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Signorile WJ, Mahajan A, Fulbright RK, Zubair AS. Comparative analysis of energy expenditure and costs in neuroimaging. J Neurol Sci 2024:123001. [PMID: 38616465 DOI: 10.1016/j.jns.2024.123001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Affiliation(s)
- William J Signorile
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - Adeel S Zubair
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States of America
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Haider SP, Zeevi T, Sharaf K, Gross M, Mahajan A, Kann BH, Judson BL, Prasad ML, Burtness B, Aboian M, Canis M, Reichel CA, Baumeister P, Payabvash S. Impact of 18F-FDG PET Intensity Normalization on Radiomic Features of Oropharyngeal Squamous Cell Carcinomas and Machine Learning-Generated Biomarkers. J Nucl Med 2024:jnumed.123.266637. [PMID: 38514087 DOI: 10.2967/jnumed.123.266637] [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: 09/12/2023] [Revised: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
We aimed to investigate the effects of 18F-FDG PET voxel intensity normalization on radiomic features of oropharyngeal squamous cell carcinoma (OPSCC) and machine learning-generated radiomic biomarkers. Methods: We extracted 1,037 18F-FDG PET radiomic features quantifying the shape, intensity, and texture of 430 OPSCC primary tumors. The reproducibility of individual features across 3 intensity-normalized images (body-weight SUV, reference tissue activity ratio to lentiform nucleus of brain and cerebellum) and the raw PET data was assessed using an intraclass correlation coefficient (ICC). We investigated the effects of intensity normalization on the features' utility in predicting the human papillomavirus (HPV) status of OPSCCs in univariate logistic regression, receiver-operating-characteristic analysis, and extreme-gradient-boosting (XGBoost) machine-learning classifiers. Results: Of 1,037 features, a high (ICC ≥ 0.90), medium (0.90 > ICC ≥ 0.75), and low (ICC < 0.75) degree of reproducibility across normalization methods was attained in 356 (34.3%), 608 (58.6%), and 73 (7%) features, respectively. In univariate analysis, features from the PET normalized to the lentiform nucleus had the strongest association with HPV status, with 865 of 1,037 (83.4%) significant features after multiple testing corrections and a median area under the receiver-operating-characteristic curve (AUC) of 0.65 (interquartile range, 0.62-0.68). Similar tendencies were observed in XGBoost models, with the lentiform nucleus-normalized model achieving the numerically highest average AUC of 0.72 (SD, 0.07) in the cross validation within the training cohort. The model generalized well to the validation cohorts, attaining an AUC of 0.73 (95% CI, 0.60-0.85) in independent validation and 0.76 (95% CI, 0.58-0.95) in external validation. The AUCs of the XGBoost models were not significantly different. Conclusion: Only one third of the features demonstrated a high degree of reproducibility across intensity-normalization techniques, making uniform normalization a prerequisite for interindividual comparability of radiomic markers. The choice of normalization technique may affect the radiomic features' predictive value with respect to HPV. Our results show trends that normalization to the lentiform nucleus may improve model performance, although more evidence is needed to draw a firm conclusion.
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Affiliation(s)
- Stefan P Haider
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany;
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Tal Zeevi
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Kariem Sharaf
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Moritz Gross
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
- Charité Center for Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Amit Mahajan
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L Judson
- Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut; and
| | - Barbara Burtness
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Mariam Aboian
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Martin Canis
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Christoph A Reichel
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
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Shukla S, Karbhari A, Rastogi S, Agarwal U, Rai P, Mahajan A. Bench-to-bedside imaging in brain metastases: a road to precision oncology. Clin Radiol 2024:S0009-9260(24)00137-5. [PMID: 38637186 DOI: 10.1016/j.crad.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/20/2024]
Abstract
Radiology has seen tremendous evolution in the last few decades. At the same time, oncology has made great strides in diagnosing and treating cancer. Distant metastases of neoplasms are being encountered more often in light of longer patient survival due to better therapeutic strategies and diagnostic methods. Brain metastasis (BM) is a dismal manifestation of systemic cancer. In the present scenario, magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) are playing a big role in providing molecular information about cancer. Lately, molecular imaging has emerged as a stirring arena of dynamic imaging techniques that have enabled clinicians and scientists to noninvasively visualize and understand biological processes at the cellular and molecular levels. This knowledge has impacted etiopathogenesis, detection, personalized treatment, drug development, and our understanding of carcinogenesis. This article offers insight into the molecular biology underlying brain metastasis, its pathogenesis, imaging protocols, and algorithms. It also discusses disease-specific molecular imaging features, focusing on common tumors that spread to the brain, such as lung, breast, colorectal cancer, melanoma, and renal cell carcinoma. Additionally, it covers various targeted treatment options, criteria for assessing treatment response, and the role of artificial intelligence in diagnosing, managing, and predicting prognosis for patients with brain metastases.
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Affiliation(s)
- S Shukla
- Department of Radiodiagnosis and Imaging, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Hospital, Varanasi, 221 005, Maharashtra, India; Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - A Karbhari
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - S Rastogi
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - U Agarwal
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - P Rai
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400 012, Maharashtra, India
| | - A Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, L7 8YA Liverpool, UK; Faculty of Health and Life Sciences, University of Liverpool, L7 8TX, Liverpool, UK.
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Bhattacharya K, Rastogi S, Mahajan A. Post-treatment imaging of gliomas: challenging the existing dogmas. Clin Radiol 2024; 79:e376-e392. [PMID: 38123395 DOI: 10.1016/j.crad.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Gliomas are the commonest malignant central nervous system tumours in adults and imaging is the cornerstone of diagnosis, treatment, and post-treatment follow-up of these patients. With the ever-evolving treatment strategies post-treatment imaging and interpretation in glioma remains challenging, more so with the advent of anti-angiogenic drugs and immunotherapy, which can significantly alter the appearance in this setting, thus making interpretation of routine imaging findings such as contrast enhancement, oedema, and mass effect difficult to interpret. This review details the various methods of management of glioma including the upcoming novel therapies and their impact on imaging findings, with a comprehensive description of the imaging findings in conventional and advanced imaging techniques. A systematic appraisal for the existing and emerging techniques of imaging in these settings and their clinical application including various response assessment guidelines and artificial intelligence based response assessment will also be discussed.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rastogi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- Department of imaging, The Clatterbridge Cancer Centre, NHS Foundation Trust, Pembroke Place, Liverpool L7 8YA, UK; University of Liverpool, Liverpool L69 3BX, UK.
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Tu LH, Melnick E, Venkatesh AK, Sheth KN, Navaratnam D, Yaesoubi R, Forman HP, Mahajan A. Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness. AJR Am J Roentgenol 2024; 222:e2330060. [PMID: 37937837 DOI: 10.2214/ajr.23.30060] [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] [Indexed: 11/09/2023]
Abstract
BACKGROUND. Underlying stroke is often misdiagnosed in patients presenting with dizziness. Although such patients are usually ineligible for acute stroke treatment, accurate diagnosis may still improve outcomes through selection of patients for secondary prevention measures. OBJECTIVE. The purpose of our study was to investigate the cost-effectiveness of differing neuroimaging approaches in the evaluation of patients presenting to the emergency department (ED) with dizziness who are not candidates for acute intervention. METHODS. A Markov decision-analytic model was constructed from a health care system perspective for the evaluation of a patient presenting to the ED with dizziness. Four diagnostic strategies were compared: noncontrast head CT, head and neck CTA, conventional brain MRI, and specialized brain MRI (including multiplanar high-resolution DWI). Differing long-term costs and outcomes related to stroke detection and secondary prevention measures were compared. Cost-effectiveness was calculated in terms of lifetime expenditures in 2022 U.S. dollars for each quality-adjusted life year (QALY); deterministic and probabilistic sensitivity analyses were performed. RESULTS. Specialized MRI resulted in the highest QALYs and was the most cost-effective strategy with US$13,477 greater cost and 0.48 greater QALYs compared with noncontrast head CT. Conventional MRI had the next-highest health benefit, although was dominated by extension with incremental cost of US$6757 and 0.25 QALY; CTA was also dominated by extension, with incremental cost of US$3952 for 0.13 QALY. Non-contrast CT alone had the lowest utility among the four imaging choices. In the deterministic sensitivity analyses, specialized MRI remained the most cost-effective strategy. Conventional MRI was more cost-effective than CTA across a wide range of model parameters, with incremental cost-effectiveness remaining less than US$30,000/QALY. Probabilistic sensitivity analysis yielded similar results as found in the base-case analysis, with specialized MRI being more cost-effective than conventional MRI, which in turn was more cost-effective than CTA. CONCLUSION. The use of MRI in patients presenting to the ED with dizziness improves stroke detection and selection for subsequent preventive measures. MRI-based evaluation leads to lower long-term costs and higher cumulative QALYs. CLINICAL IMPACT. MRI, incorporating specialized protocols when available, is the preferred approach for evaluation of patients presenting to the ED with dizziness, to establish a stroke diagnosis and to select patients for secondary prevention measures.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
