeks of PPI therapy, 1 week of washout, and longitudinal testing to assess: (a) clinical outcomes; (b) pH-impedance and symptom metrics including ARI, distal baseline impedance, clearance time, refluxate height, symptoms, I-GERQ-R scores, symptom association probability; (c) pharyngoesophageal motility reflexes and sensory motor characteristics. Comparisons were performed between infants with 3%-7% versus >7% ARI. KEY RESULTS From the 36 hospitalized infants treated: Pharyngoesophageal reflex latencies were prolonged (p > 0.05) and duration in ARI 3%-7% group only (p = 0.01); GER frequency, proximal ascent and clearance increased (ARI 3%-7%); weight gain velocity, oral feeding success, and fine motor score decreased while length of hospital stays increased in the ARI >7% group despite the decrease in symptoms and I-GERQ-R scores. CONCLUSIONS & INFERENCES Distinct changes in pharyngoesophageal sensory motor aspects of motility and reflex mechanisms exist after using PPI therapy in infants. Contributory factors may include the effects of maturation and aerodigestive comorbidities (GERD and BPD). Controlled studies incorporating placebo are needed to delineate the effects of PPI on causal and adaptive GERD mechanisms in infants with aerodigestive and feeding-related comorbidities.
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Affiliation(s)
- Sudarshan R Jadcherla
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Roseanna Helmick
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kathryn A Hasenstab
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Minna Njeh
- The Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Vedat O Yildiz
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Pan Y, Varghese J, Tong MS, Yildiz VO, Azzu A, Gatehouse P, Wage R, Nielles-Vallespin S, Pennell DJ, Jin N, Bacher M, Hayes C, Speier P, Simonetti OP. Two-center validation of Pilot Tone based cardiac triggering of a comprehensive cardiovascular magnetic resonance examination. Int J Cardiovasc Imaging 2024; 40:261-273. [PMID: 38082073 DOI: 10.1007/s10554-023-03002-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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. To evaluate the performance of PTC triggering in a comprehensive CMR exam. Fifteen volunteers and 20 patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.
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Affiliation(s)
- Yue Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew S Tong
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alessia Azzu
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Rick Wage
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | | | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Malvern, PA, USA
| | - Mario Bacher
- Siemens Healthineers AG, Erlangen, Germany
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Orlando P Simonetti
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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4
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Sultana Z, O Yildiz V, Jadcherla SR. Characteristics of esophageal refluxate and symptoms in infants compared between pre-treatment and on treatment with proton pump inhibitors. J Perinatol 2024; 44:87-93. [PMID: 37980392 DOI: 10.1038/s41372-023-01825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To examine longitudinal pH-impedance characteristics from those infants who remained on proton pump inhibitors therapy for gastroesophageal reflux disease (GERD) as parents/providers refused to discontinue therapy after 4 weeks. STUDY DESIGN Eighteen infants with acid reflux index >3% underwent treatment, and pH-impedance data were compared prior to and on proton pump inhibitors at 42 ± 1 and 46 ± 1 weeks' postmenstrual age, respectively. Esophageal acid and bolus exposure, symptoms and swallowing characteristics were examined. RESULTS Proton pump inhibitors reduces the acid-mediated effects of reflux but modifies impedance and clearance mechanisms (P < 0.05). Prolonged therapy did not reduce symptoms (P > 0.05). Infants evaluated while on proton pump inhibitors were 1.8 times more likely to have swallows before and after reflux. CONCLUSIONS Prescription of proton pump inhibitors for objectively determined GERD should have time limits, as prolonged treatment can result in prolonged esophageal bolus clearance time without relieving symptoms.
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Affiliation(s)
- Zakia Sultana
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vedat O Yildiz
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sudarshan R Jadcherla
- Innovative Feeding Disorders Research Program, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Neonatology and Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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5
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Ritter AR, Yildiz VO, Koirala N, Baliga S, Gogineni E, Konieczkowski DJ, Grecula J, Blakaj DM, Jhawar SR, VanKoevering KK, Mitchell D. Factors Associated with Total Laryngectomy Utilization in Patients with cT4a Laryngeal Cancer. Cancers (Basel) 2023; 15:5447. [PMID: 38001708 PMCID: PMC10670908 DOI: 10.3390/cancers15225447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Despite recommendations for upfront total laryngectomy (TL), many patients with cT4a laryngeal cancer (LC) instead undergo definitive chemoradiation, which is associated with inferior survival. Sociodemographic and oncologic characteristics associated with TL utilization in this population are understudied. METHODS This retrospective cohort study utilized hospital registry data from the National Cancer Database to analyze patients diagnosed with cT4a LC from 2004 to 2017. Patients were stratified by receipt of TL, and patient and facility characteristics were compared between the two groups. Logistic regression analyses and Cox proportional hazards methodology were performed to determine variables associated with receipt of TL and with overall survival (OS), respectively. OS was estimated using the Kaplan-Meier method and compared between treatment groups using log-rank testing. TL usage over time was assessed. RESULTS There were 11,149 patients identified. TL utilization increased from 36% in 2004 to 55% in 2017. Treatment at an academic/research program (OR 3.06) or integrated network cancer program (OR 1.50), male sex (OR 1.19), and Medicaid insurance (OR 1.31) were associated with increased likelihood of undergoing TL on multivariate analysis (MVA), whereas age > 61 (OR 0.81), Charlson-Deyo comorbidity score ≥ 3 (OR 0.74), and clinically positive regional nodes (OR 0.78 [cN1], OR 0.67 [cN2], OR 0.21 [cN3]) were associated with decreased likelihood. Those undergoing TL with post-operative radiotherapy (+/- chemotherapy) had better survival than those receiving chemoradiation (median OS 121 vs. 97 months; p = 0.003), and TL + PORT was associated with lower risk of death compared to chemoradiation on MVA (HR 0.72; p = 0.024). CONCLUSIONS Usage of TL for cT4a LC is increasing over time but remains below 60%. Patients seeking care at academic/research centers are significantly more likely to undergo TL, highlighting the importance of decreasing barriers to accessing these centers. Increased focus should be placed on understanding and addressing the additional patient-, physician-, and system-level factors that lead to decreased utilization of surgery.
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Affiliation(s)
- Alex R. Ritter
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Vedat O. Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, 1800 Cannon Dr., Columbus, OH 43210, USA
| | - Nischal Koirala
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - David J. Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Sachin R. Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Kyle K. VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
| | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, OH 43210, USA
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6
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Pan Y, Varghese J, Tong MS, Yildiz VO, Azzu A, Gatehouse P, Wage R, Nielles-Vallespin S, Pennell D, Jin N, Bacher M, Hayes C, Speier P, Simonetti OP. Two-center validation of Pilot Tone Based Cardiac Triggering of a Comprehensive Cardiovascular Magnetic Resonance Examination. Res Sq 2023:rs.3.rs-3121723. [PMID: 37461505 PMCID: PMC10350216 DOI: 10.21203/rs.3.rs-3121723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background The electrocardiogram (ECG) signal is prone to distortions from gradient and radiofrequency interference and the magnetohydrodynamic effect during cardiovascular magnetic resonance imaging (CMR). Although Pilot Tone Cardiac (PTC) triggering has the potential to overcome these limitations, effectiveness across various CMR techniques has yet to be established. Purpose To evaluate the performance of PTC triggering in a comprehensive CMR exam. Methods Fifteen volunteers and twenty patients were recruited at two centers. ECG triggered images were collected for comparison in a subset of sequences. The PTC trigger accuracy was evaluated against ECG in cine acquisitions. Two experienced readers scored image quality in PTC-triggered cine, late gadolinium enhancement (LGE), and T1- and T2-weighted dark-blood turbo spin echo (DB-TSE) images. Quantitative cardiac function, flow, and parametric mapping values obtained using PTC and ECG triggered sequences were compared. Results Breath-held segmented cine used for trigger timing analysis was collected in 15 volunteers and 14 patients. PTC calibration failed in three volunteers and one patient; ECG trigger recording failed in one patient. Out of 1987 total heartbeats, three mismatched trigger PTC-ECG pairs were found. Image quality scores showed no significant difference between PTC and ECG triggering. There was no significant difference found in quantitative measurements in volunteers. In patients, the only significant difference was found in post-contrast T1 (p = 0.04). ICC showed moderate to excellent agreement in all measurements. Conclusion PTC performance was equivalent to ECG in terms of triggering consistency, image quality, and quantitative image measurements across multiple CMR applications.
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Boutzoukas AE, Freedman DA, Koterba C, Hunt GW, Mack K, Cass J, Yildiz VO, de Los Reyes E, Twanow J, Chung MG, Ouellette CP. La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Analysis of Clinical/Neurobehavioral Outcomes and Predictors of Disease Severity. Clin Infect Dis 2023; 76:e1114-e1122. [PMID: 35607778 PMCID: PMC10169387 DOI: 10.1093/cid/ciac403] [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: 12/10/2021] [Revised: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse. METHODS This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0-18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires. RESULTS One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5-11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03-19.95]; P = .0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45-30.86]; P = .0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4-128.77]; P = .024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%-54%) irrespective of disease severity. CONCLUSIONS Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND.
