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Storino A, Polanco-Santana JC, Sampson R, Glass C, Fabrizio A, Kent TS. Geographic Reach of Surgery Residency Applicants During In-Person and Virtual Interviews. J Grad Med Educ 2023; 15:685-691. [PMID: 38045929 PMCID: PMC10686643 DOI: 10.4300/jgme-d-23-00181.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 12/05/2023] Open
Abstract
Background Virtual interviews for surgery residency may improve interview opportunities for applicants from underrepresented in medicine (UIM) and lower socioeconomic backgrounds. Objective To compare the geographic reach of surgical residency applicants during in-person versus virtual interviews. Methods This study compared applicants for the 2019 (in-person) and 2020 (virtual interviews) application cycle for surgery residency. Geographic reach (GR) was defined as the distance between applicants' current location and the program. Federal Financial Institutions Examination Council's website supplied socioeconomic data using applicants' geographic locations. Applicant demographics, United States Medical Licensing Examination (USMLE) scores, and geographic distance to program were collected. Multivariable analyses examined GR with interaction terms between interview type, UIM status, and socioeconomic status, while controlling for USMLE scores. Results A total of 667 (2019) and 698 (2020) National Resident Matching Program applications were reviewed. Overall, there was no difference in GR for applicants during in-person and virtual interviews in multivariable testing. UIM status had no association with GR for in-person interviews, but virtual interviews were associated with an increased GR for UIM applicants compared to non-UIM applicants (235.17; 95% CI 28.87-441.47; P=.02). For in-person interviews, applicants living in communities with poverty levels ≥7% had less GR vs those in communities with levels <7% (-332.45; 95% CI -492.10, -172.79; P<.001), an effect not observed during virtual interviews. Conclusions There was no difference in overall GR, or the proportion of UIM applicants or those from higher poverty level communities, but virtual survey interviews during the COVID-19 pandemic were associated with increased GR for UIM and from lower socioeconomic backgrounds applicants.
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Affiliation(s)
- Alessandra Storino
- Alessandra Storino, MD, MSc, is PGY-5 Surgery Resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - John C. Polanco-Santana
- John C. Polanco-Santana, MD, MSc, is PGY-2 Surgery Resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rachel Sampson
- Rachel Sampson, MBA, is Residency Program Coordinator, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Charity Glass
- Charity Glass, MD, MPP, is a Breast Surgery Fellow, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anne Fabrizio
- Anne Fabrizio, MD, is a Colorectal Surgeon and Associate Program Director, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; and
| | - Tara S. Kent
- Tara S. Kent, MD, MS, FACS, is Hepatobiliary Surgeon, Vice Chair for Education, and Program Director, General Surgery Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, and Associate Professor of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Arndt KR, Dombek GE, Allar BG, Storino A, Fleishman A, Quinn J, Fabrizio A, Cataldo TE, Messaris E. Impact of National Accreditation Program for Rectal Cancer guidelines on surgical margin status. Surg Oncol 2023; 51:101921. [PMID: 36898906 DOI: 10.1016/j.suronc.2023.101921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The American College of Surgeons established the National Accreditation Program for Rectal Cancer (NAPRC) to standardize rectal cancer care. We sought to assess the impact of NAPRC guidelines at a tertiary care center on surgical margin status. MATERIALS AND METHODS The Institutional NSQIP database was queried for patients with rectal adenocarcinoma undergoing surgery for curative intent two years prior to and following implementation of NAPRC guidelines. Primary outcome was surgical margin status before (pre-NAPRC) versus after (post-NAPRC) implementation of NAPRC guidelines. RESULTS Surgical pathology in five (5%) pre-NAPRC and seven (8%) post-NAPRC patients had positive radial margins (p = 0.59); distal margins were positive in three (3%) post-NAPRC and six (7%) post-NAPRC patients (p = 0.37). Local recurrence was observed in seven (6%) pre-NAPRC patients, there were no recurrences to date in post-NAPRC patients (p = 0.15). Metastasis was observed in 18 (17%) pre-NAPRC patients and four (4%) post-NAPRC patients (p = 0.55). CONCLUSION NAPRC implementation was not associated with a change in surgical margin status for rectal cancer at our institution. However, the NAPRC guidelines formalize evidence-based rectal cancer care and we anticipate that improvements will be greatest in low-volume hospitals which may not utilize multidisciplinary collaboration.