| | - Edward Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | | | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
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6
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Tu LH, Melnick E, Venkatesh AK, Sheth KN, Navaratnam D, Yaesoubi R, Forman HP, Mahajan A. Reply to "Considering Health Systems Worldwide: Point of View From a Middle-Income Country". AJR Am J Roentgenol 2024; 222:e2430900. [PMID: 38294162 DOI: 10.2214/ajr.24.30900] [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: 02/01/2024]
Affiliation(s)
- Long H Tu
- Yale School of Medicine New Haven, CT
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Kachapila M, Oppong R, Ademuyiwa AO, Bhangu A, Dauda R, Ghosh DN, Kamarajah SK, Lawani I, Medina ARDL, Monahan M, Morton DG, Omar O, Picciochi M, Tabiri S, Roberts TE, Brocklehurst P, Chakrabortee S, Glasbey J, Hardy P, Harrison E, Lillywhite R, Magill L, Nepogodiev D, Simoes J, Smith D, Kadir B, Pinkney T, Brant F, Li E, Runigamugabo E, Bahrami-Hessari M, Bywater E, Martinez L, Habumuremyi S, Ntirenganya F, Williams E, Fourtounas M, Melic BKC, Ghosh DN, Suroy A, Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Dewamon H, Akpo I, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BBD, Guinnou R, Hamadou S, Kola H, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou Y, Agbanda L, Attinon J, Hounsou NR, Gbassi M, Adagrah A, Alhassan BBA, Amoako-Boateng MP, Appiah AB, Asante-Asamani A, Boakye B, Debrah SA, Ganiyu RA, Enti D, Koggoh P, Kpankpari R, Opandoh INM, Manu MA, Manu MPO, Mensah S, Morna MT, Nortey M, Nkrumah J, Ofori EO, Quartson EM, Acquah AO, Adam-Zakariah LI, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Twerefour EY, Ankomah J, Assah-Adjei F, Boakye AA, Fosu G, Serbeh G, Gyan KY, Nyarko IO, Robertson Z, Acheampong DO, Acquaye J, Adinku M, Agbedinu K, Agbeko AE, Amankwa EG, Amoah M, Amoah G, Appiah J, Arthur J, Ayim A, Ayodeji EK, Boakye-Yiadom J, Boateng EA, Dally C, Davor A, Gyasi-Sarpong CK, Hamidu NNN, Haruna I, Kwarley N, Lovi AK, Nimako B, Nyadu BB, Opoku D, Osabutey A, Sagoe R, Tuffour S, Tufour Y, Yamoah FA, Yefieye AC, Yorke J, Addo KG, Akosa EA, Boakye P, Coompson CL, Gyamfi B, Kontor BE, Kyeremeh C, Manu R, Mensah E, Solae FI, Toffah GK, Adu-Brobbey R, Coompson CL, Labaran AH, Owusu JA, Adobea V, Bennin A, Dankwah F, Doe S, Kantanka RS, Kobby E, Larnyor H, Owusu PY, Sie-Broni CA, Zume M, Abantanga FA, Abdulai DR, Acquah DK, Ayingayure E, Osman I, Kunfah S, Limann G, Mohammed SA, Mohammed S, Musah Y, Ofori B, Owusu EA, Saba AH, Seidu AS, Yakubu M, Yenli EMTA, Bhatti K, Dhiman J, Dhir K, Hans M, Haque PD, Jesudason EDM, Madankumar L, Mittal R, Nagomy I, Prasad S, Dasari A, Jacob P, Kurien E, Mathew A, Prakash D, Susan A, Varghese R, Ortiz RC, Gonzalez GH, Krauss RH, Miguelena LH, Romero MH, Gomez IB, Aguirre CC, Avendaño AC, Sansores LD, Mejia HO, Campo LUGD, Sánchez ID, Vazquez DG, Lara MM, Maldonado LMP, Fuente ANSDL, Medina ARDL, Adeleye V, Adeniyi O, Akinajo O, Akinboyewa D, Alasi I, Alakaloko F, Atoyebi O, Balogun O, Belie O, Bode C, Ekwesianya A, Elebute O, Ezenwankwo F, Fatuga A, Ihediwa G, Jimoh A, Kuku J, Ladipo-Ajayi O, Makanjuola A, Mokwenyei O, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Ugwu A, Williams E, Abdur-Rahman L, Adeleke N, Adesola M, Afolabi R, Agodirin S, Aremu I, Bello J, Lawal S, Lawal A, Raji H, Sayomi O, Shittu A, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah P, Opandoh INM, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, AkotoAmpaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Ciociano MCJMC, Valle CJZFD, Aziz HIAG, Calvillo MDCG, Iriarte DGIM, Namur LDCM, Medina ARDL, Mustapha BKLA, Utumatwishima AMJN, Abdul-Aziz IIA, Anasara GAG, Ogudi DKD, Quansah JIK, Kumar NAU, Mehraj IMA, Nayak SMP, Díaz KVA, Herrera VJA, Camacho FJB, Pérez IVB, Llamas MAC, Cardona GAC, Andrade LRC, Flores AOC, Torres EJC, Valadez TAC, Valadez AEC, Cardoza JAF, González LAG, Bojorquez JLG, Ponce FYG, Ramírez CSG, Barba JAG, Ramírez BGG, Ruvalcaba MJG, Alva DAH, Camargo SAI, Peña JCI, Pérez ZML, Tellez MPM, Ackerman RCM, Vallejo LRP, Bocanegra VHP, Navarro JVP, Posada FJP, Hernández MAQ, Gonzalez LRR, Elizalde EAR, Ascencio EVR, Velasco CBR, Martínez JAS, Pulido JIS, García AGS, Carreón LOS, Ávila JJT, Gastelum JOV, Ramirez MLV, Casas MFZ, Mata JAA, Vanegas MAC, Arias RGC, Barajas BVE, Angeles LOM, Lomeli AFM, Navarro JEO, Baolboa LGP, Dominguez ACG, Morales JFM, Pesquera JAA, Maldonado LMP, Fonseca RKC, Hernandez EEL, Ramirez JAR, Moscoso MRB, Duniya SAN, Adeleye GTC, Bakare TIB, Ohemu AA, Habumuremyi DUS, Seneza GNC, Haragirimana JDD, Ingabire AJC, Ekwunife OH, Acheampong DO, Agbeko AE, Gyamfi FE, Nyadu BB, Adu-Aryee NA, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Brown GD, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Olatola DO, Tsatsu SE, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Kantanka RS, Owusu PY, Acquah DK, Adams SM, Alhassan MS, Asirifi SA, Dery MK, Ofori BA, Sam NB, Seidu AS, Acquah EK, Coompson CL, Gyambibi AK, Kontor BE, Poonia DR, Rathod KK, Rodha MS, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Lokavarapu MJ, Seenivasagam RK, Kalyanapu JA, Gautham AK, Singh DS, Abraham ES, Gold CS, Joseph JN, Kurien EN, Mathew AJ, Mathew AE, Prakash DD, Hans MA, Haque PD, Sam VD, Thind RS, Veetil SK, Daniel ER, Jacob SE, Jesudason MR, Samuel VM, Sivakumar MV, Saluja SS, Attri AK, Pai MV, Prabhu PS, T SP, Alexander PV, Ismavel VA, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Malik MA, Peters NJ, Chowdri NA, Dar RA, Parray FQ, Shah ZA, Wani RA, Villaseñor SA, Hernández AB, Ahumada EB, Cardiel GC, Guevara GC, Perez EC, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Orozco CF, Reyna BG, Sánchez EG, Espinoza EG, Ojeda AG, Torres MI, Tornero JJ, País RM, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Bravo CR, Villaseñor GS, Tinajero CC, Samano FD, Banuelos GG, Ortiz FI, Ramirez ML, Arroyo GL, Perez JO, Ramirez DO, Lozano JP, Reyes GY, Castillo MN, Mellado DH, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Quiros BC, Ambriz-González G, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Aliyu MS, Balogun AO, Francis AA, Duromola KM, Gana SG, George MD, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Saidu IA, Sholadoye TT, Abdulkarim AA, Abdullahi LB, Tolani MA, Tukur AM, Umar AS, Umar AM, Yusuf SA, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Takai IU, Umar GI, Adze JA, Airede LR, Bature SB, Galadima MC, Hamza BK, Kache SA, Kagomi WY, Kene IA, Makama JG, Mohammed-Durosinlorun AA, Taingson MC, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Atobatele KM, Bakare OO, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Salami OS, Williams OM, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Oluseye OO, Orowale AA, Osinowo AO, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Eseile IS, Ogundoyin OO, Olulana DI, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Akaba GO, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Osagie OO, Sani SA, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Osagie OT, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Lawal SA, Raji HO, Igwe PO, Iweha IE, John RE, Okoro PE, Oriji VK, Oweredaba IT, Majyabere JP, Habiyakare JA, Nabada MG, Masengesho JP, Niyomuremyi JP, Uwimana JC, Maniraguha HL, Urimubabo CJ, Shyirakera JY, Adams MA, Ede CJ, Mathe MN, Nhlabathi NA, Nxumalo HS, Sethoana ME, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Abdulai S, Agboadoh N, Akoto E, Boakye-Yiadom K, Dedey F, Nsaful J, Wordui T, Abubakari F, Akunyam J, Ballu C, Ngaaso K, Adobea V, Bennin A, Doe S, Kobby E, Kyeremeh C, Osei E, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Amadu M, Awe M, Azanlerigu M, Edwin Y, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Yahaya S, Alhassan J, Boakye P, Jeffery-Felix A, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Sharma N, Sharma N, Huda F, Mishra N, Ranjan R, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kutma A, Philips S, Hepzibah A, Mary G, Chetana C, Dasari A, Dummala P, Jacob J, Mary P, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Goyal A, Goyal S, Jain D, Jain R, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Singh P, Suroy A, Williams R, D S, Kumari P, Mittal R, Prasad S, Shankar B, Sharma S, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Kumar P, S A, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Thomas J, Zechariah P, Kichu M, Joseph S, Pundir N, Samujh R, Kour R, Saqib N, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Roy B, Abdullahi A, Abubakar M, Awaisu M, Bakari F, Bashir M, Bello A, Daniyan M, Gimba J, Gundu I, Oyelowo N, Sufyan I, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Abdullahi M, Soladoye A, Yahaya A, Abdulrasheed L, Aminu B, Bello-Tukur F, Chinyio D, Joshua S, Lawal J, Mohammed C, Nuwam D, Sale D, Sani A, Tabara S, Usam E, Yakubu J, Adegoke F, Ige O, Bakare A, Akande O, Anyanwu N, Eke G, Oyewole Y, Abunimye E, Adeoluwa A, Adesiyakan A, Amao M, Ashley-Osuzoka C, Gbenga-Oke C, Makanjuola A, Olanrewaju O, Olayioye O, Olutola S, Onyekachi K, Osariemen E, Osunwusi B, Owie E, Okoro C, Ugwuanyi K, Ugwunne C, Olasehinde O, Akinloye A, Akinniyi A, Ejimogu J, Okedare A, Omotola O, Sanwo F, Awodele K, Aisuodionoe-Shadrach O, Alfred J, Atim T, Mbajiekwe N, Olori A, Suleiman S, Sunday H, Ida G, Oruade D, Osemwegie O, Ajibola G, Elemile P, Fakoya A, Ojediran O, Olagunju N, Bello R, Lawal A, Ojajuni A, Oyewale S, Sayomi O, Shittu A, Abhulimen V, Okoi N, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Byaruhanga A, Dukuzimana R, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Mpirimbanyi C, Mukamazera L, Mukangabo C, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Dusabe M, Izabiriza E, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Dieudonne A, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Batangana M, Bucyibaruta G, Habumuremyi S, Imanishimwe A, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Dusabimana A, Kanyesigye S, Munyaneza R, Fourtounas M, Hyman G, Moore R, Sentholang N, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R, Cook J, Jayne D, Laurberg S, Brown J, Smart N, Cousens S. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet Glob Health 2024; 12:e235-e242. [PMID: 38245114 DOI: 10.1016/s2214-109x(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. METHODS A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). FINDINGS In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. INTERPRETATION Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. FUNDING National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.