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Affiliation(s)
- Angelique E Boutzoukas
- Department of Pediatrics, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Christine Koterba
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Garrett W Hunt
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathy Mack
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Cass
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Emily de Los Reyes
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaime Twanow
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa G Chung
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher P Ouellette
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.,Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.,Host Defense Program, Nationwide Children's Hospital, Columbus, OH, USA
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8
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Baliga S, Mitchell D, Yildiz VO, Gogineni E, Konieczkowski DJ, Grecula J, Blakaj DM, Liu X, Gamez ME. Disparities in survival outcomes among Black patients with HPV-associated oropharyngeal cancer. J Med Virol 2023; 95:e28448. [PMID: 36583477 PMCID: PMC10107101 DOI: 10.1002/jmv.28448] [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: 11/22/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) have a favorable prognosis and excellent overall survival (OS), and studies have demonstrated these findings in cohorts of predominantly White patients. Racial/ethnic (R/E) minorities, particularly Black patients, with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes compared with White patients. In this study, we aimed to determine if Black patients with HPV-OPSCC have a similar favorable prognosis to the White population. This was a population-based retrospective cohort study that analyzed HNSCC patients using the National Cancer Database from 2010 to 2016. We identified patients with Stage I-IV HPV- OPSCC who were treated with radiation, surgery, chemotherapy, or a combination of modalities. Patient outcomes were stratified by R/E groups including White Versus Black patients. The main outcome in this study was OS. Analyses for proportions of categorical variables were performed using a χ2 or Fisher's exact test. Univariate and multivariate time-to-event survival analyses were performed using Kaplan-Meier product limit estimates and log-rank test to test the differences between strata. A Cox proportional hazards regression model was used to assess the association between covariates and risk of death (OS). We identified 9256 OPSCC patients who met inclusion criteria and were treated between 2010 and 2016, of which 7912 were White (85.5%) and 1344 were Black (14.5%). A total of 1727 were HPV-OPSCC, of which 1598 were White (92.5%) and 129 (7.5%) were Black. By race, the 5-year OS for White versus Black OPSCC patients was 42% versus 23%, respectively (log-rank, p < 0.0001). Among HPV-positive OPSCC patients, the 5-year OS for White versus Black patients was 65% versus 39% (log-rank, p < 0.0001). Among HPV-negative patients, the 5-year OS for White versus Black patients was 36% versus 13% (log-rank, p < 0.0001). On multivariate analysis, after accounting for age, sex, insurance status, income, Charlson-Deyo score, receipt of surgery, distance from facility, and total treatment time, Black race trended toward, but was not associated with worse survival. Hazard ratio (HR:1.24, 95% confidence interval [CI] 0.85-1.81, p = 0.255). This national cohort study of OPSCC patients demonstrates that Black patients with HPV-OPSCC have a poor prognosis and OS similar to HPV-negative White patients. This may be partly due to socioeconomic barriers such as insurance and income. Further work is needed to better understand the specific drivers of inferior survival outcomes in this specific patient population.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, Ohio, USA
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Xuefeng Liu
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mauricio E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Sultana Z, Hasenstab KA, Moore RK, Osborn EK, Yildiz VO, Wei L, Slaughter JL, Jadcherla SR. Symptom Scores and pH-Impedance: Secondary Analysis of a Randomized Controlled Trial in Infants Treated for Gastroesophageal Reflux. Gastro Hep Adv 2022; 1:869-881. [PMID: 36310566 PMCID: PMC9615096 DOI: 10.1016/j.gastha.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS To evaluate and compare gastro-esophageal reflux (GER) symptom scores with pH-impedance and test the effects of acid-suppressive medications with or without feeding modifications on pH-impedance in high-risk infants. METHODS Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) and 24-hour pH-impedance data were analyzed from 94 infants evaluated in a tertiary care setting for GER disease. Longitudinal data from 40 infants that received randomized GER therapy (proton pump inhibitor [PPI] with or without feeding modifications) for 4 weeks followed by 1-week washout were analyzed. Relationships between I-GERQ-R and pH-impedance metrics (acid reflux index, acid and bolus GER events, distal baseline impedance, and symptoms) were examined and effects of treatments compared. RESULTS (A) Correlations between I-GERQ-R and pH-impedance metrics were weak. (B) I-GERQ-R sensitivity, specificity, and positive predictive values were suboptimal when correlated with pH-impedance metrics. I-GERQ-R negative predictive value (NPV) was high for acid symptom-association probability (NPV = 84%) and distal baseline impedence (NPV = 86%) thresholds. (C) PPI with feeding modifications (vs PPI alone) did not alter pH-impedance metrics or symptom scores (P > .05); however, bolus clearance metrics worsened for both treatment groups (P < .05). CONCLUSIONS In high-risk infants (1) I-GERQ-R may be a helpful clinical screening tool to exclude acid-GER disease diagnosis and minimize unnecessary acid-suppressive treatment, but further testing is needed for diagnosis. (2) Acid-suppressive therapy with feeding modifications has no effect on symptom scores or pH-impedance metrics. Clearance of refluxate worsened despite PPI therapy, which may signal development of pharyngoesophageal dysmotility and persistence of symptoms. (3) Placebo-controlled trials are needed in high-risk infants with objective pH-impedance criteria to determine efficacy, safety, and underlying mechanisms. Clinicaltrials.gov ID: NCT02486263.
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Affiliation(s)
- Zakia Sultana
- Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathryn A. Hasenstab
- Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Rebecca K. Moore
- Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Erika K. Osborn
- Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Vedat O. Yildiz
- Biostatistics Resource at Nationwide Children’s Hospital, (BRANCH), Columbus, Ohio
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Lai Wei
- Biostatistics Resource at Nationwide Children’s Hospital, (BRANCH), Columbus, Ohio
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jonathan L. Slaughter
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Sudarshan R. Jadcherla
- Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio
- Division of Pediatric Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Ohio State University College of Medicine, Columbus, Ohio
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10
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Palmer JD, Prasad RN, Fabian D, Wei L, Yildiz VO, Tan Y, Grecula J, Welliver M, Williams T, Elder JB, Raval R, Blakaj D, Haglund K, Bazan J, Kendra K, Arnett A, Beyer S, Liebner D, Giglio P, Puduvalli V, Chakravarti A, Wuthrick E. Phase I study of trametinib in combination with whole brain radiation therapy for brain metastases. Radiother Oncol 2022; 170:21-26. [DOI: 10.1016/j.radonc.2022.03.016] [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: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
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11
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Prasad RN, Patel T, Perlow HK, Yildiz VO, Baliga S, Brownstein J, Gamez ME, Konieczkowski DJ, Royce TJ, Palmer JD. List Prices for Proton Radiation Therapy. Pract Radiat Oncol 2022; 12:e163-e168. [DOI: 10.1016/j.prro.2021.11.013] [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: 09/09/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 10/18/2022]
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12
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Prasad RN, McIntyre M, Guha A, Carter RR, Yildiz VO, Paskett E, Lustberg M, Ruz P, Williams TM, Kola-Kehinde O, Miller ED, Addison D. Cardiovascular Event Reporting in Modern Cancer Radiation Therapy Trials. Adv Radiat Oncol 2022; 7:100888. [PMID: 35198835 PMCID: PMC8844682 DOI: 10.1016/j.adro.2021.100888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/21/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in cancer survivors, particularly after chest radiation therapy (RT). However, the extent to which CVD events are consistently reported in contemporary prospective trials is unknown. Methods and Materials From 10 high-impact RT, oncology, and medicine journals, we identified all latter phase trials from 2000 to 2019 enrolling patients with breast, lung, lymphoma, mesothelioma, or esophageal cancer wherein chest-RT was delivered. The primary outcome was the report of major adverse cardiac events (MACEs), defined as incident myocardial infarction, heart failure, coronary revascularization, arrhythmia, stroke, or CVD death across treatment arms. The secondary outcome was the report of any CVD event. Multivariable regression was used to identify factors associated with CVD reporting. Pooled annualized incidence rates of MACEs across RT trials were compared with contemporary population rates using relative risks (RRs). Results The 108 trials that met criteria enrolled 59,070 patients (mean age, 58.0 ± 10.2 years; 46.0% female), with 273,587 person-years of available follow-up. During a median follow-up of 48 months, 468 MACEs were reported (including 96 heart failures, 75 acute coronary syndrome, 1 revascularization, 94 arrhythmias, 28 strokes, and 20 CVD deaths; 307 occurred in the intervention arms vs 144 in the control arms; RR, 1.96; P < .001). Altogether, 50.0% of trials did not report MACEs, and 37.0% did not report any CVD. The overall weighted-trial incidence was 376 events per 100,000 person-years compared with 1408 events per 100,000 person-years in similar nontrial patients (RR, 0.27; P < .001). There were no RT factors associated with CVD reporting. Conclusion In contemporary chest RT–based clinical trials, reported CVD rates were lower than expected population rates.
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Affiliation(s)
- Rahul N. Prasad
- Department of Radiation Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mark McIntyre
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
| | - Rebecca R. Carter
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, Ohio
| | - Vedat O. Yildiz
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio
| | - Electra Paskett
- Division of Cancer Control and Prevention, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Maryam Lustberg
- Department of Breast Medical Oncology, Yale Cancer Center, New Haven, Connecticut
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
| | - Terence M. Williams
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
| | - Eric D. Miller
- Department of Radiation Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, Ohio
- Division of Cancer Control and Prevention, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
- Corresponding author: Daniel Addison, MD
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13
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Blakaj DM, Palmer JD, Dibs K, Olausson A, Bourekas EC, Boulter D, Ayan AS, Cochran E, Marras WS, Mageswaran P, Katzir M, Yildiz VO, Grecula J, Arnett A, Raval R, Scharschmidt T, Elder JB, Lonser R, Chakravarti A, Mendel E. Postoperative Stereotactic Body Radiotherapy for Spinal Metastasis and Predictors of Local Control. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa587_s126] [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: 11/15/2022] Open
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14
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Jadcherla SR, Hasenstab KA, Osborn EK, Levy DS, Ipek H, Helmick R, Sultana Z, Logue N, Yildiz VO, Blosser H, Shah SH, Wei L. Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study. Sci Rep 2021; 11:19934. [PMID: 34620898 PMCID: PMC8497609 DOI: 10.1038/s41598-021-99070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76-94%] in study (N = 60) vs. 63% [50-77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.