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Affiliation(s)
- Kevin R Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Gabrielle E Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeanne Quinn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas E Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Storino A, Polanco-Santana JC, Ruiz de Somocurcio J, Sampson R, Gangadharan SP, Kent TS. Impact of Surgeon Gender and Seniority in use of Agentic and Communal Language in Letters of Recommendation for Surgery Residency Applicants. J Surg Educ 2022; 79:1140-1149. [PMID: 35577725 DOI: 10.1016/j.jsurg.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Differential use of communal (kindness, cooperation, morality) and agentic terms (competence, assertiveness, decisiveness) may reveal bias and has been extensively reported in letters of recommendation (LoR) for residency but letter writer factors have not been thoroughly studied. We estimate the association between use of agentic and communal language with letter writer and applicant characteristics. DESIGN Retrospective review of LoR comparing 2 letters written for the same applicant. Applicant demographics and USMLE scores as well as letter writer demographics and academic/departmental rank were compared. Multilevel regression controlling for clustering of letters within applicant was performed. SETTING Single academic surgery residency program in a tertiary center. PARTICIPANTS US medical students applying for categorical surgery residency. RESULTS Applications of 667 US medical students (age 27.1, interquartile range [IQR] 26.2-28.6; female 340, 51%, white 337, 54.2%) were evaluated. Most commonly, letters writers were males (n = 1031, 77.3%), Full Professors (n = 660, 49.48%) and Department Chairs or Division Chiefs (n = 629, 47.151%). Overall, median bias score was 14.29 (interquartile range -4 to 33.33), indicating predominance of agentic terms. Applicant female gender (coef 3.64, 95% confidence interval [CI] 0.33-6.96) and higher Step 1 USMLE scores (coef 0.12, 95% CI 0.0026-0.24) were associated with increased use of agentic terms. For letter writer characteristics, female (coef -4.23, 95% CI -8.14 to -0.32) and fewer years in practice (coef -0.32, 95% CI -0.48 to -0.16) were independent predictors of increased use of communal traits. CONCLUSIONS Comparing 2 LoR written for the same applicant, male and more senior surgeons use more agentic language in their LoR as compared to female and younger surgeons. Increased use of communal language is expected as the pool of letter writers is diversified and reflects essential characteristics of contemporary surgeons.
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Affiliation(s)
- Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
| | - John C Polanco-Santana
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jorge Ruiz de Somocurcio
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Rachel Sampson
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Sidharta P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Storino A, Vigna C, Polanco-Santana JC, Park E, Crowell K, Fabrizio A, Cataldo TE, Messaris E. Disparities in industry funding among Colorectal Surgeons: a cross-sectional study. Surg Endosc 2022; 36:6592-6600. [PMID: 35103858 DOI: 10.1007/s00464-022-09062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health Industry and physician collaboration generates innovation. Colorectal Surgeon (CRS) selection to collaborate might not be random. We aim to identify CRS personal and professional characteristics that facilitate collaboration with the Industry. METHOD Cross-sectional study of Industry payments to CRS (2014-2018) using Open Payments Database from Centers for Medicare & Medicaid Services. Multivariable regression compared variables predicting payment amount including gender, years in practice, leadership positions, H-index, Twitter presence and geographic location. RESULTS Surgeons who were male received 3.1 times the amount in Industry payments as compared to females (p = 0.014). Chairs and Division Chiefs received 2.7 times the amount in payments as compared to those without these leadership positions (p = 0.003). Surgeons with an H-index ≥ 8 received 2.2 times the amount in payments as compared to those with H-index < 8 (p = 0.001). Surgeons in practice for 12-19 and 20-30 years received 3 times and 4.4 times the amount in payments as compared to surgeons in practice for 1-11 years (p = 0.036 and p = 0.017, respectively). Surgeons in the South received 3.2 times and 2 times the amount in payments as compared to surgeons in the Northeast (p < 0.0005) and in the Midwest (p = 0.006). Surgeons with Twitter accounts received 1.7 times the amount in payments as compared to surgeons without Twitter (p = 0.036). Among Twitter users, those with 321-17,200 followers received 4.7 times and 9.5 times the amount in payments as compared to those with 0-15 and 16-79 followers, respectively (p = 0.008 and p = 0.009). CONCLUSION Industry payments are more commonly addressed to male, senior surgeons in leadership tracks with strong social media outreach. With the increasing gender and racial variety in the CRS field, it is expected that collaborations between industry and surgeons will become more diverse and inclusive.