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Al Habsi T, Al-Ajmi E, Washahi MA, Lawati MA, Maawali SA, Mahajan A, Sirasanagandla SR. Does Frontal Recess Cell Variation Associate with the Development of Frontal Sinusitis? A Narrative Review. Diagnostics (Basel) 2024; 14:103. [PMID: 38201412 PMCID: PMC10795722 DOI: 10.3390/diagnostics14010103] [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: 11/03/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Chronic rhinosinusitis (CRS) can have a significant impact on quality of life. With persistent symptoms and the failure of initial medical treatments, surgical management is indicated. Despite the excellent results of endoscopic sinus surgery for persistent CRS, it is quite a challenging procedure for frontal sinusitis given the complex anatomy and location of the frontal sinus. Frontal recess cells significantly contribute to the complexity of the frontal sinus, and numerous studies have sought to establish their association with sinusitis. This review offers a comprehensive understanding of frontal recess cells, their different classifications, their prevalence among different populations, and their relationship to sinusitis. After an extensive review of the current literature, the International Frontal Sinus Anatomy Classification (IFAC) is the most recent classification method and a preferred practical preoperative assessment tool. Although the agger nasi cell is the most prevalent cell among all reported populations, ethnic variations are still influencing the other cells' distribution. Studies are inconsistent in reporting a relationship between frontal recess cells and sinusitis, and that is mainly because of the differences in the classification methods used. More research using a standardized classification method is needed to understand the association between frontal recess cells and sinusitis.
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Affiliation(s)
- Tariq Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (T.A.H.); (M.A.L.); (S.A.M.)
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Mohammed Al Washahi
- Department of Surgery, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (M.A.W.); (A.M.)
| | - Maitham Al Lawati
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (T.A.H.); (M.A.L.); (S.A.M.)
| | - Shihab Al Maawali
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (T.A.H.); (M.A.L.); (S.A.M.)
| | - Amit Mahajan
- Department of Surgery, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (M.A.W.); (A.M.)
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
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Avellaneda N, Al Masri M, Baimakhanov A, Balasubramaniam D, Bhangu A, Bouchagier K, Bozbiyik O, Carpelan A, Chwat C, Cunha M, Dawson BE, Mallen MVD, Ellebæk MB, Gonzalez TE, Elshami M, Fakhradiyev I, Ozkan OF, Fleres F, Futaba K, Gallo G, Ghosh D, Glasbey JC, Harrison E, Hooper RL, Jain R, Kamarajah S, Veetil SK, Kamer E, Keatley J, Knowles CH, Kulimbet M, Lal P, Li E, Polamreddy BM, Minaya-Bravo A, Mittal R, Morton DG, Nadal LRM, Negoi I, Nepogodiev D, Omar O, Pata F, Pinkney T, Potter MA, Rottoli M, Santos G, Smith I, Spinelli A, Venn M, Hooper R, Morton D, Bywater E, Evans J, Magill L, McKay S, Bordom DO, Simões J, Venn ML, Adeyeye A, Avellaneda N, Buchs N, Cato L, Finch D, Umar GI, Bravo AM, Junior HM, Neary P, Poskus T, Roslani A, Samadov E, Sbaih M, Shalaby M, Singh B, Sinha A, Vardanyan A, Chaudhry S, Frasson M, Millward J, Sánchez-Guillén L, Stijns J, Zimmerman DDE, Beard D, Campbell M, Moug S, Aytac E, Blackwell S, Buchwald P, Chowdhury SM, Dardanov D, Dulskas A, Elhadi M, 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Mohamed M, Mohamed N, Mahmoud S, Mahmoud S, Rashed AM, Abd-Errazik MA, Ammar MA, Mohammed R, Ebrahem A, Abd El Aal A, Abdou K, Wagdy M, Qassem M, Taha M, El-Wafa YA, Shehta A, El Metwally A, Hamed H, Ali MA, Elrefai M, El Sorogy M, Abdelkhalek M, Ragab A, Refky B, Metwally IH, Abdelkhalek M, Kamal M, Zuhdy M, Shetiwy M, Sakr A, Elfallal A, Elfeki H, Eldakroury I, Elbahrawy K, Mostafa M, Emile S, Tessema A, Tasew A, Gezahegn H, Bekele K, Belay M, Gudisa Z, Teferu Z, Väyrynen A, Kechagias A, Turunen A, Katunin J, Parhiala M, Pengerma P, Lahti P, Vihervaara H, Huhtinen H, Pasonen J, Heino R, Pakarinen S, Falenius V, Pinard B, Nobile C, Duchalais E, Drissi F, Meurette G, Podevin J, Lepenndu M, Hoetzel A, Jud A, Jauch D, Stefan FF, Neeff H, Holzner P, Nguyen P, Ryl A, Kehl F, Pullig F, Baral J, Münch S, Fütterer C, Reißfelder C, Sandra-Petrescu F, Herrle F, Hardt J, Lamm L, Seyfried S, Gharbi A, Aydin F, Stavrou G, Sperber J, de Deken J, Schwarzkopf K, Widyaningsih R, Polidorou A, Mpakas A, Tokidis E, Loun L, Petropoulou T, Balalis D, Korkolis D, Manatakis D, Assimakopoulou E, Bourazani M, Gklavas A, Kalamara E, Papaconstantinou I, Theodoraki K, Chardalias L, Konstadoulakis M, Theodosopoulos T, Soulioti E, Kavezou F, Filippou J, Papadoliopoulou M, Michalopoulos N, Vassiliu P, Sidiropoulos T, Charakopoulou A, Panagiotou A, Kokkinakis K, Lambridi E, Psarologos M, Maria S, Giannaraki S, Kapiris S, Triantafyllou A, Theodoropoulos C, Matthaiou G, Westzaan N, Etelka S, Triantafyllou T, Schizas D, Mpaili E, Karydakis L, Mpoura M, Danassi D, Karavokyros I, Dimitriou N, Livanou X, Kikira A, Tsourouflis G, Tomara NK, Nikiteas N, Dorovinis P, Tsiotos G, Stamou K, Kocka N, Ballian N, Kalakonas S, Athanasakis E, Chrysos E, Xynos E, Tsiaoussis J, Papadaki K, Xenaki S, Nyktari V, Sarakatsianou C, Bompou E, Arnaoutoglou E, Tzovaras G, Baloyiannis I, Mamaloudis I, Perivoliotis K, Apostolidi E, Mulita F, Karpetas G, Maroulis I, Vailas M, Petra A, Kontis E, Kaouras E, Katsaros I, Katsiaras 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Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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Tu LH, Navaratnam D, Melnick ER, Forman HP, Venkatesh AK, Malhotra A, Yaesoubi R, Sureshanand S, Sheth KN, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. AJR Am J Roentgenol 2023; 221:836-845. [PMID: 37404082 DOI: 10.2214/ajr.23.29617] [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] [Indexed: 07/06/2023]
Abstract
BACKGROUND. CT with CTA is widely used to exclude stroke in patients with dizziness, although MRI has higher sensitivity. OBJECTIVE. The purpose of this article was to compare patients presenting to the emergency department (ED) with dizziness who undergo CT with CTA alone versus those who undergo MRI in terms of stroke-related management and outcomes. METHODS. This retrospective study included 1917 patients (mean age, 59.5 years; 776 men, 1141 women) presenting to the ED with dizziness from January 1, 2018, to December 31, 2021. A first propensity score matching analysis incorporated demographic characteristics, medical history, findings from the review of systems, physical examination findings, and symptoms to construct matched groups of patients discharged from the ED after undergoing head CT with head and neck CTA alone and patients who underwent brain MRI (with or without CT and CTA). Outcomes were compared. A second analysis compared matched patients discharged after CT with CTA alone and patients who underwent specialized abbreviated MRI using multiplanar high-resolution DWI for increased sensitivity for posterior circulation stroke. Sensitivity analyses were performed involving MRI examinations performed as the first or only neuroimaging examination and involving alternative matching and imputation techniques. RESULTS. In the first analysis (406 patients per group), patients who underwent MRI, compared with patients who underwent CT with CTA alone, showed greater frequency of critical neuroimaging results (10.1% vs 4.7%, p = .005), change in secondary stroke prevention medication (9.6% vs 3.2%, p = .001), and subsequent echocardiography evaluation (6.4% vs 1.0%, p < .001). In the second analysis (100 patients per group), patients who underwent specialized abbreviated MRI, compared with patients who underwent CT with CTA alone, showed greater frequency of critical neuroimaging results (10.0% vs 2.0%, p = .04), change in secondary stroke prevention medication (14.0% vs 1.0%, p = .001), and subsequent echocardiography evaluation (12.0% vs 2.0%, p = .01) and lower frequency of 90-day ED readmissions (12.0% vs 28.0%, p = .008). Sensitivity analyses showed qualitatively similar findings. CONCLUSION. A proportion of patients discharged after CT with CTA alone may have benefitted from alternative or additional evaluation by MRI (including MRI using a specialized abbreviated protocol). CLINICAL IMPACT. Use of MRI may motivate clinically impactful management changes in patients presenting with dizziness.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | | | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | | | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
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Djureinovic D, Weiss SA, Krykbaeva I, Qu R, Vathiotis I, Moutafi M, Zhang L, Perdigoto AL, Wei W, Anderson G, Damsky W, Hurwitz M, Johnson B, Schoenfeld D, Mahajan A, Hsu F, Miller-Jensen K, Kluger Y, Sznol M, Kaech SM, Bosenberg M, Jilaveanu LB, Kluger HM. A bedside to bench study of anti-PD-1, anti-CD40, and anti-CSF1R indicates that more is not necessarily better. Mol Cancer 2023; 22:182. [PMID: 37964379 PMCID: PMC10644655 DOI: 10.1186/s12943-023-01884-x] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Stimulating inflammatory tumor associated macrophages can overcome resistance to PD-(L)1 blockade. We previously conducted a phase I trial of cabiralizumab (anti-CSF1R), sotigalimab (CD40-agonist) and nivolumab. Our current purpose was to study the activity and cellular effects of this three-drug regimen in anti-PD-1-resistant melanoma. METHODS We employed a Simon's two-stage design and analyzed circulating immune cells from patients treated with this regimen for treatment-related changes. We assessed various dose levels of anti-CSF1R in murine melanoma models and studied the cellular and molecular effects. RESULTS Thirteen patients were enrolled in the first stage. We observed one (7.7%) confirmed and one (7.7%) unconfirmed partial response, 5 patients had stable disease (38.5%) and 6 disease progression (42.6%). We elected not to proceed to the second stage. CyTOF analysis revealed a reduction in non-classical monocytes. Patients with prolonged stable disease or partial response who remained on study for longer had increased markers of antigen presentation after treatment compared to patients whose disease progressed rapidly. In a murine model, higher anti-CSF1R doses resulted in increased tumor growth and worse survival. Using single-cell RNA-sequencing, we identified a suppressive monocyte/macrophage population in murine tumors exposed to higher doses. CONCLUSIONS Higher anti-CSF1R doses are inferior to lower doses in a preclinical model, inducing a suppressive macrophage population, and potentially explaining the disappointing results observed in patients. While it is impossible to directly infer human doses from murine studies, careful intra-species evaluation can provide important insight. Cabiralizumab dose optimization is necessary for this patient population with limited treatment options. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03502330.