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Affiliation(s)
- Sudarshan R. Jadcherla
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA ,grid.412332.50000 0001 1545 0811Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kathryn A. Hasenstab
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Erika K. Osborn
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Deborah S. Levy
- grid.8532.c0000 0001 2200 7498Department of Speech and Language Pathology, Hospital de Clínicas de Porto Alegre, Department of Health and Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Haluk Ipek
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Roseanna Helmick
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Zakia Sultana
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Nicole Logue
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Vedat O. Yildiz
- grid.240344.50000 0004 0392 3476Biostatistics Resource at Nationwide Children’s Hospital (BRANCH), Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Hailey Blosser
- grid.240344.50000 0004 0392 3476Division of Clinical Therapies, Nationwide Children’s Hospital, Columbus, OH USA
| | - Summit H. Shah
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Lai Wei
- grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
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15
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Brammer JE, Braunstein Z, Katapadi A, Porter K, Biersmith M, Guha A, Vasu S, Yildiz VO, Smith SA, Buck B, Haddad D, Gumina R, William BM, Penza S, Saad A, Denlinger N, Vallakati A, Baliga R, Benza R, Binkley P, Wei L, Mocarski M, Devine SM, Jaglowski S, Addison D. Early toxicity and clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy for lymphoma. J Immunother Cancer 2021; 9:e002303. [PMID: 34429331 PMCID: PMC8386216 DOI: 10.1136/jitc-2020-002303] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Chimeric antigen receptor T-cell (CAR-T) infusion is associated with early toxicity. Yet, whether early toxicity development holds ramifications for long-term outcomes is unknown. METHODS From a large cohort of consecutive adult patients treated with CAR-T therapies for relapsed or refractory lymphomas from 2016 to 2019, we assessed progression-free survival (PFS), by toxicity development (cytokine release syndrome (CRS), neurotoxicity, or cardiotoxicity]. We also assessed the relationship of toxicity development to objective disease response, and overall survival (OS). Multivariable regression was utilized to evaluate relationships between standard clinical and laboratory measures and disease outcomes. Differences in outcomes, by toxicity status, were also assessed via 30-day landmark analysis. Furthermore, we assessed the effects of early anti-CRS toxicity therapy use (at ≤grade 2 toxicity) on maximum toxicity grade observed, and long-term disease outcomes (PFS and OS). RESULTS Overall, from 102 CAR-T-treated patients, 90 were identified as treated with single-agent therapy, of which 88.9% developed toxicity (80 CRS, 41 neurotoxicity, and 17 cardiotoxicity), including 28.9% with high-grade (≥3) events. The most common manifestations were hypotension at 96.6% and fever at 94.8%. Among patients with cardiac events, there was a non-significant trend toward a higher prevalence of concurrent or preceding high-grade (≥3) CRS. 50.0% required tocilizumab or corticosteroids. The median time to toxicity was 3 days; high grade CRS development was associated with cardiac and neurotoxicity. In multivariable regression, accounting for disease severity and traditional predictors of disease response, moderate (maximum grade 2) CRS development was associated with higher complete response at 1 year (HR: 2.34; p=0.07), and longer PFS (HR: 0.41; p=0.02, in landmark analysis), and OS (HR: 0.43; p=0.03). Among those with CRS, relative blood pressure (HR: 2.25; p=0.004), respectively, also associated with improved PFS. There was no difference in disease outcomes, or maximum toxicity grade (CRS, neurotoxicity, or cardiotoxicity) observed, based on the presence or absence of the use of early CRS-directed therapies. CONCLUSIONS Among adult lymphoma patients, moderate toxicity manifest as grade 2 CRS after CAR-T infusion may associate with favorable clinical outcomes. Further studies are needed to confirm these findings.
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Affiliation(s)
- Jonathan E Brammer
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Zachary Braunstein
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aashish Katapadi
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Biersmith
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Cardiology, University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Sumithira Vasu
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sakima A Smith
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin Buck
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Devin Haddad
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Gumina
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Basem M William
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Sam Penza
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Ayman Saad
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Ajay Vallakati
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ragavendra Baliga
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raymond Benza
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Philip Binkley
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mason Mocarski
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Samantha Jaglowski
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Cancer Control and Prevention, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
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16
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Blakaj DM, Palmer JD, Dibs K, Olausson A, Bourekas EC, Boulter D, Ayan AS, Cochran E, Marras WS, Mageswaran P, Katzir M, Yildiz VO, Grecula J, Arnett A, Raval R, Scharschmidt T, Elder JB, Lonser R, Chakravarti A, Mendel E. Postoperative Stereotactic Body Radiotherapy for Spinal Metastasis and Predictors of Local Control. Neurosurgery 2021; 88:1021-1027. [PMID: 33575784 DOI: 10.1093/neuros/nyaa587] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/20/2020] [Accepted: 11/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spine surgery is indicated for select patients with mechanical instability, pain, and/or malignant epidural spinal cord compression, with or without neurological compromise. Stereotactic body radiotherapy (SBRT) is an option for durable local control (LC) for metastatic spine disease. OBJECTIVE To determine factors associated with LC and progression-free survival (PFS) for patients receiving postoperative stereotactic spine radiosurgery. METHODS We analyzed consecutive patients from 2013 to 2019 treated with surgical intervention followed by SBRT. Surgical interventions included laminectomy and vertebrectomy. SBRT included patients treated with 1 to 5 fractions of radiosurgery. We analyzed LC, PFS, overall survival (OS), and toxicity. Univariate and multivariate analyses were performed. RESULTS A total of 63 patients were treated with a median follow-up of 12.5 mo. Approximately 75% of patients underwent vertebrectomy and 25% underwent laminectomy. One-year cumulative incidence of local failure was 19%. LC was significantly improved for patients receiving radiosurgery ≤40 d from surgery compared to that for patients receiving radiosurgery ≥40 d from surgery, 94% vs 75%, respectively, at 1 yr (P = .03). Patients who received preoperative embolization had improved LC with 1-yr LC of 88% vs 76% for those who did not receive preoperative embolization (P = .037). Significant predictors for LC on multivariate analysis were time from surgery to radiosurgery, higher radiotherapy dose, and preoperative embolization. The 1-yr PFS and OS was 56% and 60%, respectively. CONCLUSION Postoperative radiosurgery has excellent and durable LC for spine metastasis. An important consideration when planning postoperative radiosurgery is minimizing delay from surgery to radiosurgery. Preoperative embolization and higher radiotherapy dose were associated with improved LC warranting further study.
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Affiliation(s)
- Dukagjin M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Khaled Dibs
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alexander Olausson
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric C Bourekas
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Radiology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Boulter
- Department of Radiology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ahmet S Ayan
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric Cochran
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William S Marras
- Spine Research Institute, College of Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Prasath Mageswaran
- Spine Research Institute, College of Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Miki Katzir
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Vedat O Yildiz
- Center for Biostatistics, College of Medicine Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John Grecula
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrea Arnett
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raju Raval
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas Scharschmidt
- Department of Orthopedic Surgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James B Elder
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Russell Lonser
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ehud Mendel
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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17
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Rosenthal ME, Lyons MM, Schweller J, Yildiz VO, Chio EG, Khan MS. Association between anxiety, depression, and emotional distress and hypoglossal nerve stimulator adherence. Sleep Breath 2021; 26:141-147. [PMID: 33856642 DOI: 10.1007/s11325-021-02366-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate relationships between hypoglossal nerve stimulator (HNS) adherence and the presence of anxiety, depression, and emotional distress. METHODS This is a cross-sectional study of subjects with moderate to severe obstructive sleep apnea (OSA), who had HNS implanted and activated at The Ohio State University Medical Center (OSUMC). Patient usage data from the previous 6 months was obtained from 33 patients. Adherence was defined as ≥28 h of use per week. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were administered, and the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) score was calculated for all subjects. RESULTS Sixty-five percent were adherent with average usage of 46.5±11.7 h per week vs 7.7±7.5 h per week in the non-adherent group. The average GAD-7 were 3.90±3.98 in the adherent group vs. 8.27±6.69 in the non-adherent group (p=0.049). PHQ-9 score was 6.15±4.31 vs. 10.09±7.53 (p=0.118), and PHQ-ADS was 10.05±7.49 vs. 19.20±9.80 (p=0.035). There were no statistically significant differences in age, gender, pre-treatment AHI, and post-treatment AHI between the two groups, though there was a trend to higher age in the adherent group. CONCLUSIONS This study demonstrated higher GAD-7 and PHQ-ADS scores in the non-adherent group compared to those who were adherent to HNS supporting that anxiety and emotional distress may contribute to HNS therapy adherence. To our knowledge, this is the first study evaluating the relationship between anxiety, depression, emotional distress, and HNS adherence. Screening patients with the GAD-7 and PHQ-9 prior to implantation may be helpful when evaluating patient adherence to therapy.