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Affiliation(s)
- Alessandra Storino
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - John C Polanco-Santana
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Ernest Park
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Kristen Crowell
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA.
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Storino A, Polanco-Santana JC, Allar BG, Fakler MN, Wong D, Whyte R, Gangadharan SP, Kent TS. Paging Patterns Among Junior Surgery Residents in a Tertiary Care Center. J Surg Educ 2021; 78:1483-1491. [PMID: 33812806 DOI: 10.1016/j.jsurg.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE An excessive amount of nonurgent pages may disrupt patient care, reduce efficiency, and contribute to burnout. We present detailed paging data to analyze frequency, content, and urgency of pages received by surgery residents to provide recommendations to reduce resident distractions and fatigue. DESIGN Prospective review of pages received by surgery residents over 15 weeks in 2019. Pages were analyzed by content and urgency (routine, important, emergent) by author consensus and compared among day and night shifts, and page senders' profession. SETTING University tertiary-care hospital PARTICIPANTS: Seventeen junior surgery residents (PGY-1 and PGY-2) RESULTS: Total 1,740 resident-hours yielded 1,871 pages. Residents working day and night shift received a median of 11 (IQR 7-14) and 13 (IQR 6-22) pages, respectively. Pages from nurses were most common for both shifts but constituted a significantly increased proportion at night (71.3% vs 36.7%, p < 0.00005). Most pages during day shift were routine (74.4%) and pertained to plan of care and order request (38.4% and 15.7%, respectively). Emergent and important pages were more common at night (8.9% and 24.7% vs 1.8 and 14.8%, p < 0.00005) which paralleled an increase in pages reporting change in patient condition compared to day shift (19.7 from 6.7%, p < 0.00005). Routine pages pertaining care plan and order requests remained common at night (26.5 and 28%, respectively). CONCLUSIONS Over half of pages received by residents contain routine communications about care plan and request for non-urgent orders, even during night shift. Resident-nurse collaboration and support from technology services might optimizing communication pathways.
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Affiliation(s)
- Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John C Polanco-Santana
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Michelle N Fakler
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel Wong
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Richard Whyte
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sidharta P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Storino A, Wong D, Ore AS, Gaytan-Fuentes IA, Fabrizio A, Cataldo T, Messaris E. Recurrence and Survival of Neuroendocrine Neoplasms of the Rectum: Single-Center Experience. J Gastrointest Surg 2021; 25:2398-2400. [PMID: 33269457 DOI: 10.1007/s11605-020-04854-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2010, the World Health Organization proposed that rectal neuroendocrine neoplasms (NENs) be considered malignant. We hypothesized that patients with small, low-grade, locally excised tumors have a low risk of recurrence and death. METHODS Retrospective review of institutional database 2006-2017 including consecutive adults with newly diagnosed rectum NENs. Outcome measures included risk of recurrence and 5-year overall survival. RESULTS A total of 122 patients were diagnosed with rectal NENs. Most patients were asymptomatic and diagnosed during screening colonoscopy (80, 66.1%), had small tumors (median 0.6 cm, IQR 0.5-1) with intact muscularis propria on EUS (62/65, 95.4%), and were low grade (2017 WHO grades 1-2, n = 116, 95.1%). Lymph node and distant metastasis were found in 4 (3.3%) and 4 (3.3%) of patients, respectively. Patients were treated with local excision in 93.4% of cases with polypectomy (52, 42.6%), endoscopic mucosal resection (48, 39.3%), and transanal excision (14, 11.5%). Three patients (2.5%) required abdominoperineal resection or low anterior resection, and five patients (4.1%) received adjuvant chemotherapy. Of 87 patients surveilled, 4 (4.6%) recurred at a median time of 1 year (IQR 0.6-8). Death from neuroendocrine neoplasms occurred in 5 (4.1%) patients, all with lymph node (1/4) or metastatic disease (4/5) on presentation. Median time to death from NEN was 0.8 years (0.7-2.4). Overall 5-year survival for patients with localized disease was 98.2% (95% CI 93-99.5, Fig. 1). CONCLUSION Patients with small, low grade rectal NENs treated with local excision have excellent oncologic outcomes.