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Affiliation(s)
- Dijana Djureinovic
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Sarah A Weiss
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Irina Krykbaeva
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Rihao Qu
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Ioannis Vathiotis
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Myrto Moutafi
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Lin Zhang
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Ana L Perdigoto
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Wei Wei
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Gail Anderson
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - William Damsky
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Hurwitz
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Barbara Johnson
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - David Schoenfeld
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | | | - Kathryn Miller-Jensen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, CT, USA
- Systems Biology Institute, Yale University, New Haven, CT, USA
| | - Yuval Kluger
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Sznol
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, Salk Institute, La Jolla, CA, USA
| | - Marcus Bosenberg
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Lucia B Jilaveanu
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA
| | - Harriet M Kluger
- Department of Medicine (Medical Oncology), Yale University School of Medicine, 333 Cedar Street, WWW211B, New Haven, CT, 06520, USA.
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12
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Frechette KM, Lucido J, Harmsen WS, Laack NN, Mahajan A, Yan ES, Routman DM, Merrell KW, Grams M, Brooks JL, Parney IF, Sener U, Brown PD, Breen W. Stereotactic Radiosurgery (SRS) for Large Brain Metastases: Dosimetric and Clinical Predictors of Local Progression and Radionecrosis. Int J Radiat Oncol Biol Phys 2023; 117:e105. [PMID: 37784635 DOI: 10.1016/j.ijrobp.2023.06.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic radiosurgery (SRS) provides high rates of local control for small brain metastases with low rates of radionecrosis (RN). Larger targets are associated with increased risk of both local progression (LP) and RN. In this analysis, we hypothesized that dosimetric and clinical parameters predict for risk of LP and RN in SRS targets larger than two centimeters. MATERIALS/METHODS We retrospectively reviewed patients with one or more targets with either an intact versus post-operative cavity larger than 2.0 cm treated with LINAC-based SRS between 2017 and 2022 at one institution. We assessed for association between patient, treatment, and disease variables with LP and RN. Variables assessed included tumor resection status, PDL1 positivity, target volume, maximum and minimum target dose, EQD2 and BED (a/b = 2 for necrosis and a/b = 10 for tumor control), as well as receipt of steroids, bevacizumab, or systemic therapy before or after SRS. Radionecrosis was determined by characteristic radiographic changes. Analyses were performed for the entire cohort and within subsets including by resection status and dose fractionation. RESULTS A total of 178 lesions in 143 patients were included. Targets with volume diameters measuring at least 2 cm were used. Median follow-up was 2.3 years. Overall survival at 1 and 2 years was 56% and 32%, respectively. Most lesions (n = 119) were resected and treated with SRS post-operatively. The most common dose and fractionation schemes used were 30 Gy in 5 fractions (n = 89) and 27 Gy in 3 fractions (n = 63). For the entire cohort, the cumulative incidence of LP 1 and 2 years was 26% and 34%, respectively. The cumulative incidence of radiographic radionecrosis at 1 and 2 years was 12% and 17%, respectively. There was no difference in LP or RN between 27 Gy in 3 fractions versus 30 Gy in 5 fractions (p>0.5 for both). Median planning target volume (PTV) size was 18.5 cc for the 27 Gy in 3 fraction group compared to 21.9 cc in the 30 Gy in 5 fraction group. Minimum or maximum dose within the target was not associated with increased risk of LP or RN. Among patients receiving 27 Gy in 3 fractions, patients treated with resection followed by SRS had lower risk of LP compared to those treated with SRS alone (HR: 0.15, 95% CI: 0.03-0.64, p = 0.011). Among patients receiving 30 Gy in 5 fractions, patients who received corticosteroids prior to SRS had a lower risk of RN (HR: 0.14, 95% CI: 0.03-0.66, p = 0.013). For the entire cohort as well as within all subgroups, PD-L1≥1% was associated with increased risk of RN (p<0.001 for all). CONCLUSION Selecting the optimal SRS dose fractionation and planning parameters to minimize both LP and RN remains a challenge for large targets. In this analysis, 27 Gy in 3 fractions appeared to provide equivalent LP and RN compared to 30 Gy in 5 fractions, and may be more convenient for patients. Patients with PD-L1≥1% with large brain targets treated with SRS may be at increased risk of RN; corticosteroid prophylaxis may be considered in this population.
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Affiliation(s)
- K M Frechette
- Mayo Clinic College of Medicine and Science Rochester, Rochester, MN, United States
| | - J Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W S Harmsen
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - E S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J L Brooks
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - I F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - U Sener
- Mayo Clinic Department of Neurology, Rochester, MN
| | - P D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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McKone EL, Breen W, Foster NR, Bogan AW, Alstat RA, Boyce S, Schwartz JD, Ahmed SK, Mahajan A, Laack NN. Memantine for Pediatric Patients Receiving Cranial Irradiation: A Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:S134-S135. [PMID: 37784344 DOI: 10.1016/j.ijrobp.2023.06.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While memantine has become standard in certain adults receiving brain RT to decrease the cognitive impacts of RT, it is unknown whether pediatric patients can take and tolerate memantine or experience benefit. In this prospective single-arm feasibility study, we hypothesized pediatric patients receiving brain RT would tolerate memantine with good treatment adherence. MATERIALS/METHODS Patients aged 4-18 years with a primary CNS malignancy (excluding WHO Grade IV astrocytoma and glioblastoma) receiving intracranial RT were eligible. A 6-month course of memantine was given during and after RT. Dosing began once daily at 5 mg with up-titration in 5 mg increments over 4 weeks to a weight-based maximum (0.4 mg/kg to the closest 5 mg), not to exceed 10 mg BID. To reduce patient and clinical research associate (CRA) burden, medication adherence was tracked via the Medisafe Pill and Reminder application which study staff helped install on the patient or parent's smart phone. A paper pill diary was provided for those unable to use the app. The primary endpoint was to achieve 80% adherence rate to memantine in 80% of patients measured 1-month post-RT. RESULTS Eighteen patients (14 male and 4 female, median age 11.5 years (range: 4-18)) were enrolled from 2020-2022. The study closed early after enrolling 18 of 20 planned patients to avoid competing with the phase III randomized Children's Oncology Group (COG) study AACL2031. One patient withdrew for cognition-altering substance-use, leaving 17 patients with data available for analysis. Histologies included germ cell tumor (n = 6), craniopharyngioma (n = 3), choroid plexus papilloma (n = 2), ependymoma (n = 2), glial/astrocytoma (n = 2), medulloblastoma (n = 1), and meningioma (n = 1). Thirteen had surgery, and 9 received chemotherapy. Eight received craniospinal irradiation (CSI). Median RT dose was 54 Gy (range 36-59.4) in 30 fractions (range: 20-33). At data freeze, all 17 had passed the 1-month post-RT time point. One patient discontinued memantine after a single dose due to nausea. Pill-reports were available for 14 of the remaining 16; two patients did not complete digital pill logs. For those with complete logs, all adherence rates were above 80%, with a median of 99.32% pill completion rate (range: 92.67-100). Seven (50%) took 100% of prescribed doses. Irrespective of adherence for the 2 unavailable for evaluation, the primary endpoint was still achieved. Grade 1 toxicities included headache (n = 6, 35%) and constipation (n = 1, 6%); there were no grade 2+ toxicities. At last follow-up, 15/16 have completed the full 6-month memantine course. Secondary endpoints including neurocognitive evaluations have not yet been met and will be the subject of future reports. CONCLUSION Memantine is a feasible and well-tolerated addition to multi-modality treatment for pediatric brain tumors. Secondary endpoints of this study and results of the ongoing COG study are awaited to define the value of memantine in this population.
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Affiliation(s)
- E L McKone
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N R Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - A W Bogan
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | | | - S Boyce
- Mayo Clinic College of Medicine and Science Rochester, Rochester, MN
| | - J D Schwartz
- Department of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN
| | - S K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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14
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Laughlin BS, Zaniletti I, Vern-Gross T, Van Der Walt C, Allen-Rhoades W, Polites S, Rose PS, Ashman JB, Petersen IA, Haddock MG, Mahajan A, Keole SR, Laack NN, Ahmed SK. Clinical Outcomes for Chest Wall Ewing Sarcoma: A Multi-Center Single Institution Experience. Int J Radiat Oncol Biol Phys 2023; 117:e525. [PMID: 37785633 DOI: 10.1016/j.ijrobp.2023.06.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report tumor and treatment characteristics, oncologic outcomes, and treatment-associated toxicities in a cohort of chest wall Ewing sarcoma (cwES) patients treated at a single tertiary care institution. MATERIALS/METHODS After IRB approval, patients with cwES treated from 1997-2022 were retrospectively reviewed. Patient, tumor, treatment, outcomes, and toxicity data were abstracted. Local control (LC), progression-free survival (PFS), and overall survival (OS) were defined from end of treatment and assessed using the Kaplan-Meier method. Log-rank test and unadjusted Cox models were performed to determine factors associated with outcomes. RESULTS The cohort includes 45 patients. Median age at diagnosis was 19.8 years (range: 3.5 - 57.8 years). Five patients (11.1%) presented with pleural effusion and eight patients with lung metastases (17.8%). Two (4.4%) patients had metastatic disease outside the thorax. Median tumor volume (TV) was 138.6 mL (range: 3.0-6762.0 mL). All patients received VDC/IE chemotherapy. LC modality was surgery (S) in 21 patients (47%), radiation therapy (RT) in 5 (11%), and S+RT in 19 (42%). Median TV was larger in S+RT patients (319.4 mL, range: 5.3-6761.9 mL) compared to RT (152.3 mL, range: 20.4-366.9 mL) or S (70.4 mL, range: 3.1-1037.8 mL) (p = 0.03). R0 and R1 resections were performed in 36 (90%) and 4 (10%) patients, respectively. Proton beam therapy was used in 15 (63%) patients. Median dose was 50.40 Gy (range: 34.2 - 60 Gy) in 28 fractions to the primary tumor or post operative bed. Median dose for hemithorax (1 patient, 2.2%) and whole lung irradiation (7 patients, 15.6%) was 15.0 Gy (range: 15.0-15.0 Gy) in 10 fractions. Median follow-up was 2.38 years (range: 0 - 21.90 years). Five-year LC, PFS, and OS for all patients was 77.9% (95% CI, 65.3 - 92.9%), 54.2% (95% CI, 39.9 - 73.5%), and 63.5% (95% CI, 49.3 - 81.8%), respectively. In patients with localized disease, 5-year LC, PFS, and OS were 82.4% (95% CI, 67.9-99.8%), 66.4% (95% CI, 49.7-88.8%), and 71.3% (95% CI, 54.2-93.9%), respectively. Two-year LC by modality was 100% for RT (95% CI, 100-100%), 84.2% (95% CI, 69.3- 100%) for S and 73.3% (95% CI, 54 - 99.5%) for S+RT (p = 0.51). On univariate analysis, TV ≥ 200 mL was associated with a significantly worse 5-year OS (49.5%, TV ≥ 200 mL vs. 80.8%, TV < 200 mL; HR 4.44, p = 0.032) and PFS (35.2%, TV ≥ 200 mL vs. 76%, TV < 200 mL; HR 3.55, p = 0.025). TV ≥ 200 mL trended towards worse 5-year LC: 69.2% for TV ≥ 200 mL versus 81.5% for TV <200 mL [HR 2.26(95% CI 0.49 - 10.47), p = 0.287]. Overall, low rates of grade ≥2 toxicity were observed: 4 (8.9%) fatigue, 4 (8.9%) radiation dermatitis, 1 (2.2%) chyle leak, 3 (6.6%) scoliosis, 4 (8.9%) infection, 1 (2.2%) pneumonia, and 1 (2.2%) chest wall deformity. CONCLUSION RT is a safe, effective local therapy for small to moderate cwES tumors. Patients with TV ≥ 200 mL had significantly worse survival outcomes and an inferior LC rate. This suggests large cwES tumors may benefit from an aggressive multi-modality approach.