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Affiliation(s)
- Madelyn E Rosenthal
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, OH, Columbus, USA
| | - M Melanie Lyons
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, OH, Columbus, USA
| | - Jessica Schweller
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, OH, Columbus, USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Eugene G Chio
- Department of Otolaryngology Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Meena S Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and Neurology, The Ohio State University Wexner Medical Center, OH, Columbus, USA.
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18
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Suarez-Kelly L, Sun SH, Ren C, Rampersaud IV, Albertson D, Duggan MC, Noel TC, Courtney N, Buteyn NJ, Moritz C, Yu L, Yildiz VO, Butchar JP, Tridandapani S, Rampersaud AA, Carson WE. Antibody Conjugation of Fluorescent Nanodiamonds for Targeted Innate Immune Cell Activation. ACS Appl Nano Mater 2021; 4:3122-3139. [PMID: 34027313 PMCID: PMC8136585 DOI: 10.1021/acsanm.1c00256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND fluorescent nanodiamonds (FND) are nontoxic, infinitely photostable nanoparticles that emit near-infrared fluorescence and have a modifiable surface allowing for the generation of protein-FND conjugates. FND-mediated immune cell targeting may serve as a strategy to visualize immune cells and promote immune cell activation. METHODS uncoated-FND (uFND) were fabricated, coated with glycidol (gFND), and conjugated with immunoglobulin G (IgG-gFND). In vitro studies were performed using a breast cancer/natural killer/monocyte co-culture system, and in vivo studies were performed using a breast cancer mouse model. RESULTS in vitro studies demonstrated the targeted immune cell uptake of IgG-gFND, resulting in significant immune cell activation and no compromise in immune cell viability. IgG-gFND remained at the tumor site following intratumoral injection compared to uFND which migrated to the liver and kidneys. CONCLUSION antibody-conjugated FND may serve as immune drug delivery vehicles with "track and trace capabilities" to promote directed antitumor activity and minimize systemic toxicities.
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Affiliation(s)
- Lorena
P. Suarez-Kelly
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Steven H. Sun
- Department
of Surgery, The Ohio State University, Columbus, Ohio 43210, United States
| | - Casey Ren
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Isaac V. Rampersaud
- Columbus
NanoWorks, Inc., 1507
Chambers Road, Columbus, Ohio 43212, United
States
| | - David Albertson
- Columbus
NanoWorks, Inc., 1507
Chambers Road, Columbus, Ohio 43212, United
States
| | - Megan C. Duggan
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Tiffany C. Noel
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Nicholas Courtney
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
| | - Nathaniel J. Buteyn
- Division
of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department
of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, United States
| | - Charles Moritz
- Columbus
NanoWorks, Inc., 1507
Chambers Road, Columbus, Ohio 43212, United
States
| | - Lianbo Yu
- Department
of Biomedical Informatics, The Ohio State
University, Columbus, Ohio 43210, United States
| | - Vedat O. Yildiz
- Department
of Biomedical Informatics, The Ohio State
University, Columbus, Ohio 43210, United States
| | - Jonathan P. Butchar
- Division
of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department
of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, United States
| | - Susheela Tridandapani
- Division
of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department
of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, United States
| | - Arfaan A. Rampersaud
- Columbus
NanoWorks, Inc., 1507
Chambers Road, Columbus, Ohio 43212, United
States
| | - William E. Carson
- The
Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, Columbus, Ohio 43210, United States
- Department
of Surgery, The Ohio State University, Columbus, Ohio 43210, United States
- . Phone: (614)
293-6306. Fax: (614) 293-3465
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19
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Ciciora SL, Yildiz VO, Jin WY, Zhao B, Saps M. Complementary and Alternative Medicine Use in Pediatric Functional Abdominal Pain Disorders at a Large Academic Center. J Pediatr 2020; 227:53-59.e1. [PMID: 32798564 DOI: 10.1016/j.jpeds.2020.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the use of complementary and alternative medicine (CAM) in pediatric functional abdominal pain disorders at a large Midwestern pediatric gastroenterology center. STUDY DESIGN A survey of patients attending a follow-up visit for functional abdominal pain disorders was completed. Data were collected on demographics, quality of life, use of conventional therapies, patient's opinions, and perception of provider's knowledge of CAM. RESULTS Of 100 respondents (mean age, 13.3 ± 3.5 years), 47 (60% female) had irritable bowel syndrome, 29 (83% female) had functional dyspepsia, 18 (67% female) had functional abdominal pain, and 6 (83% female) had abdominal migraine (Rome III criteria). Ninety-six percent reported using at least 1 CAM modality. Dietary changes were undertaken by 69%. Multivitamins and probiotics were the most common supplements used by 48% and 33% of respondents, respectively. One-quarter had seen a psychologist. Children with self-reported severe disease were more likely to use exercise (P < .05); those with active symptoms (P < .01) or in a high-income group (P < .05) were more likely to make dietary changes; and those without private insurance (P < .05), or who felt poorly informed regarding CAM (P < .05), were more likely to use vitamins and supplements. Seventy-seven percent of patients described their quality of life as very good or excellent. CONCLUSIONS The use of CAM in children with functional abdominal pain disorders is common, with a majority reporting a high quality of life. Our study underscores the importance of asking about CAM use and patient/family knowledge of these treatments.
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Affiliation(s)
| | - Vedat O Yildiz
- Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Department of Biomedical Informatics, Columbus, OH
| | - Wendy Y Jin
- Nationwide Children's Hospital, Columbus, OH
| | - Becky Zhao
- Nationwide Children's Hospital, Columbus, OH
| | - Miguel Saps
- University of Miami Miller School of Medicine, Miami, FL
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20
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Kofina V, Demirer M, Erdal BS, Eubank TD, Yildiz VO, Tatakis DN, Leblebicioglu B. Bone grafting history affects soft tissue healing following implant placement. J Periodontol 2020; 92:234-243. [PMID: 32779206 DOI: 10.1002/jper.19-0709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to determine and compare soft tissue healing outcomes following implant placement in grafted (GG) and non-grafted bone (NGG). METHODS Patients receiving single implant in a tooth-bound maxillary non-molar site were recruited. Clinical healing was documented. Volume and content of wound fluid (WF; at 3, 6, and 9 days) were compared with adjacent gingival crevicular fluid (GCF; at baseline, 1, and 4 months). Buccal flap blood perfusion recovery and changes in bone thickness were recorded. Linear mixed model regression analysis and generalized estimating equations with Bonferroni adjustments were conducted for repeated measures. RESULTS Twenty-five patients (49 ± 4 years; 13 males; nine NGG) completed the study. Soft tissue closure was slower in GG (P < 0.01). Differential response in WF/GCF protein concentrations was detected for ACTH (increased in GG only) and insulin, leptin, osteocalcin (decreased in NGG only) at day 6 (P ≤0.04), with no inter-group differences at any time(P > 0.05). Blood perfusion rate decreased immediately postoperatively (P < 0.01, GG) followed by 3-day hyperemia (P > 0.05 both groups). The recovery to baseline values was almost complete for NGG whereas GG stayed ischemic even at 4 months (P = 0.05). Buccal bone thickness changes were significant in GG sites (P ≤ 0.05). CONCLUSION History of bone grafting alters the clinical, physiological, and molecular healing response of overlying soft tissues after implant placement surgery.
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Affiliation(s)
- Vrisiis Kofina
- Division of Periodontology, College of Dentistry, Ohio State University, Columbus, Ohio, USA
| | - Mutlu Demirer
- Department of Radiology, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Barbaros S Erdal
- Department of Radiology, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Timothy D Eubank
- Department of Microbiology, Immunology, & Cell Biology, College of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, Ohio, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, Ohio State University, Columbus, Ohio, USA
| | - Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, Ohio State University, Columbus, Ohio, USA
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21
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Wolfe AR, Prabhakar D, Yildiz VO, Cloyd JM, Dillhoff M, Abushahin L, Alexandra Diaz D, Miller ED, Chen W, Frankel WL, Noonan A, Williams TM. Neoadjuvant-modified FOLFIRINOX vs nab-paclitaxel plus gemcitabine for borderline resectable or locally advanced pancreatic cancer patients who achieved surgical resection. Cancer Med 2020; 9:4711-4723. [PMID: 32415696 PMCID: PMC7333854 DOI: 10.1002/cam4.3075] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022] Open
Abstract
We conducted an institutional study to compare the clinical and pathological efficacy between the neoadjuvant therapy (NAT)‐modified FOLFIRINOX (mFOLF) vs nanoparticle albumin–bound paclitaxel plus gemcitabine (nab‐P/G) for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients who completed resection. The study retrospectively enrolled patients with pathologically confirmed BRPC or LAPC from 2010 to 2018 at our institution. The survival rates were determined by the Kaplan‐Meier method and log‐rank test was used to test differences. Cox's proportional hazard model was used to assess survival with respect to covariates. Seventy‐two patients who completed at least two cycles of neoadjuvant chemotherapy and surgical resection were included, with 52 (72.2%) patients receiving mFOLF and 20 (27.8%) receiving nab‐P/G. Patients treated with mFOLF had statistically higher rates of RECIST 1.1 partial or complete response (16/52 vs 1/20, P = .028). Additionally, mFOLF patients had greater pathological tumor size reduction, fewer positive lymph nodes, and higher treatment response grade compared to the nab‐P/G patients (all P < .05). The median overall survival was 33.3 months vs 27.1 months (P = .105), and distant metastasis‒free survival (DMFS) was 21.3 months vs 14.6 months (P = .042) in the mFOLF vs nab‐P/G groups, respectively. On multivariate analysis, mFOLF (hazard ratio, 0.428; 95% confidence interval [CI], 0.186‐0.987) and abnormal postoperative CA 19‐9 (hazard ratio, 2.47; 95% CI, 1.06‐5.76) were associated with DMFS. Among patients with BRPC and LAPC who complete surgical resection, neoadjuvant mFOLF was associated with improved pathological and clinical outcomes compared with nab‐P/G.