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Affiliation(s)
- Alessandra Storino
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. .,Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gryzmish Building, 6th Floor, Boston,, MA, 02215, USA.
| | - Daniel Wong
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Israel A Gaytan-Fuentes
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Thomas Cataldo
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Polanco-Santana JC, Storino A, Souza-Mota L, Gangadharan SP, Kent TS. Ethnic/Racial Bias in Medical School Performance Evaluation of General Surgery Residency Applicants. J Surg Educ 2021; 78:1524-1534. [PMID: 33637477 DOI: 10.1016/j.jsurg.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Differential use of communal terms (caring/unselfish traits) versus agentic terms (goal-oriented/leadership/achievement traits) may reveal bias and has been extensively reported in letters of recommendation for residency. We evaluated bias in medical student performance evaluations (MSPE) of general surgery residency applicants. DESIGN This is a retrospective study evaluating ethnic/race bias, as measured by differential use of agentic and communal terms, in MSPEs of residency applicants. 50% of MSPEs were randomly selected. An ethnic bias calculator derived from an open-source online gender bias calculator was populated with a list of validated agentic and communal terms. Relative frequency of communal and agentic terms was used to estimate bias. Multivariable regression was used to assess the association between the terms and ethnicity/race. PARTICIPANTS US medical students applying for a categorical surgery residency position at a single academic institution for a single Match cycle. RESULTS A total of 339 MSPEs were reviewed from 119 US medical schools. Genders were equally represented (women, 51.6%); most participants were white and Asian applicants (79.1%). Overall, MSPEs were more agency biased (65.2%) than communal biased (16.2%) or neutral (18.6%). MSPEs for Black and Hispanic/Latinx applicants were more likely to contain communal rather than agentic terms (adjusted OR: 3.02, 95% CI: 1.52-6.02) when compared to white and Asian applicants. This finding was independent of MSPE writer's gender or rank. CONCLUSIONS Surgery residency applicants self-identifying as Black and Hispanic/Latinx were more likely to be described using communal traits compared to white and Asian applicants, suggesting ethnic/racial bias. Such differences in language utilized in MSPEs may impact residency opportunities for applicants who are under-represented in medicine. Educational efforts aimed at MSPE writers may help to reduce bias.