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Affiliation(s)
- B S Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - I Zaniletti
- Department of Quantitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - T Vern-Gross
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - C Van Der Walt
- Department of Quantitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - W Allen-Rhoades
- Department of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN
| | - S Polites
- Department of Pediatric Surgery, Mayo Clinic, Rochester, MN
| | - P S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - J B Ashman
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - I A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
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15
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Dupere JM, Lucido J, Blackwell R, Breen W, Mahajan A, Stafford SL, Remmes N. Spot Scanning Proton Therapy for Pregnant Patients with Brain and Head and Neck Tumors. Int J Radiat Oncol Biol Phys 2023; 117:S39. [PMID: 37784489 DOI: 10.1016/j.ijrobp.2023.06.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) When radiotherapy is medically necessary, x-ray based treatments (XRT) have traditionally been used to treat pregnant patients. Treatment planning and delivery techniques may be modified to minimize dose to the fetus but results in less optimal plans due to avoiding posterior beams or arcs. Monte Carlo calculations and published case studies suggest spot scanning proton therapy (PRT) reduces the equivalent dose to the fetus by a factor of 10 compared to XRT and does not require modified treatment planning techniques. However, due to concern for dose uncertainties and neutron scatter with PRT, few centers have adopted PRT over XRT for pregnant patients. The purpose of this work is to perform a retrospective study on the pregnant patients previously treated at our institution with XRT to measure the equivalent dose that would be delivered to the fetus with spot scanning PRT compared to XRT. MATERIALS/METHODS PRT plans were made for seven pregnant patients, 4 brain tumors and 3 head and neck tumors, who had received XRT. Due to the finite range of protons, the fetal exposure is dominated by neutrons and not the primary beam. Thus, no beam arrangement modifications were required to minimize fetal dose for PRT plans. Fetal dose measurements were performed with the patient plans using a Rando phantom and Wendi-2 (Thermo Scientific) meter placed at the phantom's abdomen. The Wendi-2 measures ambient dose equivalent, which accounts for the biological effect of the neutron energies. Measurements were made at various distances from isocenter to the center of the detector. The total dose equivalent from PRT at several out of field distances was compared to that from XRT. Patient specific measurements were used to determine the total fetal dose from each modality, accounting for the changing position of the fetus each week of the mother's treatment. The imaging dose for standard of practice imaging, including verification CT scans and daily alignment imaging, was also evaluated using a similar setup with a Fluke 451 dose meter. RESULTS The average measured fetal equivalent dose for the brain plans was 0.4 mSv for PRT and 7 mSv for XRT. For the head and neck plans, it was 6 mSv for PRT and 90 mSv for XRT. The dose from PRT was consistently at least a factor of 10 less than the XRT plans. In addition, the PRT plans were preferred by the physicians when considering tumor coverage and other normal tissue sparing. Daily imaging added between 0.05 and 1.5 mSv to the total dose in the PRT treatments. CONCLUSION This retrospective study showed that when treating brain or head and neck tumors in pregnant patients, the equivalent dose a fetus would receive with PRT is approximately a factor of 10 less than XRT without making any compromises in treatment planning. These results support changing the standard of practice to utilizing spot scanning PRT as the preferred method for treating pregnant patients with brain or head and neck tumors when available instead of XRT. We have brought this process to clinic at our center.
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Affiliation(s)
- J M Dupere
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - R Blackwell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N Remmes
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Jain S, Mahajan A, Patil PM, Bhandarkar P, Khajanchi M. Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration). J Postgrad Med 2023; 69:198-204. [PMID: 37449588 PMCID: PMC10846812 DOI: 10.4103/jpgm.jpgm_485_22] [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: 06/14/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 07/18/2023] Open
Abstract
Context The COVID-19 pandemic and subsequent lockdowns adversely affected global healthcare services to varying extents. To accommodate its added burden, emergency services were affected along-with elective surgeries. Aims To quantify and analyze the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Settings and Design Multi-centric retrospective study. Methods and Material A research consortium led by World Health Organization (WHO) Collaboration Center (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centers. All surgeries performed during April 2020 (Wave I), November 2020 (Recovery I), and April 2021 (Wave II) were compared with those performed in April 2019 (pre-pandemic period). Statistical Analysis Used Microsoft Excel 2019 and SPSS Version 20. Results The total number of surgeries reduced by 77% during Wave I, which improved to a 52% reduction in Recovery I compared to the pre-pandemic period. However, surgeries were reduced again during Wave II to 68%, but the reduction was less compared to Wave I. Emergency and essential surgeries were affected along with the elective ones but to a lesser extent. Conclusions The present study has quantified the effects of the pandemic on surgical-care delivery across a timeline and documented a reduction in overall surgical volumes during the peaks of the pandemic (Wave I and II) with minimal improvement as the surge of COVID-19 cases declined (Recovery II). The surgical volumes improved during the second wave compared to the first one which may be attributable to better preparedness. Cesarean sections were affected the least.
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Affiliation(s)
- S Jain
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A Mahajan
- Government Medical College, Amritsar, Punjab, India
| | - PM Patil
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - P Bhandarkar
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - M Khajanchi
- Department of Surgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
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Chakrabarty N, Mahajan A. Imaging Analytics using Artificial Intelligence in Oncology: A Comprehensive Review. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00334-5. [PMID: 37806795 DOI: 10.1016/j.clon.2023.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/09/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
The present era has seen a surge in artificial intelligence-related research in oncology, mainly using deep learning, because of powerful computer hardware, improved algorithms and the availability of large amounts of data from open-source domains and the use of transfer learning. Here we discuss the multifaceted role of deep learning in cancer care, ranging from risk stratification, the screening and diagnosis of cancer, to the prediction of genomic mutations, treatment response and survival outcome prediction, through the use of convolutional neural networks. Another role of artificial intelligence is in the generation of automated radiology reports, which is a boon in high-volume centres to minimise report turnaround time. Although a validated and deployable deep-learning model for clinical use is still in its infancy, there is ongoing research to overcome the barriers for its universal implementation and we also delve into this aspect. We also briefly describe the role of radiomics in oncoimaging. Artificial intelligence can provide answers pertaining to cancer management at baseline imaging, saving cost and time. Imaging biobanks, which are repositories of anonymised images, are also briefly described. We also discuss the commercialisation and ethical issues pertaining to artificial intelligence. The latest generation generalist artificial intelligence model is also briefly described at the end of the article. We believe this article will not only enrich knowledge, but also promote research acumen in the minds of readers to take oncoimaging to another level using artificial intelligence and also work towards clinical translation of such research.
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Affiliation(s)
- N Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India.
| | - A Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
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Biccard BM, Smith D, Peters S, Boutall A, Wilson G, Coetzee E, Flint M, Gumede S, Rayamajhi S, Bannister S, Daniel N, Fourtounas M, Moore R, Sentholang N, Osayomwanbo O, Ifeanyi kene A, Yakubu SY, Chukwu A, Tolani M, Adinoyi YM, Aliyu A, Salahu D, Isa kabir, Salisu I, Adigun T, Adenekan A, Williams E, Bhatia PK, Chaudhary R, Kothari N, Misra S, Pareek P, Poonia DR, Rathod KK, Rodha MS, Sharma N, Sharma N, Chandra Soni S, Varshney VK, Vishnoi JR, Balija SS, Goyal A, Hudda F, Joshva M, Seenivasagam RK, Shajahan S, Sharma S, Singh SK, Talwar P, Tripathi DK, Bhatt, Daniel S, Dhiman J, George C, Ghosh DN, Goyal S, Hans P, Haque PD, Jain D, Kaur H, Kumar K, Mahajan A, Michael V, Rajappa R, Rajkumar A, Suroy A, Thind RS, Veetil SK, Aggarwal AM, Dhamija P, Garry GK, Gupta H, Jakhar R, Kumar A, Kumar K, Kumar P, Singh G, Chowdhury S, Desai N, Goswami J, Mathai S, Patro V. Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries. BJA Open 2023; 7:100207. [PMID: 37655933 PMCID: PMC10457493 DOI: 10.1016/j.bjao.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 09/02/2023]
Abstract
Background This study assessed the potential cost-effectiveness of high (80-100%) vs low (21-35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a -$6 (95% confidence interval [CI]: -$13 to -$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a -$11 (95% CI: -$15 to -$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a -$93 (95% CI: -$132 to -$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a -1.05 (95% CI: -1.14 to -0.90) percentage point reduction in SSIs. Conclusion High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.