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Affiliation(s)
- Adam R Wolfe
- Department of Radiation Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Dhivya Prabhakar
- Department of Medical Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Ohio State College of Medicine, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgical Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgical Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laith Abushahin
- Department of Medical Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Dayssy Alexandra Diaz
- Department of Radiation Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Eric D Miller
- Department of Radiation Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Wei Chen
- Department of Pathology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Wendy L Frankel
- Department of Pathology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anne Noonan
- Department of Medical Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Terence M Williams
- Department of Radiation Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
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22
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Abstract
Clinical parameters available to evaluate early healing phases of bone regeneration procedures are limited. This study explores wound fluid (WF) content for molecular markers to differentiate wound healing responses in the early postoperative period after bone graft placement. Fifteen patients (50 ± 5 years old; 8 men) scheduled to receive tooth extraction and bone graft placement at maxillary nonmolar single-tooth sites were recruited. Primary wound closure was not intended at time of surgery. Gingival crevicular fluid from adjacent teeth or WF from surgical wound edges were collected (30 seconds) at baseline, at 3, 6, and 9 days, and at 1 and 4 months. Multiplex protein assay was used to determine concentration of various wound healing mediators. Immediately after surgery, 87% of surgical sites exhibited open wound. At day 9, mean wound exposure was 4.8 ± 0.4 mm. At 1 month, all wounds were clinically closed. The WF tripled in volume at day 3 and day 6 (P ≤ .05), compared with baseline gingival crevicular fluid, and gradually decreased as wounds closed. The WF concentrations of interleukin (IL)-6, placental growth factor, plasminogen activator inhibitor 1, insulin-like growth factor binding protein 1, and soluble cluster determinant 40 ligand were increased during early healing days, generally with peak concentration at day 6 (P ≤ .004). Conversely, WF concentrations of IL-18 and epidermal growth factor were decreased after surgery, generally not reaching baseline values until wound closure (P ≤ .008). In general, WF cytokine expression kinetics were concordant with wound closure dynamics (P ≤ .04). These results suggest that WF molecular markers such as IL-6, and to a lesser extent placental growth factor and IL-18, might help differentiate wound healing responses after bone regeneration procedures.
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Affiliation(s)
- Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio
| | - Lamees Alssum
- Department of Periodontics & Community Dentistry, College of Dentistry, King Saud University, Saudi Arabia; previously with The Ohio State University, Columbus, Ohio
| | - Timothy D Eubank
- Department of Microbiology, Immunology and Cell Biology, School of Medicine, West Virginia University, Mogantown, WV
| | - Vedat O Yildiz
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio
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23
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Kelley HV, Waibel SM, Sidiki S, Tomatis-Souverbielle C, Scordo JM, Hunt WG, Barr N, Smith R, Silwani SN, Averill JJ, Baer S, Hengesbach J, Yildiz VO, Pan X, Gebreyes WA, Balada-Llasat JM, Wang SH, Torrelles JB. Accuracy of Two Point-of-Care Tests for Rapid Diagnosis of Bovine Tuberculosis at Animal Level using Non-Invasive Specimens. Sci Rep 2020; 10:5441. [PMID: 32214170 PMCID: PMC7096388 DOI: 10.1038/s41598-020-62314-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/11/2020] [Indexed: 12/23/2022] Open
Abstract
Bovine tuberculosis (BTB) testing in cattle requires a significant investment of time, equipment, and labor. Novel, rapid, cheaper and accurate methods are needed. The Alere Determine TB lipoarabinomannan antigen (LAM-test) is a World Health Organization-endorsed point-of-care urine test designed to detect active TB disease in humans. The Lionex Animal TB Rapid Test (Lionex-test) is a novel animal specific TB diagnostic blood test. An animal level analysis was performed using urine (n = 141) and milk (n = 63) samples from depopulated BTB-suspected cattle to test the accuracy of the LAM-test when compared to results of positive TB detection by any routine BTB tests (BOVIGAM, necropsy, histology, culture, PCR) that are regularly performed by the United States Department of Agriculture (USDA). The agreement between the urine LAM-test and USDA standard tests were poor at varying testing time points. The same milk samples did not elicit statistically significant agreement with the Lionex-test, although positive trends were present. Hence, we cannot recommend the LAM-test as a valid BTB diagnostic test in cattle using either urine or milk. The Lionex-test’s production of positive trends using milk samples suggests larger sample sizes may validate the Lionex-test in accurately diagnosing BTB in cattle using milk samples, potentially providing a quick and reliable field test for BTB.
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Affiliation(s)
- Holden V Kelley
- Texas Biomedical Research Institute, San Antonio, TX, United States.,Department of Microbial infection and Immunity, College of Medicine (COM), The Ohio State University (OSU), Columbus, OH, United States
| | - Sarah M Waibel
- Department of Preventative Medicine, College of Veterinary Medicine, OSU, Columbus, OH, United States
| | - Sabeen Sidiki
- Department of Microbial infection and Immunity, College of Medicine (COM), The Ohio State University (OSU), Columbus, OH, United States
| | | | - Julia M Scordo
- Texas Biomedical Research Institute, San Antonio, TX, United States.,Department of Microbial infection and Immunity, College of Medicine (COM), The Ohio State University (OSU), Columbus, OH, United States
| | - W Garret Hunt
- Nationwide Children's Hospital, Division of Infectious Diseases, OSU, Columbus, OH, United States
| | - N Barr
- Michigan Department of Agriculture and Rural Development, Lansing, MI, United States
| | - R Smith
- Michigan Department of Agriculture and Rural Development, Lansing, MI, United States
| | - Sayeed N Silwani
- Texas Biomedical Research Institute, San Antonio, TX, United States.,Department of Microbial infection and Immunity, College of Medicine (COM), The Ohio State University (OSU), Columbus, OH, United States
| | - James J Averill
- Michigan Department of Agriculture and Rural Development, Lansing, MI, United States
| | - Susan Baer
- Diagnostic Center for Population and Animal Health, Michigan State University, East Lansing, MI, United States
| | - Janet Hengesbach
- Diagnostic Center for Population and Animal Health, Michigan State University, East Lansing, MI, United States
| | - Vedat O Yildiz
- Center for Biostatistics, COM, OSU, Columbus, OH, United States
| | - Xueliang Pan
- Center for Biostatistics, COM, OSU, Columbus, OH, United States
| | - Wondwossen A Gebreyes
- Department of Preventative Medicine, College of Veterinary Medicine, OSU, Columbus, OH, United States.,OSU Global One Health Initiative, Columbus, OH, United States
| | - Joan-Miquel Balada-Llasat
- OSU Global One Health Initiative, Columbus, OH, United States.,Department of Pathology, COM, OSU, Columbus, OH, United States
| | - Shu-Hua Wang
- OSU Global One Health Initiative, Columbus, OH, United States. .,Department of Internal Medicine, Division of Infectious Diseases, COM, OSU, Columbus, OH, United States.
| | - Jordi B Torrelles
- Texas Biomedical Research Institute, San Antonio, TX, United States. .,Department of Microbial infection and Immunity, College of Medicine (COM), The Ohio State University (OSU), Columbus, OH, United States.
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24
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Milks MW, Velez MR, Mehta N, Ishola A, Van Houten T, Yildiz VO, Reinbolt R, Lustberg M, Smith SA, Orsinelli DA. Usefulness of Integrating Heart Failure Risk Factors Into Impairment of Global Longitudinal Strain to Predict Anthracycline-Related Cardiac Dysfunction. Am J Cardiol 2018; 121:867-873. [PMID: 29454478 DOI: 10.1016/j.amjcard.2017.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022]
Abstract
The prediction of cancer therapeutics-related cardiac dysfunction (CTRCD) is an essential aspect of care for individuals who receive potentially cardiotoxic oncologic treatments. Certain clinical risk factors have been described for incident CTRCD, and measurement of left ventricular (LV) longitudinal strain by speckle tracking 2-dimensional echocardiography (2DE) is the best-validated myocardial mechanical imaging assessment to detect subtle changes in LV function during cancer treatment. However, the direct integration of clinical and imaging risk factors to predict CTRCD has not yet been extensively examined. This was a retrospective study of 183 women with breast cancer aged 50.9 ± 10.8 years who received treatment with anthracyclines (doxorubicin dose of 422 ± 69 mg/m2, with 41.2% of subjects also receiving trastuzumab) and underwent 2DE at clinically determined intervals. CTRCD was diagnosed when LV ejection fraction dropped ≥10% to a subnormal (<53%) value by 2DE. Left ventricular global longitudinal strain (LV-GLS) was assessed offline. The risk prediction tool based only on clinical factors previously described by Ezaz et al was applied to our cohort and accurately stratified these subjects into low-, intermediate-, and high-risk groups, with incident CTRCD in 7.4%, 26.9%, and 54.6%, respectively (chi-square = 20.7, p <0.0001). We developed novel multivariate models to predict CTRCD using (1) demographic variables only (c = 0.8674), (2) echocardiographic (peak LV-GLS) variables only (c = 0.8440), or (3) a combination of demographic and echocardiographic variables, with the combined model exhibiting superior receiver-operating characteristics (c = 0.9629). In conclusion, estimation of CTRCD risk should integrate all available data, including both clinical variables and an imaging assessment.