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Affiliation(s)
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lucas Souza-Mota
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sidhu P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Abstract
BACKGROUND Malignant cutaneous adnexal tumors (MCATs) are rare and their natural history is poorly understood. Available literature indicates aggressive behavior with a significant risk of metastasis. STUDY DESIGN Retrospective review of our institutional surgical oncology databases was performed for patients diagnosed with MCATs (2001-2020). We hypothesized that most patients have a low risk of lymph node involvement, recurrence, and death. Kaplan-Meier statistical analysis was used to assess risk of recurrence and 5-year survival. RESULTS We identified 41 patients diagnosed with MCATs (median age 59 years, 68% were men). Most patients had long-standing cutaneous lesions (median 24 months) and no palpable adenopathy. Most patients had stage I or II disease (98%). Primary tumors were treated with wide local excision (n = 28 [68%]), Mohs surgery (n = 5 [12%]), or amputation (n = 8 [19%]). Of 25 patients who underwent SLNB (61%), 1 had lymphatic metastasis. These include apocrine carcinoma (1 of 3), digital papillary adenocarcinoma (0 of 8), porocarcinoma (0 of 4), and additional MCAT sub-types (0 of 10). Three patients (7%) had disease recurrence at a median interval of 3.6 years (interquartile range 1.5 to 4.4 years). Five patients (12%) died at a median interval of 7 years (interquartile range 6.7 to 9.2 years), but only 1 patient was known to have succumbed to MCAT. Overall 5-year survival rate was 96% (95% CI, 75% to 99%). CONCLUSIONS Despite the historical impression that MCATs have a high metastatic potential, most patients have low recurrence rates and excellent 5-year survival rates. Lymphatic disease identified after SLNB in early-stage tumors is rare and the value of this staging procedure in MCAT remains unclear.
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Affiliation(s)
- Alessandra Storino
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Reed E Drews
- Division of Hematology-Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Nicholas E Tawa
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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Stackhouse KA, Storino A, Watkins AA, Gooding W, Callery MP, Kent TS, Sawhney MS, Moser AJ. Biliary palliation for unresectable pancreatic adenocarcinoma: surgical bypass or self-expanding metal stent? HPB (Oxford) 2020; 22:563-569. [PMID: 31537457 DOI: 10.1016/j.hpb.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Standard of care guidelines endorse self-expanding metal stents (SEMS) rather than open surgical biliary bypass (OSBB) for biliary palliation in the setting of unresectable pancreatic ductal adenocarcinoma (PDAC). This study used competing risk analysis to compare short- and long-term morbidity and overall survival among patients undergoing SEMS or OSBB after unresectable or metastatic disease is identified at the time of exploration. METHODS Single institution retrospective cohort study (n = 127) evaluating outcomes after OSBB and SEMS for biliary palliation in patients found to have unresectable PDAC at exploration. Short-term, long-term, and lifetime risk of biliary occlusion and survival were compared after adjustment for stage and comprehensive complication index (CCI). RESULTS Baseline demographics and tumor characteristics were equivalent between cohorts. Short-term complications were more frequent after OSBB, whereas late complications were greater after SEMS. The cumulative incidence of recurrent biliary obstruction was greater after SEMS, but lifetime complication burden and median survival were equivalent. CONCLUSION OSBB was associated with longer hospital stays and more short-term complications, and SEMS was associated with a higher risk of recurrent biliary obstruction among surgical patients with unresectable PDAC. Patient preference should be defined pre-operatively in the case the unresectable disease is encountered during attempted resection.
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Affiliation(s)
- Kathryn A Stackhouse
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alessandra Storino
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ammara A Watkins
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - William Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, USA
| | - Mark P Callery
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tara S Kent
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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10
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Storino A, Guetter C, Castillo-Angeles M, Watkins AA, Mancias JD, Bullock A, James Moser A, Kent TS. What Patients Look for When Browsing Online for Pancreatic Cancer: The Bait Behind the Byte. World J Surg 2018; 42:4097-4106. [PMID: 29971463 DOI: 10.1007/s00268-018-4719-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Suitability is a patient-centered metric defined as how appropriately health information is targeted to specific populations to increase knowledge. However, suitability is most commonly evaluated exclusively by healthcare professionals without collaboration from intended audiences. Suitability (as rated by intended audiences), accuracy and readability have not been evaluated on websites discussing pancreatic cancer. METHODS Ten healthy volunteers evaluated fifty pancreatic cancer websites using the suitability assessment of materials (SAM instrument) for the materials' overall suitability. Readability and accuracy were correlated. RESULTS Ten recruited volunteers (ages 23-63, 50% female) found websites to be on average "adequate" or "superior" in suitability. Surgery, radiotherapy and nonprofit websites had higher suitability scores as compared to counterparts (p ≤ 0.03). There was no correlation between readability and accuracy levels and suitability scores (p ≥ 0.3). Presence of visual aids was associated with better suitability scores after controlling for website quality (p ≤ 0.01). CONCLUSION Suitability of websites discussing pancreatic cancer treatments as rated by lay audiences differed based on therapy type and website affiliation, and was independent of readability level and accuracy of information. Nonprofit affiliation websites focusing on surgery or radiotherapy were most suitable. Online information should be assessed for suitability by target populations, in addition to readability level and accuracy, to ensure information reaches the intended audience.