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Glasbey JC, Kadir B, Ademuyiwa AO, Adisa AO, Bhangu A, Brocklehurst P, Chakrabortee S, Hardy P, Harrison E, Ingabire JCA, Haque PD, Ismail L, Ghosh D, Gyamfi FE, Li E, Lillywhite R, de la Medina AR, Moore R, Magill L, Morton D, Nepogodiev D, Ntirenganya F, Pinkney T, Omar O, Simoes JFF, Smith D, Tabiri S, Runigamugabo E, Sodonougbo P, Behanzin H, Kangni S, Agboton G, Adagrah LA, Adjei-Acquah E, Acquah AO, Ankomah J, Armah R, Acquah R, Addo KG, Acheampong DO, Adu-Aryee NA, Abubakari F, Titigah A, Owusu F, Adu-Brobbey R, Adobea V, Abantanga FA, Gautham A, Bhatti D, Jesudason EDM, Aggarwal M, Alexander P, Dasari A, Alpheus R, Kumar H, Raul S, Bueno WÁ, Ortiz RC, Gomez IB, Cerdan CC, Gallo MB, Gamez RR, Sánchez ID, Abdullahi L, Adesanya O, Abdulsalam M, Adeleye V, Egwuonwu O, Adeleke A, Adebayo F, Chiejina G, Abayomi O, Abdur-Rahman L, Ede J, Ezinne U, Kanyarukiko S, Dusabe M, Hirwa AD, Bucyibaruta G, Adams MA, Birtles C, Ally Z, Adewunmi AS, Cook J, Brown J, Verjee A, Assouto P, Seto DM, Kpangon C, Ahossi R, Alhassan BBA, Agyekum V, Adam-Zakariah LI, Assah-Adjei F, Asare C, Amoako J, Akosa EA, Acquaye J, Adjei F, Ballu C, Coompson CL, Bennin A, Abdulai DR, Hepzibah A, Bhatti W, Paul PK, Dhamija P, Thomas J, Jacob P, Choudhrie A, Peters N, Sharma R, Camacho FB, Gonzalez GH, Aguirre CC, Solano DD, Flores AC, Menindez RL, Vazquez DG, Ado K, Awonuga D, Adeniran A, Ademuyiwa A, Ekwunife O, Adenikinju W, Aisuodionoe-Shadrach O, Edet E, Abdus-Salam R, Adeleke N, Ekenze S, Francis M, Mukaneza F, Izabiriza E, Kabanda E, Bunogerane GJ, Crawford R, Ivy M, Jayne D, Cousens S, Brant F, Fiogbe M, Tandje Y, Akpla M, Ngabo RB, Amoako-Boateng MP, Agyemang E, Asabre E, Boakye AA, Gakpetor DA, Appiah AD, Boakye P, Adinku M, Akoto E, Barimah CG, Labaran AH, Dankwah F, Acquah DK, Mary G, Bir K, Madankumar L, Gupta H, Zechariah P, Kurien E, Vakil R, Hernández AB, Krauss RH, Avendaño AC, Garcia RT, Ojeda AG, Peón AN, Lara MM, Aliyu M, Fasiku O, Ajai O, Adeniyi O, Modekwe V, Adeniyi O, Akaba G, Inyang A, Adebayo S, Adesola M, Enemuo V, Ikechukwu I, Mukantibaziyaremye D, Maniraguha HL, Mbonimpaye S, Habumuremyi S, Ede CJ, Mbavhalelo C, Laurberg S, Smart N, Koco H, Chobli HH, Bisimwa N, Appiah AB, Akesseh RA, Boateng RA, Fosu G, Gawu VS, Aseti M, Coompson CL, Agbedinu K, Ametefe E, Boateng GC, Owusu JA, Doe S, Ayingayure E, Singh D, Daniel S, Mittal R, Kanna V, Mathew A, Arellano AB, Miguelena LH, Sansores LD, Velasco MJ, Muñoz MP, Perez-Maldonado LM, Anyanwu LJ, Ogo C, Akande O, Akinajo O, Okoro C, Adepiti A, Ameh L, Isa M, Ajao A, Afolabi R, Eze M, Nnyonno O, Munyaneza A, Mpirimbanyi C, Mukakomite C, Haragirimana JDD, Fourtounas M, Chakrabortee S, Metchinhoungbe S, Kovohouande B, Kandokponou CMB, Asante-Asamani A, Amponsah-Manu F, Koomson B, Serbeh G, Obbeng A, Banka C, Gyamfi B, Agbeko AE, Amoako JK, Luri PT, Kantanka RS, Osman I, Dhar T, Nagomy I, Kumar A, Prakash D, Torres EC, Romero MH, Mejia HO, de la Fuente ANS, Magashi M, Atobatele K, Akinboyewa D, Uche C, Aderounmu A, Mbajiekwe N, Iseh F, Amusat O, Agodirin S, Ezomike U, Okoro P, Ndegamiye G, Mutuyimana J, Muroruhirwe P, Imanishimwe A, Hyman G, Sogbo H, Dokponou M, Boakye B, Ofosu-Akromah R, Kusiwaa A, Gyan KY, Ofosuhene D, Dadzie S, Kontor BE, Amankwa EG, Attepor GS, Kobby E, Kunfah S, Dhiman J, Selvakumar R, Singh G, Susan A, Orozco CF, del Campo LUG, de la Medina ARD, Muhammad A, Eke G, Alasi I, Ugwuanyi K, Adesunkanmi A, Ogbo F, Marwa A, Ayandipo O, Aremu I, Izuka E, Patrick I, Tubasiime R, Mwenedata O, Ingabire JCA, Khan Z, Dossou FM, Debrah SA, Enti D, Twerefour EY, Nyarko IO, Osei-Poku D, Essien D, Kyeremeh C, Amoah M, Brown GD, Larnyor KKKH, Limann G, Ghosh D, Shankar B, Varghese R, de Rojas EGG, Muhammad S, Faboya O, Alakaloko F, Ugwunne C, Adisa A, Olori S, Ogbeche S, Egbuchulem K, Bello J, Mbadiwe O, Raphael J, Rwagahirima E, Mukanyange V, Kwati M, Dzemta C, Ganiyu RA, Robertson Z, Puozaa D, Gyamfi FE, Manu R, Amoah G, Fenu B, Osei E, Mohammed SA, Goyal S, Sivakumar M, Ojeda AG, Muideen B, Imam Z, Atoyebi O, Ajekwu S, Osagie O, Olory E, Ekwuazi H, Lawal S, Mbah N, Vaduneme O, Uwizeyimana F, Munyaneza E, Mathe MN, Gaou A, Koggoh P, Tackie E, Hussey R, Mensah E, Appiah J, Kumassah PK, Owusu PY, Mohammed S, Goyal A, Sridhar R, Ramírez BG, Takai I, Momson E, Balogun O, Ajenjfuja O, Sadiq A, Udie G, Elemile P, Lawal A, Victor A, Zirikana J, Mutabazi E, Moore R, Heritage E, Goudou R, Kpankpari R, Temitope AE, Kwarteng J, Solae FI, Arthur J, Olayiwola DO, Sie-Broni CA, Musah Y, Goyal S, Thomas C, Valadez MHV, Ukata O, Nwaenyi F, Belie O, Akindojutimi J, Sani S, Udosen J, Lawal T, Raji H, Ncogoza I, Nhlabathi NA, Hedefoun E, Opandoh INM, Sowah NA, Toffah GK, Ayim A, Wordui T, Zume M, Ofori B, Hans M, Titus D, Acevedo DL, Ogunyemi A, Bode C, Akinkuolie A, Tabuanu N, Usang U, Lawal O, Sayomi O, Ntirenganya F, Nxumalo HS, Kroese K, Houtoukpe S, Manu MA, Yeboah G, Ayodeji EK, Agboadoh N, Owusu EA, Haque P, Galaviz RM, Oludara M, Ekwesianya A, Alatise O, Uanikhoba M, Olagunju S, Shittu A, Nyirahabimana J, Pattinson P, Lapitan C, Kamga F, Manu MPO, Yeboah C, Boakye-Yiadom J, Saba AH, Konda S, Flores OO, Omisanjo O, Elebute O, Allen O, Osuala P, Urimubabo C, Sentholang N, Kiki-Migan E, Mensah S, Boateng EA, Seidu AS, Luther A, Navarro JP, Oshodi O, Ezenwankwo F, Amosu L, Suleman B, Sethoana ME, Lissauer D, Lawani S, Morna MT, Dally C, Tabiri S, Mahajan A, Belmontes KP, Oshodi Y, Fatuga A, Archibong M, Takure A, Stassen ME, Lawani I, Nkrumah J, Davor A, Yakubu M, Makkar S, Marbello FR, Oyewole Y, Ihediwa G, Arowolo O, Thornley L, Loko R, Nortey M, Gyasi-Sarpong CK, Yenli EMTA, Mandrelle K, Ramírez-González L, Salami O, Jimoh A, Ayantona D, Wondoh P, Mistry P, Moutaïrou A, Ofori EO, Hamidu NNN, Michael V, Aguirre LR, Williams O, Kuku J, Ayinde A, Monahan M, Ogouyemi P, Quartson EMQ, Haruna I, Mukherjee P, García RR, Ladipo-Ajayi O, Badejoko O, Soumanou F, Kwarley N, Rajappa R, Robles EV, Makanjuola A, Badmus T, Tamadaho P, Lovi AK, Singh P, Mokwenyei O, Etonyeaku A, Zounon MA, Nimako B, Suroy A, Nwokocha S, Igbodike E, Nyadu BB, Thind R, Ogein O, Ijarotimi O, Opoku D, Thomas A, Ojewola R, Lawal A, Osabutey A, Tuli A, Oladimeji A, Nana F, Roberts T, Sagoe R, Veetil S, Olajide T, Oduanafolabi T, Tuffour S, Oluseye O, Olasehinde O, Tufour Y, Seyi-Olajide J, Olayemi O, Winkles N, Yamoah FA, Soibi-Harry A, Omitinde S, Yefieye AC, Ugwu A, Oni O, Yorke J, Williams E, Onyeze C, Orji E, Rotimi A, Salako A, Solaja O, Sowemimo O, Talabi A, Tajudeen M, Wuraola F. The importance of post-discharge surgical site infection surveillance: an exploration of surrogate outcome validity in a global randomised controlled trial (FALCON). Lancet Glob Health 2023; 11:e1178-e1179. [PMID: 37474222 DOI: 10.1016/s2214-109x(23)00256-5] [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: 08/15/2022] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/22/2023]
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [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: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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Younce JR, Cascella RH, Berman BD, Jinnah HA, Bellows S, Feuerstein J, Wagle Shukla A, Mahajan A, Chang FCF, Duque KR, Reich S, Richardson SP, Deik A, Stover N, Luna JM, Norris SA. Anatomical categorization of isolated non-focal dystonia: novel and existing patterns using a data-driven approach. Dystonia 2023; 2:11305. [PMID: 37920445 PMCID: PMC10621194 DOI: 10.3389/dyst.2023.11305] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
According to expert consensus, dystonia can be classified as focal, segmental, multifocal, and generalized, based on the affected body distribution. To provide an empirical and data-driven approach to categorizing these distributions, we used a data-driven clustering approach to compare frequency and co-occurrence rates of non-focal dystonia in pre-defined body regions using the Dystonia Coalition (DC) dataset. We analyzed 1,618 participants with isolated non-focal dystonia from the DC database. The analytic approach included construction of frequency tables, variable-wise analysis using hierarchical clustering and independent component analysis (ICA), and case-wise consensus hierarchical clustering to describe associations and clusters for dystonia affecting any combination of eighteen pre-defined body regions. Variable-wise hierarchical clustering demonstrated closest relationships between bilateral upper legs (distance = 0.40), upper and lower face (distance = 0.45), bilateral hands (distance = 0.53), and bilateral feet (distance = 0.53). ICA demonstrated clear grouping for the a) bilateral hands, b) neck, and c) upper and lower face. Case-wise consensus hierarchical clustering at k = 9 identified 3 major clusters. Major clusters consisted primarily of a) cervical dystonia with nearby regions, b) bilateral hand dystonia, and c) cranial dystonia. Our data-driven approach in a large dataset of isolated non-focal dystonia reinforces common segmental patterns in cranial and cervical regions. We observed unexpectedly strong associations between bilateral upper or lower limbs, which suggests that symmetric multifocal patterns may represent a previously underrecognized dystonia subtype.