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Affiliation(s)
- M Wesley Milks
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Michael R Velez
- Columbus Cardiology Consultants, Mount Carmel Health System, Columbus, Ohio
| | - Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Abiodun Ishola
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Thomas Van Houten
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vedat O Yildiz
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Raquel Reinbolt
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sakima A Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David A Orsinelli
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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25
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Suarez-Kelly LP, Kemper GM, Duggan MC, Stiff A, Noel TC, Markowitz J, Luedke EA, Yildiz VO, Yu L, Jaime-Ramirez AC, Karpa V, Zhang X, Carson WE. The combination of MLN2238 (ixazomib) with interferon-alpha results in enhanced cell death in melanoma. Oncotarget 2018; 7:81172-81186. [PMID: 27783987 PMCID: PMC5348384 DOI: 10.18632/oncotarget.12791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 10/10/2016] [Indexed: 11/25/2022] Open
Abstract
The ubiquitin-proteasome signaling pathway is critical for cell cycle regulation and neoplastic growth. Proteasome inhibition can activate apoptotic pathways. Bortezomib, a selective proteasome inhibitor, has anti-melanoma activity. MLN2238 (ixazomib), an oral proteasome inhibitor, has improved pharmacotherapeutic parameters compared to bortezomib. Interferon-alpha (IFN-α), an immune boosting agent, is FDA-approved for treatment of melanoma. In this study in vitro and in vivo evaluation of the antitumor potential of ixazomib and combination treatments with ixazomib and IFN-α were performed. Apoptosis induced by ixazomib was first observed at 12 hours and was maximal at 48 hours with similar levels of cell death compared to bortezomib. IFN-α alone had little effect on cell viability in vitro. However, the combination of ixazomib with IFN-α significantly enhanced ixazomib's ability to induce apoptotic cell death in BRAF V600E mutant and BRAF wild-type human melanoma tumor cells. The combination of ixazomib and IFN-α also enhanced inhibition of cell proliferation in BRAF V600E mutant melanoma tumor cells; however, this was not seen in BRAF wild-type cells. Ixazomib-induced apoptosis was associated with processing of the pro-apoptotic proteins procaspase-3, -7, -8, and -9, and cleavage of poly-ADP-ribose polymerase (PARP). In an in vivo xenograft model of human melanoma, combination treatment with IFN-α-2b and ixazomib demonstrated a significant reduction in tumor volume when compared to vehicle (p = 0.005) and single therapy ixazomib (p = 0.017) and IFN-α-2b (p = 0.036). These pre-clinical results support further evaluation of combination treatment with ixazomib and IFN-α for the treatment of advanced BRAF V600E mutant melanoma.
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Affiliation(s)
- Lorena P Suarez-Kelly
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Gregory M Kemper
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Megan C Duggan
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.,Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Andrew Stiff
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.,Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Tiffany C Noel
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Joseph Markowitz
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.,Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus OH, USA
| | - Eric A Luedke
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.,Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus OH, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Lianbo Yu
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Alena Cristina Jaime-Ramirez
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Volodymyr Karpa
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Xiaoli Zhang
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.,Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus OH, USA
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Von Visger TT, Kuntz KK, Phillips GS, Yildiz VO, Sood N. Quality of life and psychological symptoms in patients with pulmonary hypertension. Heart Lung 2018; 47:115-121. [PMID: 29361341 DOI: 10.1016/j.hrtlng.2017.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) has a delay in diagnosis that makes time since diagnosis of interest in this population. OBJECTIVES To assess psychological conditions, perceived stress, QOL, and interpersonal support and to explore whether these factors may correlate with time since diagnosis in patients with PAH. METHODS Participants at an academic medical center (n = 108) completed psychological questionnaires (Cambridge Pulmonary Hypertension Outcome Review, Patient Health Questionnaire-9, Perceived Stress Scale-10, and Interpersonal Support Evaluation List-Short Form). RESULTS Prevalence of psychiatric disorder, major depression, and "other depressive disorder" were 29.6%, 15.7%, and 9.3%, respectively. Participants reported adequate social support, high perceived stress, and average quality of life. Time since diagnosis was positively associated with greater perceived social support (ρ = 0.174, p = .075) and greater perceived stress (ρ = 0.191, p = .048), but no other psychological factor. CONCLUSIONS Routine psychological assessment and timely referral for mental health services are suggested. Social support may buffer patients from stress.
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Affiliation(s)
- Tania T Von Visger
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University College of Nursing, Columbus, OH.
| | - Kristin K Kuntz
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Gary S Phillips
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vedat O Yildiz
- The Ohio State University Wexner Medical Center, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Namita Sood
- The Ohio State University Wexner Medical Center, Columbus, OH
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Alssum L, Eubank TD, Roy S, Erdal BS, Yildiz VO, Tatakis DN, Leblebicioglu B. Gingival Perfusion and Tissue Biomarkers During Early Healing of Postextraction Regenerative Procedures: A Prospective Case Series. J Periodontol 2017. [PMID: 28644107 DOI: 10.1902/jop.2017.170117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postextraction alveolar bone loss, mostly affecting the buccal plate, occurs despite regenerative procedures. To better understand possible determinants, this prospective case series assesses gingival blood perfusion and tissue molecular responses in relation to postextraction regenerative outcomes. METHODS Adults scheduled to receive bone grafting in maxillary, non-molar, single-tooth extraction sites were recruited. Clinical documentation included the following: 1) probing depth (PD); 2) keratinized tissue width (KT); 3) tissue biotype (TB); and 4) plaque level. Wound closure was clinically evaluated. Gingival blood perfusion was measured by laser Doppler flowmetry (LDF). Wound fluid (WF) and gingival biopsies were analyzed for protein levels and gene expression, respectively, of relevant molecular markers. Bone healing outcomes were determined radiographically (cone-beam computed tomography). Healing was followed for 4 months. RESULTS Data from 15 patients are reported. Postoperatively, neither complications nor changes in PD, KT, or TB were observed. LDF revealed decreased perfusion followed by hyperemia that persisted for 1 month (P ≤0.05). WF levels of angiopoietin-2, interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor peaked on day 6 (P ≤0.05) and decreased thereafter. Only IL-8 and TNF-α exhibited increased gene expression. Linear bone changes were negligible. Volumetric bone changes were minimal but statistically significant, with more bone loss when membrane was used (P = 0.05). CONCLUSIONS Gingival blood perfusion after postextraction bone regenerative procedures follows an ischemia-reperfusion model. Transient increases in angiogenic factor levels and prolonged hyperemia characterize the soft tissue response. These soft tissue responses do not determine radiographic bone changes.
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Affiliation(s)
- Lamees Alssum
- Currently, Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; previously, Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Timothy D Eubank
- Department of Microbiology, Immunology and Cell Biology; School of Medicine; West Virginia University; Morgantown, WV
| | - Sashwati Roy
- Department of Surgery, College of Medicine, The Ohio State University
| | - Barbaros S Erdal
- Department of Radiology, College of Medicine, The Ohio State University
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University
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Powell JL, Hawley JR, Lipari AM, Yildiz VO, Erdal BS, Carkaci S. Impact of the Addition of Digital Breast Tomosynthesis (DBT) to Standard 2D Digital Screening Mammography on the Rates of Patient Recall, Cancer Detection, and Recommendations for Short-term Follow-up. Acad Radiol 2017; 24:302-307. [PMID: 27919540 DOI: 10.1016/j.acra.2016.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES The addition of digital breast tomosynthesis (DBT) to digital screening mammography (DM) has been shown to decrease recall rates and improve cancer detection rates, but there is a lack of data regarding the impact of DBT on rates of short-term follow-up. We assessed possible changes in performance measures with the introduction of DBT at our facility. MATERIALS AND METHODS In our observational study, databases were used to compare rates of recall, short-term follow-up, biopsy, and cancer detection between women undergoing DM without (n = 10,477) and women undergoing DM with (n = 2304) the addition of DBT. Regression analysis was performed to determine associations with patient age, breast density, and availability of comparison examinations. RESULTS The addition of DBT resulted in significantly lower recall rates (16%-14%, P = .017), higher rates of biopsy (12.7%-19.1%, P < .01), and increased detection of ductal carcinoma in situ, with a difference of 2.3 cases per 1000 screens (P = .044). A 33% increase in cancer detection rates was observed with DBT, which did not reach statistical significance. Short-term follow-up of probably benign findings was 80% higher in the DBT group (odds ratio = 1.80, 95% confidence interval = 1.38-2.36, P < .001). CONCLUSIONS To our knowledge, we are the first to study the impact of DBT on rates of short-term follow-up, and observed an 80% increase over the DM group. Further research is needed to determine the malignancy rate of Breast Imaging Reporting and Data System 3 lesions detected with DBT, and establish appropriate follow-up to maximize cancer detection while minimizing expense and patient anxiety.
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Affiliation(s)
- Jaclynn L Powell
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH 43210.
| | - Jeffrey R Hawley
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH 43210
| | - Adele M Lipari
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH 43210
| | - Vedat O Yildiz
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - B Selnur Erdal
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH 43210
| | - Selin Carkaci
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Columbus, OH 43210
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Hawley JR, Taylor CR, Cubbison AM, Erdal BS, Yildiz VO, Carkaci S. Influences of Radiology Trainees on Screening Mammography Interpretation. J Am Coll Radiol 2016; 13:554-61. [PMID: 26924162 DOI: 10.1016/j.jacr.2016.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Participation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes. METHODS Screening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded. RESULTS A total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly. CONCLUSIONS These results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.