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Affiliation(s)
- Alessandra Storino
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Camila Guetter
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Manuel Castillo-Angeles
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ammara A Watkins
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph D Mancias
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Bullock
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tara S Kent
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Surgical Education, Beth Israel Deaconess Medical Center, LMOB 9B, 110 Francis Street, Boston, MA, 02215, USA.
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11
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Pedroso FE, Angriman F, Endo A, Dasenbrock H, Storino A, Castillo R, Watkins AA, Castillo-Angeles M, Goodman JE, Zitsman JL. Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis. Surg Obes Relat Dis 2017; 14:413-422. [PMID: 29248351 DOI: 10.1016/j.soard.2017.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 01/06/2023]
Abstract
Of adolescents in the United States, 20% have obesity and current treatment options prioritize intensive lifestyle interventions that are largely ineffective. Bariatric surgery is increasingly being offered to obese adolescent patients; however, large-scale effectiveness data is lacking. We used MEDLINE, Embase, and Cochrane databases, and a manual search of references to conduct a systematic review and meta-analysis on overall weight loss after gastric band, gastric sleeve, and gastric bypass in obese adolescent patients (age ≤19) and young adults (age ≤21) in separate analyses. We provided estimates of absolute change in body mass index (BMI, kg/m2) and percent excess weight loss across 4 postoperative time points (6, 12, 24, and 36 mo) for each surgical subgroup. Study quality was assessed using a 10 category scoring system. Data were extracted from 24 studies with 4 having multiple surgical subgroups (1 with 3, and 3 with 2 subgroups), totaling 29 surgical subgroup populations (gastric band: 16, gastric sleeve: 5, gastric bypass: 8), and 1928 patients (gastric band: 1010, gastric sleeve: 139, gastric bypass: 779). Mean preoperative BMI (kg/m2) was 45.5 (95% confidence interval [CI]: 44.7, 46.3) in gastric band, 48.8 (95%CI: 44.9, 52.8) in gastric sleeve, and 53.3 (95%CI: 50.2, 56.4) in gastric bypass patients. The short-term weight loss, measured as mean (95%CI) absolute change in BMI (kg/m2) at 6 months, was -5.4 (-3.0, -7.8) after gastric band, -11.5 (-8.8, -14.2) after gastric sleeve, and -18.8 (-10.9, -26.6) after gastric bypass. Weight loss at 36 months, measured as mean (95%CI) absolute change in BMI (kg/m2) was -10.3 (-7.0, -13.7) after gastric band, -13.0 (-11.0, -15.0) after gastric sleeve, and -15.0 (-13.5, -16.5) after gastric bypass. Bariatric surgery in obese adolescent patients is effective in achieving short-term and sustained weight loss at 36 months; however, long-term data remains necessary to better understand its long-term efficacy.
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Affiliation(s)
- Felipe E Pedroso
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York.
| | | | - Atsushi Endo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hormuzdiyar Dasenbrock
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Neurological Surgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts
| | | | - Ricardo Castillo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ammara A Watkins
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Julie E Goodman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeffrey L Zitsman
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
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12
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Mulla CM, Storino A, Yee EU, Lautz D, Sawnhey MS, Moser AJ, Patti ME. Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches. Obes Surg 2016; 26:874-81. [PMID: 26846121 DOI: 10.1007/s11695-016-2092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1-3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms.