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Affiliation(s)
- Jeffrey R Hawley
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | | | | | - B Selnur Erdal
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vedat O Yildiz
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Selin Carkaci
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Bergese SD, Puente EG, Antor MA, Capo G, Yildiz VO, Uribe AA. The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study. Front Med (Lausanne) 2016; 3:1. [PMID: 26870733 PMCID: PMC4735400 DOI: 10.3389/fmed.2016.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Postoperative nausea and vomiting (PONV) is a displeasing experience that distresses surgical patients during the first 24 h after a surgical procedure. The incidence of postoperative nausea occurs in about 50%, the incidence of postoperative vomiting is about 30%, and in high-risk patients, the PONV rate could be as high as 80%. Therefore, the study design of this single arm, non-randomized, pilot study assessed the efficacy and safety profile of a triple therapy combination with palonosetron, dexamethasone, and promethazine to prevent PONV in patients undergoing craniotomies under general anesthesia. Methods The research protocol was approved by the institutional review board and 40 subjects were provided written informed consent. At induction of anesthesia, a triple therapy of palonosetron 0.075 mg IV, dexamethasone 10 mg IV, and promethazine 25 mg IV was given as PONV prophylaxis. After surgery, subjects were transferred to the surgical intensive care unit or post anesthesia care unit as clinically indicated. Ondansetron 4 mg IV was administered as primary rescue medication to subjects with PONV symptoms. PONV was assessed and collected every 24 h for 5 days via direct interview and/or medical charts review. Results The overall incidence of PONV during the first 24 h after surgery was 30% (n = 12). The incidence of nausea and emesis 24 h after surgery was 30% (n = 12) and 7.5% (n = 3), respectively. The mean time to first emetic episode, first rescue, and first significant nausea was 31.3 (±33.6), 15.1 (±25.8), and 21.1 (±25.4) hours, respectively. The overall incidence of nausea and vomiting after 24–120 h period after surgery was 30% (n = 12). The percentage of subjects without emesis episodes over 24–120 h postoperatively was 70% (n = 28). No subjects presented a prolonged QTc interval ≥500 ms before and/or after surgery. Conclusion Our data demonstrated that this triple therapy regimen may be an adequate alternative regimen for the treatment of PONV in patients undergoing neurological surgery under general anesthesia. More studies with a control group should be performed to demonstrate the efficacy of this regimen and that palonosetron is a low risk for QTc prolongation. ClinicalTrials.gov Identifier NCT02635828 (https://clinicaltrials.gov/show/NCT02635828).
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Affiliation(s)
- Sergio D Bergese
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA
| | - Erika G Puente
- Department of Anesthesiology, The Ohio State University Medical Center , Columbus, OH , USA
| | - Maria A Antor
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami , Miami, FL , USA
| | - Gerardo Capo
- College of Arts and Sciences, The Ohio State University , Columbus, OH , USA
| | - Vedat O Yildiz
- Center for Biostatistics, The Ohio State University , Columbus, OH , USA
| | - Alberto A Uribe
- Department of Anesthesiology, The Ohio State University Medical Center , Columbus, OH , USA
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Dowell JD, Wagner D, Elliott E, Yildiz VO, Pan X. Factors Associated with Advanced Inferior Vena Cava Filter Removals: A Single-Center Retrospective Study of 203 Patients Over 7 Years. Cardiovasc Intervent Radiol 2015; 39:218-26. [DOI: 10.1007/s00270-015-1256-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/08/2015] [Indexed: 11/29/2022]
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Zaky W, Dhall G, Khatua S, Brown RJ, Ginn KF, Gardner SL, Yildiz VO, Yankelevich M, Finlay JL. Choroid plexus carcinoma in children: the Head Start experience. Pediatr Blood Cancer 2015; 62:784-9. [PMID: 25662896 DOI: 10.1002/pbc.25436] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/26/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Choroid plexus carcinoma (CPC) is a rare aggressive intracranial neoplasm with a predilection for young children and a historically poor outcome. Currently, no defined optimal therapeutic strategy exists. The Head Start (HS) regimens have included irradiation-avoiding strategies in young children with malignant brain tumors using high dose chemotherapy to improve survival and minimize neurocognitive sequelae. PROCEDURE Three sequential HS studies have been conducted from 1991 to 2009. HS treatment strategy has consisted of maximal surgical resection followed by five cycles of intensive induction followed by consolidation myeloablative chemotherapy with autologous hematopoietic stem cell rescue (AuHCR). Irradiation was given following recovery from consolidation based on the patient's age and evidence of residual disease. RESULTS Twelve children with CPC (median age of 19.5 months) have been treated with HS regimens. Ten patients had >95% resection. Three patients had disseminated disease at diagnosis. Ten patients completed consolidation of whom five are alive, irradiation and disease free at 29, 43, 61, 66 and 89 months from diagnosis. Seven patients experienced tumor recurrence/progression at a median time of 13 months (range 2-43 months). Five patients received irradiation, one for residual disease and four upon progression or recurrence, of whom one is alive at 61 months. The 3- and 5-year progression-free survivals are 58% and 38% and overall survivals 83% and 62% respectively. Late deaths from disease beyond 5 years were also noted. CONCLUSION Head Start strategies may produce long-term remission in young children with newly diagnosed CPC with avoidance of cranial irradiation.
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Affiliation(s)
- Wafik Zaky
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Crandall CJ, Yildiz VO, Wactawski-Wende J, Johnson KC, Chen Z, Going SB, Wright NC, Cauley JA. Postmenopausal weight change and incidence of fracture: post hoc findings from Women's Health Initiative Observational Study and Clinical Trials. BMJ 2015; 350:h25. [PMID: 25627698 PMCID: PMC6168976 DOI: 10.1136/bmj.h25] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine associations between postmenopausal change in body weight and incidence of fracture and associations between voluntary and involuntary weight loss and risk of fracture. DESIGN Post hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials. SETTING 40 clinical centers in the United States. PARTICIPANTS 120,566 postmenopausal women, aged 50-79 at baseline (1993-98), followed through 2013 (mean fracture follow-up duration 11 years from baseline). EXPOSURES Annualized percentage change in measured body weight from baseline to year 3, classified as stable (<5% change), weight loss (≥ 5%), or weight gain (≥ 5%). Self assessment of whether weight loss was intentional or unintentional. Cox proportional hazards regression models were adjusted for age, race/ethnicity, baseline body mass index (BMI), smoking, alcohol intake, level of physical activity, energy expenditure, calcium and vitamin D intake, physical function score, oophorectomy, hysterectomy, previous fracture, comorbidity score, and drug use. MAIN OUTCOMES Incident self reported fractures of the upper limbs, lower limbs, and central body; hip fractures confirmed by medical records. RESULTS Mean participant age was 63.3. Mean annualized percent weight change was 0.30% (95% confidence interval 0.28 to 0.32). Overall, 79,279 (65.6%) had stable weight; 18,266 (15.2%) lost weight; and 23,021 (19.0%) gained weight. Compared with stable weight, weight loss was associated with a 65% higher incidence rates of fracture in hip (adjusted hazard ratio 1.65, 95% confidence interval 1.49 to 1.82), upper limb (1.09, 1.03 to 1.16), and central body (1.30, 1.20 to 1.39); weight gain was associated with higher incidence rates of fracture in upper limb (1.10, 1.05 to 1.18) and lower limb (1.18, 1.12 to 1.25). Compared with stable weight, unintentional weight loss was associated with a 33% higher incidence rates of hip fracture (1.33, 1.19 to 1.47) and increased incidence rates of vertebral fracture (1.16, 1.06 to 1.26); intentional weight loss was associated with increased incidence rates of lower limb fracture (1.11, 1.05 to 1.17) and decreased incidence of hip fracture (0.85, 0.76 to 0.95). CONCLUSIONS Weight gain, weight loss, and intentional weight loss are associated with increased incidence of fracture, but associations differ by fracture location. Clinicians should be aware of fracture patterns after weight gain and weight loss.
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Affiliation(s)
- Carolyn J Crandall
- David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, UCLA Medicine/GIM, 911 Broxton Avenue, 1st floor, Los Angeles, CA, 90024, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Ohio State University, 2012 Kenny Road, Columbus, Ohio, USA
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, University at Buffalo, State University of New York, 65 Farber Hall, 3435 Main Street, Buffalo, NY 14214-3000 State University of NY at Buffalo, Buffalo, NY, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Suite 633, Memphis, TN 38163, USA
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Scott B Going
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, RPHB 523C, Birmingham, AL, 35294, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Leblebicioglu B, Hegde R, Yildiz VO, Tatakis DN. Immediate effects of tooth extraction on ridge integrity and dimensions. Clin Oral Investig 2015; 19:1777-84. [DOI: 10.1007/s00784-014-1392-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
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Kapoor R, Barnett CJ, Gutmann RM, Yildiz VO, Joseph NC, Stoicea N, Reyes S, Rogers BM. Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients. Front Public Health 2014; 2:204. [PMID: 25405147 PMCID: PMC4217322 DOI: 10.3389/fpubh.2014.00204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus.
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Affiliation(s)
- Ritu Kapoor
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Rebecca M Gutmann
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Nicoleta Stoicea
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Barbara M Rogers
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
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Ho WJ, Simon MS, Yildiz VO, Shikany JM, Kato I, Beebe-Dimmer JL, Cetnar JP, Bock CH. Antioxidant micronutrients and the risk of renal cell carcinoma in the Women's Health Initiative cohort. Cancer 2014; 121:580-8. [PMID: 25302685 DOI: 10.1002/cncr.29091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 04/29/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the eighth leading cancer among women in incidence and commonly is diagnosed at a more advanced stage. Oxidative stress has been considered to play an important role in the pathogenesis of RCC. Various dietary micronutrients have antioxidant properties, including carotenoids and vitamins C and E; thus, diets rich in these nutrients have been evaluated in relation to RCC prevention. The objective of this study was to explore the correlation between antioxidant micronutrients and the risk of RCC. METHODS In total, 96,196 postmenopausal women who enrolled in the Women's Health Initiative (WHI) between 1993 and 1998 and were followed through July 2013 were included in this analysis. Dietary micronutrient intake was estimated from the baseline WHI food frequency questionnaire, and data on supplement use were collected using an interview-based inventory procedure. RCC cases were ascertained from follow-up surveys and were centrally adjudicated. The risks for RCC associated with intake of α-carotene, β-carotene, β-cryptoxanthin, lutein plus zeaxanthin, lycopene, vitamin C, and vitamin E were analyzed using Cox proportional hazards regression adjusted for confounders. RESULTS Two hundred forty women with RCC were identified during follow-up. Lycopene intake was inversely associated with RCC risk (P = .015); compared with the lowest quartile of lycopene intake, the highest quartile of intake was associated with a 39% lower risk of RCC (hazard ratio, 0.61; 95% confidence interval, 0.39-0.97). No other micronutrient was significantly associated with RCC risk. CONCLUSIONS The current results suggest that further investigation into the correlation between lycopene intake and the risk of RCC is warranted.
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Affiliation(s)
- Won Jin Ho
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
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Ho WJ, Simon MS, Yildiz VO, Shikany J, Kato I, Beebe-Dimmer J, Cetnar JP, Bock C. Antioxidant micronutrients and renal cell carcinoma: Results from the Women’s Health Initiative. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Won Jin Ho
- Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | | | - Vedat O. Yildiz
- Center for Biostatistics, Ohio State University, Columbus, OH
| | - James Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ikuko Kato
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | - Cathryn Bock
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Patterson AM, Yildiz VO, Klatt MD, Malarkey WB. Perceived stress predicts allergy flares. Ann Allergy Asthma Immunol 2013; 112:317-21. [PMID: 24428966 DOI: 10.1016/j.anai.2013.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/03/2013] [Accepted: 07/11/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND A relation between stress and symptoms of rhinitis has not been established. OBJECTIVE To determine if participants' reporting of allergy flares correlated with perceived emotional stress, depression, mood, and a biomarker of stress (cortisol). METHODS This study was a secondary analysis of 179 university employees who participated in a study evaluating the influence of several lifestyle interventions on health symptoms and inflammation. Perceived stress and depressive symptom questionnaires were obtained before each 2-week study period. Online diary entries documenting same-day allergy flares, stressful events, perceived stress, mood, and salivary cortisol levels were collected daily during 2 14-day blocks. RESULTS Thirty-nine percent of subjects (n = 69) self-reported allergy symptoms. This allergy flare group had higher perceived stress scores than the group without allergy symptoms. Perceived stress, but not depressive symptoms, positively correlated with allergy flares evaluated during 2 independent 14-day periods. There also was a positive relation between negative mood scores and allergy flares over the course of the study. Cortisol had no association with allergy symptom flares. CONCLUSION These findings suggest that individuals with persistent emotional stress have more frequent allergy flares. Furthermore, those with more flares have greater negative mood.
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Affiliation(s)
- Amber M Patterson
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - Vedat O Yildiz
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Maryanna D Klatt
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - William B Malarkey
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio; Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio.
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Leblebicioglu B, Salas M, Ort Y, Johnson A, Yildiz VO, Kim DG, Agarwal S, Tatakis DN. Determinants of alveolar ridge preservation differ by anatomic location. J Clin Periodontol 2013; 40:387-95. [PMID: 23432761 DOI: 10.1111/jcpe.12065] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 10/30/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022]
Abstract
AIM To investigate and compare outcomes following alveolar ridge preservation (ARP) in posterior maxilla and mandible. METHODS Twenty-four patients (54 ± 3 years) with single posterior tooth extraction were included. ARP was performed with freeze-dried bone allograft and collagen membrane. Clinical parameters were recorded at extraction and re-entry. Harvested bone cores were analysed by microcomputed tomography (micro-CT), histomorphometry and immunohistochemistry. RESULTS In both jaws, ARP prevented ridge height loss, but ridge width was significantly reduced by approximately 2.5 mm. Healing time, initial clinical attachment loss and amount of keratinized tissue at extraction site were identified as determinants of ridge height outcome. Buccal plate thickness and tooth root length were identified as determinants of ridge width outcome. In addition, initial ridge width was positively correlated with ridge width loss. Micro-CT revealed greater mineralization per unit volume in new bone compared with existing bone in mandible (p < 0.001). Distributions of residual graft, new cellular bone and immature tissue were similar in both jaws. CONCLUSION Within the limitations of this study, the results indicate that in different anatomic locations different factors may determine ARP outcomes. Further studies are needed to better understand determinants of ARP outcomes.
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Affiliation(s)
- Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University, OH 43210, USA.
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Erdal BS, Clymer BD, Yildiz VO, Julian MW, Crouser ED. Unexpectedly high prevalence of sarcoidosis in a representative U.S. Metropolitan population. Respir Med 2012; 106:893-9. [PMID: 22417737 DOI: 10.1016/j.rmed.2012.02.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/07/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
The prevalence of sarcoidosis in the United States is unknown, with estimates ranging widely from 1 to 40 per 100,000. We sought to determine the prevalence of sarcoidosis in our health system compared to other rare lung diseases and to further establish if the prevalence was changing over time. We interrogated the electronic medical records of all patients treated in our health system from 1995 to 2010 (1.48 million patients) using the common ICD9 codes for sarcoidosis (135), lung cancer (162), and several other lung diseases characterized, like sarcoidosis, as "rare lung diseases". The patient demographic information (race, gender, age) was further analyzed to identify signature data patterns. The prevalence of sarcoidosis in our health system increased steadily from 164/100,000 in 1995 to 330/100,000 in 2010, and this trend could not be ascribed simply to changes in patient demographics or patient referral patterns. We further estimate that the prevalence of sarcoidosis exceeds 48 per 100,000 in Franklin County, Ohio, the demographic profile of which is nearly identical to that of the U.S. Sarcoidosis prevalence increased over time relative to lung cancer, a benchmark disease with stable disease prevalence, and exceeded that of other rare lung diseases. We postulate that the observed 2-fold increase in sarcoidosis disease prevalence in our health system is primarily related to improved detection and diagnostic approaches, and we conclude that the actual prevalence of sarcoidosis in central Ohio greatly exceeds current U.S. estimates.
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Affiliation(s)
- Barbaros S Erdal
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, USA
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Jijiwa M, Demir H, Gupta S, Leung C, Joshi K, Orozco N, Huang T, Yildiz VO, Shibahara I, de Jesus JA, Yong WH, Mischel PS, Fernandez S, Kornblum HI, Nakano I. CD44v6 regulates growth of brain tumor stem cells partially through the AKT-mediated pathway. PLoS One 2011; 6:e24217. [PMID: 21915300 PMCID: PMC3167830 DOI: 10.1371/journal.pone.0024217] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/08/2011] [Indexed: 11/24/2022] Open
Abstract
Identification of stem cell-like brain tumor cells (brain tumor stem-like cells; BTSC) has gained substantial attention by scientists and physicians. However, the mechanism of tumor initiation and proliferation is still poorly understood. CD44 is a cell surface protein linked to tumorigenesis in various cancers. In particular, one of its variant isoforms, CD44v6, is associated with several cancer types. To date its expression and function in BTSC is yet to be identified. Here, we demonstrate the presence and function of the variant form 6 of CD44 (CD44v6) in BTSC of a subset of glioblastoma multiforme (GBM). Patients with CD44high GBM exhibited significantly poorer prognoses. Among various variant forms, CD44v6 was the only isoform that was detected in BTSC and its knockdown inhibited in vitro growth of BTSC from CD44high GBM but not from CD44low GBM. In contrast, this siRNA-mediated growth inhibition was not apparent in the matched GBM sample that does not possess stem-like properties. Stimulation with a CD44v6 ligand, osteopontin (OPN), increased expression of phosphorylated AKT in CD44high GBM, but not in CD44low GBM. Lastly, in a mouse spontaneous intracranial tumor model, CD44v6 was abundantly expressed by tumor precursors, in contrast to no detectable CD44v6 expression in normal neural precursors. Furthermore, overexpression of mouse CD44v6 or OPN, but not its dominant negative form, resulted in enhanced growth of the mouse tumor stem-like cells in vitro. Collectively, these data indicate that a subset of GBM expresses high CD44 in BTSC, and its growth may depend on CD44v6/AKTpathway.
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Affiliation(s)
- Mayumi Jijiwa
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America
| | - Habibe Demir
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America
| | - Snehalata Gupta
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America
| | - Crystal Leung
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kaushal Joshi
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America
| | - Nicholas Orozco
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Tiffany Huang
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Vedat O. Yildiz
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, United States of America
| | - Ichiyo Shibahara
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jason A. de Jesus
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - William H. Yong
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Paul S. Mischel
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Soledad Fernandez
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, United States of America
| | - Harley I. Kornblum
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ichiro Nakano
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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