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Affiliation(s)
- Christopher M Mulla
- Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA.,Clinic Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA.,Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessandra Storino
- Harvard Medical School, Boston, MA, USA.,Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric U Yee
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David Lautz
- Harvard Medical School, Boston, MA, USA.,Department of Surgery, Emerson Hospital and Massachusetts General Hospital, Concord, MA, USA
| | - Mandeep S Sawnhey
- Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A James Moser
- Harvard Medical School, Boston, MA, USA.,Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mary-Elizabeth Patti
- Research Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA. .,Clinic Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA. .,Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Storino A, Guetter CR, Castillo-Angeles M, Watkins AA, Mancias JD, Bullock AJ, Moser JA, Kent TS. What Patients Look for When Browsing Online for Pancreatic Cancer: The Bait Behind the Byte. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Storino A, Castillo-Angeles M, Watkins AA, Vargas C, Mancias JD, Bullock A, Demirjian A, Moser AJ, Kent TS. Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer. JAMA Surg 2016; 151:831-7. [PMID: 27144966 DOI: 10.1001/jamasurg.2016.0730] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alessandra Storino
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Manuel Castillo-Angeles
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ammara A. Watkins
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Christina Vargas
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Joseph D. Mancias
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Andrea Bullock
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Aram Demirjian
- Division of Hepatobiliary and Pancreas Surgery, University of California, Irvine Medical Center, Orange
| | - A. James Moser
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Tara S. Kent
- Pancreas and Liver Institute, Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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15
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Bliss LA, Eskander MF, Kent TS, Watkins AA, de Geus SW, Storino A, Ng SC, Callery MP, Moser AJ, Tseng JF. Early surgical bypass versus endoscopic stent placement in pancreatic cancer. HPB (Oxford) 2016; 18:671-7. [PMID: 27485061 PMCID: PMC4972376 DOI: 10.1016/j.hpb.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The optimal treatment for biliary obstruction in pancreatic cancer remains controversial between surgical bypass and endoscopic stenting. METHODS Retrospective analysis of unresected pancreatic cancer patients in the Healthcare Cost and Utilization Project Florida State Inpatient and Ambulatory Surgery databases (2007-2011). Propensity score matching by procedure. Primary outcome was reintervention, and secondary outcomes were readmission, overall length of stay (LOS), discharge home, death and cost. Multivariate analyses performed by logistic regression. RESULTS In a matched cohort of 622, 20.3% (63) of endoscopic and 4.5% (14) of surgical patients underwent reintervention (p < 0.0001) and 56.0% (174) vs. 60.1% (187) were readmitted (p = 0.2909). Endoscopic patients had lower median LOS (10 vs. 19 days, p < 0.0001) and cost ($21,648 vs. $38,106, p < 0.0001) as well as increased discharge home (p = 0.0029). No difference in mortality on index admission. On multivariate analysis, initial procedure not predictive of readmission (p = 0.1406), but early surgical bypass associated with lower odds of reintervention (OR = 0.233, 95% CI 0.119, 0.434). DISCUSSION Among propensity score-matched patients receiving bypass vs. stenting, readmission and mortality rates are similar. However, candidates for both techniques may experience fewer subsequent procedures if offered early biliary bypass with the caveats of decreased discharge home and increased cost/LOS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jennifer F. Tseng
- Correspondence Jennifer F. Tseng, Division of Surgical Oncology, BIDMC Cancer Center, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 9, Boston, MA 02215, United States. Tel: +1 617 667 3746. Fax: +1 617 667 2792.Division of Surgical OncologyBIDMC Cancer CenterHarvard Medical SchoolBeth Israel Deaconess Medical Center330 Brookline AveStoneman 9BostonMA02215United States
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Kiyotani C, Uno T, Ogiwara H, Morota N, Nakazawa A, Tsutsumi Y, Masaki H, Mori T, Sanz JAS, Guibelalde M, Tavera A, Herandez I, Ibanez J, Brell M, Mas A, Muller HL, Gebhardt U, Warmuth-Metz M, Pietsch T, Sorensen N, Kortmann RD, Stapleton S, Gonzalez I, Steinbrueck S, Rodriguez L, Tuite G, Krzyzankova M, Mertsch S, Jeibmann A, Kordes U, Wolff J, Paulus W, Hasselblatt M, Nonaka Y, Hara S, Fukazawa S, Shimizu K, Ben-Arush M, Postovsky S, Toledano H, Peretz-Nahum M, Fujimura J, Sakaguchi S, Kondo A, Saito Y, Shimoji K, Ohara Y, Arakawa A, Saito M, Shimizu T, Benesch M, von Bueren AO, Dantonello T, von Hoff K, Pietsch T, Leuschner I, Claviez A, Bierbach U, Kropshofer G, Korinthenberg R, Graf N, Suttorp M, Kortmann RD, Friedrich C, Klingebiel T, Koscielniak E, Rutkowski S, Mesa M, Sanchez M, Mejia J, Pena G, Dussan R, Cabeza M, Storino A, Dincer F, Roffidal T, Powell M, Berrak S, Wolff JE, Fouyssac F, Delaunay C, Vignaud JM, Schmitt E, Klein O, Mansuy L, Chastagner P, Cruz O, Guillen A, Garcia G, Alamar M, Candela S, Roussos I, Garzon M, Sunol M, Muchart J, Rebollo M, Mora J, Wolff J, Diez B, Muggeri A, Arakaki N, Meli F, Sevlever G, Tsitouras V, Pettorini B, Fellows G, Blair J, Didi M, Daousi C, Steele C, Javadpour M, Sinha A, Hishii M, Kondo A, Fujimura J, Sakaguchi S, Ishii H, Shimoji K, Miyajima M, Arai H, Dvir R, Sayar D, Levin D, Ben-Sirah L, Constantini S, Elhasid R, Gertsch E, Foreman N, Valera ET, Brassesco MS, Machado HR, Oliveira RS, Santos AC, Terra VC, Barros MV, Scrideli CA, Tone LG, Merino D, Pienkowska M, Shlien A, Tabori U, Gilbertson R, Malkin D, Jeeva I, Chang B, Long V, Picton S, Burton D, Clark S, Kwok C, Mokete B, Rafiq O, Simmons I, Shing MMK, Li CK, Chan GCF, Ha SY, Yuen HL, Luk CW, Li CK, Ling SC, Li RCH, Yoon JH, Park HJ, Shin HJ, Park BK, Kim JY, Jung HL, Ra YS, Ghim TT, Wolff J, Hasselblatt M, Hartung S, Powell M, Garami M, Traunecker H, Thall P, Mahajan A, Kordes U, Sumerauer D, Grillner P, Orrego A, Mosskin M, Gustavsson B, Holm S, Peters N, Rogers M, Chowdry S, Selman W, Mitchell A, Bangert B, Ahuja S, Laschinger K, Gold D, Stearns D, Wright K, Gupta K, Klimo P, Ellison D, Keating G, Eckel L, Giannini C, Wetjen N, Patton A, Zaky W, McComb G, Finlay J, Grimm J, Wong K, Dhall G, Zaky W, Gilles F, Grimm J, Dhall G, Finlay J, Ormandy D, Alston R, Estlin E, Gattamaneni R, Birch J, Kamaly-Asl I, Hemenway M, Foreman N, Rush S, Reginald YA, Nicolin G, Bartel U, Buncic JR, Aguilera D, Flamini R, Mazewski C, Schniederjan M, Hayes L, Boydston W, MacDonald T, Fleming A, Jabado N, Saint-Martin C, Albrecht S, Ramsay DA, Farmer JP, Bendel A, Hansen M, Dugan S, Mendelsohn N. RARE TUMORS. Neuro Oncol 2012; 14:i148-i156. [PMCID: PMC3483354 DOI: 10.1093/neuonc/nos108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
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