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Affiliation(s)
- J. R. Younce
- Department of Neurology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - R. H. Cascella
- School of Medicine, Washington University, St. Louis, MO, United States
| | - B. D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - H. A. Jinnah
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - S Bellows
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - J. Feuerstein
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A. Wagle Shukla
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - A. Mahajan
- Rush Parkinson’s Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, United States
| | - F. C. F. Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - K. R. Duque
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - S. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, United States
| | - S. Pirio Richardson
- Department of Neurology, University of New Mexico and New Mexico VA Healthcare System, Albuquerque, NM, United States
| | - A. Deik
- Parkinson Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - N. Stover
- Department of Neurology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. M. Luna
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
| | - S. A. Norris
- Department of Radiology, School of Medicine, Washington University, St. Louis, MO, United States
- Department of Neurology, School of Medicine, Washington University, St. Louis, MO, United States
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Mulay M, Mahajan A, Shah N, Shah R, Chandalia S, Soni D. Comparative Evaluation of Intranasal Dexmedetomidine Spray Versus Intranasal Normal Saline Spray in Patients Undergoing Transalveolar Extractions for Anxiety Reduction: A Randomized Control Study. J Maxillofac Oral Surg 2023:1-7. [PMID: 37362875 PMCID: PMC10239611 DOI: 10.1007/s12663-023-01933-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/29/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dexmedetomidine has dose-dependent selectivity for alpha 2 adrenoceptors. It is a good sedative with analgesic characteristics and good haemodynamic stability. Intranasal sedation is a non-invasive medication delivery method that is both safe and well accepted by both children and adults. One of the most common procedures in maxillofacial surgery is transalveolar extraction. In minor oral surgery, a painless transalveolar extraction with little post-operative pain would be ideal. Aim To examine the effectiveness of intranasal dexmedetomidine spray against intranasal normal saline spray in patients undergoing transalveolar extractions for anxiety relief. Method We compared sedation effect by Ramsay sedation scale, analgesia by visual analogue scale, monitored BP and pulse rate for anxiety, and spo2 levels for any complication in this prospective double-blinded randomized control study for two groups, A group with intranasal dexmedetomidine spray and the B group of intranasal NS spray for placebo effect at 0 min, 15 min, 30 min, and 45 min until transalveolar extraction. Result As a result of the intranasal spray of dexmedetomidine, there were no related problems such as respiratory depression. There was a substantial difference in sedation and analgesia between group A and the placebo group, as well as a significant decrease in pulse rate and hypotension in the dexmedetomidine group to reduce anxiety. Conclusion Intranasal injection of atomized dexmedetomidine (1.5 mcg/kg) for patient sedation having transalveolar extractions or other minor surgical operations in oral and maxillofacial surgery is clinically effective, convenient, lowers anxiety, and safe.Clinical Trial Registration: No. CTRI/2021/07/035181.
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Affiliation(s)
- Mrudula Mulay
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
| | - Amit Mahajan
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
| | - Navin Shah
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
| | - Rakesh Shah
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
| | - Saurabh Chandalia
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
| | - Dharang Soni
- Oral and Maxillofacial Surgery, K.M Shah Dental College and Hospital, Vadodara, Gujarat 391760 India
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Avery EW, Joshi K, Mehra S, Mahajan A. Role of PET/CT in Oropharyngeal Cancers. Cancers (Basel) 2023; 15:2651. [PMID: 37174116 PMCID: PMC10177278 DOI: 10.3390/cancers15092651] [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: 01/24/2023] [Revised: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) comprises cancers of the tonsils, tongue base, soft palate, and uvula. The staging of oropharyngeal cancers varies depending upon the presence or absence of human papillomavirus (HPV)-directed pathogenesis. The incidence of HPV-associated oropharyngeal cancer (HPV + OPSCC) is expected to continue to rise over the coming decades. PET/CT is a useful modality for the diagnosis, staging, and follow up of patients with oropharyngeal cancers undergoing treatment and surveillance.
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Affiliation(s)
- Emily W. Avery
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kavita Joshi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Saral Mehra
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
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Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MJB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Kandokponou CMB, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Kpangon C, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Akpo I, Dewamon H, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BTBD, Guinnou R, Hamadou S, Kola HP, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou YE, Agbanda L, Attinon J, Gbassi M, Hounsou NR, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah S, Mensah P, Morkor Opandoh IN, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, Akoto-Ampaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Acheampong DO, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Agbeko AE, Gyamfi FE, Nyadu BB, Abdulai S, Adu-Aryee NA, Agboadoh N, Akoto E, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Boakye-Yiadom K, Brown GD, Dedey F, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Nsaful J, Olatola DO, Tsatsu SE, Wordui T, Abdul-Aziz IIA, Abubakari F, Akunyam J, Anasara GAG, Ballu C, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Ngaaso K, Ogudi DKD, Adobea V, Bennin A, Doe S, Kantanka RS, Kobby E, Kyeremeh C, Osei E, Owusu PY, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Acquah DK, Adams SM, Alhassan MS, Amadu M, Asirifi SA, Awe M, Azanlerigu M, Dery MK, Edwin Y, Francis AA, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Ofori BA, Quansah JIK, Seidu AS, Tabiri S, Yahaya S, Acquah EK, Alhassan J, Boakye P, Coompson CL, Gyambibi AK, Jeffery-Felix A, Kontor BE, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Poonia DR, Rathod KK, Rodha MS, Sharma N, Sharma N, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Huda F, Lokavarapu MJ, Mishra N, Ranjan R, Seenivasagam RK, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kalyanapu JA, Kutma A, Philips S, Gautham AK, Hepzibah A, Mary G, Singh DS, Abraham ES, Chetana C, Dasari A, Dummala P, Gold CS, Jacob J, Joseph JN, Kurien EN, Mary P, Mathew AJ, Mathew AE, Prakash DD, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Ghosh DN, Goyal A, Goyal S, Hans MA, Haque PD, Jain D, Jain R, Jyoti J, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Sam VD, Singh P, Suroy A, Thind RS, Veetil SK, Williams R, Sreekar D, Daniel ER, Jacob SE, Jesudason MR, Kumari P, Mittal R, Prasad S, Samuel VM, Shankar B, Sharma S, Sivakumar MV, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Saluja SS, Attri AK, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Agrawal N, Kumar U, Kumar P, Abhishek S, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Pai MV, Prabhu PS, Sundeep PT, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Alexander PV, Thomas J, Zechariah P, Ismavel VA, Kichu M, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Joseph S, Malik MA, Peters NJ, Pundir N, Samujh R, Ahmed HI, Aziz G, Chowdri NA, Dar RA, Kour R, Mantoo I, Mehraj A, Parray FQ, Saqib N, Shah ZA, Wani RA, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Mathai S, Nayak P, Roy B, Alvarez Villaseñor AS, Ascencio Díaz KV, Avalos Herrera VJ, Barbosa Camacho FJ, Hernández AB, Ahumada EB, Brancaccio Pérez IV, Calderón Llamas MA, Cardiel GC, Cervantes Cardona GA, Guevara GC, Perez EC, Chávez M, Chejfec Ciociano JM, Cifuentes Andrade LR, Cortés Flores AO, Cortes Torres EJ, Cueto Valadez TA, Cueto Valadez AE, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Flores Cardoza JA, Orozco CF, García González LA, Reyna BG, Sánchez EG, González Bojorquez JL, Espinoza EG, Ojeda AG, González Ponce FY, Guerrero Ramírez CS, Guzmán Barba JA, Guzmán Ramírez BG, Guzmán Ruvalcaba MJ, Hérnandez Alva DA, Ibarra Camargo SA, Ibarrola Peña JC, Torres MI, Tornero JJ, Lara Pérez ZM, País RM, Mellado Tellez MP, Miranda Ackerman RC, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Pacheco Vallejo LR, Pérez Bocanegra VH, Pérez Navarro JV, Plascencia Posada FJ, Quirarte Hernández MA, Ramirez Gonzalez LR, Reyes Elizalde EA, Romo Ascencio EV, Bravo CR, Ruiz Velasco CB, Sánchez Martínez JA, Villaseñor GS, Sandoval Pulido JI, Serrano García AG, Suárez Carreón LO, Tijerina Ávila JJ, Vega Gastelum JO, Vicencio Ramirez ML, Zarate Casas MF, Zuloaga Fernández del Valle CJ, Mata JAA, Vanegas MAC, Arias RGC, Tinajero CC, Samano FD, Zepeda FD, Barajas BVE, Banuelos GG, Calvillo MDCG, Ortiz FI, Ramirez ML, Arroyo GL, Angeles LOM, Morales Iriarte DGI, Lomeli AFM, Navarro JEO, Perez JO, Ramirez DO, Baolboa LGP, Lozano JP, Reyes GY, Castillo MN, Dominguez ACG, Mellado DH, Morales JFM, del Carmen H Namur L, Pesquera JAA, Maldonado LMP, De la Medina AR, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Fonseca RKC, Hernandez EEL, Quiros BC, Ramirez JAR, Ambriz-González G, Becerra Moscoso MR, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Abdullahi A, Abubakar M, Aliyu MS, Awaisu M, Bakari F, Balogun AO, Bashir M, Bello A, Daniyan M, Duromola KM, Gana SG, George MD, Gimba J, Gundu I, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Lawal BK, Mustapha A, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Oyelowo N, Saidu IA, Sholadoye TT, Sufyan I, Tolani MA, Tukur AM, Umar AS, Umar AM, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Yusuf SA, Abdulkarim AA, Abdullahi LB, Abdullahi M, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Soladoye A, Takai IU, Umar GI, Yahaya A, Abdulrasheed L, Adze JA, Airede LR, Aminu B, Bature SB, Bello-Tukur F, Chinyio D, Duniya SAN, Galadima MC, Hamza BK, Joshua S, Kache SA, Kagomi WY, Kene IA, Lawal J, Makama JG, Mohammed C, Mohammed-Durosinlorun AA, Nuwam D, Sale D, Sani A, Tabara S, Taingson MC, Usam E, Yakubu J, Adegoke F, Ige O, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeleye GTC, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Bakare A, Bakare TIB, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Akande O, Anyanwu N, Atobatele KM, Bakare OO, Eke G, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Oyewole Y, Salami OS, Williams OM, Abunimye E, Ademuyiwa AO, Adeoluwa A, Adesiyakan A, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Amao M, Ashley-Osuzoka C, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Gbenga-Oke C, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makanjuola A, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Olanrewaju O, Olayioye O, Oluseye OO, Olutola S, Onyekachi K, Orowale AA, Osariemen E, Osinowo AO, Osunwusi B, Owie E, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Ekwunife OH, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoro C, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Ugwuanyi K, Ugwunne C, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Olasehinde O, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Akinloye A, Akinniyi A, Ejimogu J, Eseile IS, Ogundoyin OO, Okedare A, Olulana DI, Omotola O, Sanwo F, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Awodele K, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Aisuodionoe-Shadrach O, Akaba GO, Alfred J, Atim T, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mbajiekwe N, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Ohemu AA, Olori S, Osagie OO, Sani SA, Suleiman S, Sunday H, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ida G, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Oruade D, Osagie OT, Osemwegie O, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ajibola G, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Elemile P, Fakoya A, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Ojediran O, Olagunju N, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Bello R, Lawal A, Lawal SA, Ojajuni A, Oyewale S, Raji HO, Sayomi O, Shittu A, Abhulimen V, Igwe PO, Iweha IE, John RE, Okoi N, Okoro PE, Oriji VK, Oweredaba IT, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Majyabere JP, Byaruhanga A, Dukuzimana R, Habiyakare JA, Nabada MG, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Masengesho JP, Mpirimbanyi C, Mukamazera L, Mukangabo C, Niyomuremyi JP, Ntwari G, Seneza C, Umuhoza D, Habumuremyi S, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Uwimana JC, Dusabe M, Izabiriza E, Maniraguha HL, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Hirwa AD, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Mukasine A, Utumatwishima JN, Batangana M, Bucyibaruta G, Habumuremyi S, de Dieu Haragirimana J, Imanishimwe A, Ingabire AJC, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Urimubabo CJ, Dusabimana A, Kanyesigye S, Munyaneza R, Shyirakera JY, Fourtounas M, Adams MA, Ede CJ, Hyman G, Mathe MN, Moore R, Nhlabathi NA, Nxumalo HS, Sentholang N, Sethoana ME, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R. Strategies to minimise and monitor biases and imbalances by arm in surgical cluster randomised trials: evidence from ChEETAh, a trial in seven low- and middle-income countries. Trials 2023; 24:259. [PMID: 37020311 PMCID: PMC10077601 DOI: 10.1186/s13063-022-06852-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/19/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cluster randomised controlled trials (cRCT) present challenges regarding risks of bias and chance imbalances by arm. This paper reports strategies to minimise and monitor biases and imbalances in the ChEETAh cRCT. METHODS ChEETAh was an international cRCT (hospitals as clusters) evaluating whether changing sterile gloves and instruments prior to abdominal wound closure reduces surgical site infection at 30 days postoperative. ChEETAh planned to recruit 12,800 consecutive patients from 64 hospitals in seven low-middle income countries. Eight strategies to minimise and monitor bias were pre-specified: (1) minimum of 4 hospitals per country; (2) pre-randomisation identification of units of exposure (operating theatres, lists, teams or sessions) within clusters; (3) minimisation of randomisation by country and hospital type; (4) site training delivered after randomisation; (5) dedicated 'warm-up week' to train teams; (6) trial specific sticker and patient register to monitor consecutive patient identification; (7) monitoring characteristics of patients and units of exposure; and (8) low-burden outcome-assessment. RESULTS This analysis includes 10,686 patients from 70 clusters. The results aligned to the eight strategies were (1) 6 out of 7 countries included ≥ 4 hospitals; (2) 87.1% (61/70) of hospitals maintained their planned operating theatres (82% [27/33] and 92% [34/37] in the intervention and control arms); (3) minimisation maintained balance of key factors in both arms; (4) post-randomisation training was conducted for all hospitals; (5) the 'warm-up week' was conducted at all sites, and feedback used to refine processes; (6) the sticker and trial register were maintained, with an overall inclusion of 98.1% (10,686/10,894) of eligible patients; (7) monitoring allowed swift identification of problems in patient inclusion and key patient characteristics were reported: malignancy (20.3% intervention vs 12.6% control), midline incisions (68.4% vs 58.9%) and elective surgery (52.4% vs 42.6%); and (8) 0.4% (41/9187) of patients refused consent for outcome assessment. CONCLUSION cRCTs in surgery have several potential sources of bias that include varying units of exposure and the need for consecutive inclusion of all eligible patients across complex settings. We report a system that monitored and minimised the risks of bias and imbalances by arm, with important lessons for future cRCTs within hospitals.
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Djureinovic D, Weiss SA, Krykbaeva I, Qu R, Vathiotis I, Moutafi M, Zhang L, Perdigoto AL, Wei W, Anderson G, Damsky W, Hurwitz M, Johnson B, Mahajan A, Hsu F, Miller-Jensen K, Kluger Y, Sznol M, Kaech SM, Bosenberg M, Jilaveanu L, Kluger HM. Abstract 3287: A bedside to bench study of anti-PD-1, anti-CD40, and anti-CSF1R indicates that more is not necessarily better. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-3287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Stimulating innate immunity can potentially enable us to overcome resistance to PD-(L)1 blockade. We previously conducted a phase 1 trial of cabiralizumab (anti-CSF1R) with sotigalimab (CD40 agonistic antibody) and nivolumab. Our purpose was to determine safety and the effects of this regimen on circulating and tumor-infiltrating immune cells and to determine the activity of this regimen in a phase 1b trial for melanoma patients whose disease had progressed on anti-PD-(L)1. CyTOF analysis on circulating immune cells taken before and during treatment revealed a reduction in non-classical monocytes and an increase in dendritic cells. Patients with prolonged stable disease had less T-regulatory cells and more circulating antigen presenting cells after treatment compared to patients that were treated for a shorter time. In the phase 1b component of the trial in 13 melanoma patients, objective response rates were: 1 confirmed partial response (7.7%), 1 unconfirmed partial response (7.7%), 5 stable disease (38.5%) and 6 disease progression (42.6%). Despite therapy-induced changes in circulating immune cells and previous preclinical studies supporting rationale for this combination, responses in humans were insufficient to proceed to the second stage of the phase 1b trial. Given the challenges with translating doses from mice to humans, we proceeded to study various doses of anti-CSF1R in combination with CD40 agonist and anti-PD-1 in a murine model. Higher dose anti-CSF1R in mice was associated with increased tumor growth, worse survival and by single-cell RNA-sequencing analyses, we identified a more suppressive monocyte/macrophage profile in murine tumors. Our study suggests that more anti-CSF1R might not be better. Further optimization of cabiralizumab dosing is necessary to evaluate the clinical potential in combination with anti-PD-1 and anti-CD40 in a difficult-to treat patient population whose therapeutic options are limited.
Citation Format: Dijana Djureinovic, Sarah A. Weiss, Irina Krykbaeva, Rihao Qu, Ioannis Vathiotis, Myrto Moutafi, Lin Zhang, Ana L. Perdigoto, Wei Wei, Gail Anderson, William Damsky, Michael Hurwitz, Barbara Johnson, Amit Mahajan, Frank Hsu, Kathryn Miller-Jensen, Yuval Kluger, Mario Sznol, Susan M. Kaech, Marcus Bosenberg, Lucia Jilaveanu, Harriet M. Kluger. A bedside to bench study of anti-PD-1, anti-CD40, and anti-CSF1R indicates that more is not necessarily better [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3287.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Wei
- 1Yale University, New Haven, CT
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Chakrabarty N, Mahajan A, Patil V, Noronha V, Prabhash K. Imaging of brain metastasis in non-small-cell lung cancer: indications, protocols, diagnosis, post-therapy imaging, and implications regarding management. Clin Radiol 2023; 78:175-186. [PMID: 36503631 DOI: 10.1016/j.crad.2022.09.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
Increased survival (due to the use of targeted therapies based on genomic profiling) has resulted in the increased incidence of brain metastasis during the course of disease, and thus, made it essential to have proper imaging guidelines in place for brain metastasis from non-small-cell lung cancer (NSCLC). Brain parenchymal metastases can have varied imaging appearances, and it is pertinent to be aware of the various molecular risk factors for brain metastasis from NSCLC along with their suggestive imaging appearances, so as to identify them early. Leptomeningeal metastasis requires additional imaging of the spine and an early cerebrospinal fluid (CSF) analysis. Differentiation of post-therapy change from recurrence on imaging has a bearing on the management, hence the need for its awareness. This article will provide in-depth literature review of the epidemiology, aetiopathogenesis, screening, detection, diagnosis, post-therapy imaging, and implications regarding the management of brain metastasis from NSCLC. In addition, we will also briefly highlight the role of artificial intelligence (AI) in brain metastasis screening.
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Affiliation(s)
- N Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India.
| | - V Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 400 012, Maharashtra, India
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Lim E, Castellani D, Somani B, Fong K, Ragoori D, Mriganka Mani S, Soebhali B, Mahajan A, Maheshwari P, Gadzhiev N, Tanidir Y, Ilker Gokce M, Aydin C, Bostanci Y, Bin Hamri S, De La Rosette J, Innoue T, Traxer O, Gauhar V. A multicenter propensity score matched pair study in 313 patients comparing percutaneous nephrolithotomy versus retrograde intra renal surgery for management of urolithiasis in calyceal diverticulum. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00980-6] [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: 02/12/2023]
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Bronk J, Zhang M, Mcaleer M, Mcgovern S, Lassen-Ramshad Y, Safwat A, Daw N, Rainusso N, Mahajan A, Grosshans D, Paulino A. Comprehensive Radiotherapy For Pediatric Ewing Sarcoma: Outcomes of a Prospective Proton Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Andoh AB, Atindaana Francis A, Abdulkarim AA, Adesunkanmi AO, Salako AA, Soladoye A, Sheshe AA, Sani A, Lawal AO, Lawal A, Tripathi A, S A, Akinloye A, Olajumoke Balogun A, Ariyibi AL, Okunlola AI, Ojewuyi AR, Oyedele AE, Sakyi A, Oladimeji AT, Bala Muhammad A, Yahaya A, Soibi-Harry AP, Gyambibi AK, Adeniyi AA, Adeoluwa A, Olumide Osinowo A, Salawu AI, Fatuga AL, Adesiyakan A, Fakoya A, Naah A, Adeyeye AA, Talabi AO, Fasanu AO, Ayoola Orowale A, Ojajuni A, Adelaja AT, Ademuyiwa AO, Jimoh AI, Aderounmu AA, Adisa AO, Ajagbe AO, Olajide AT, Bakare A, Okunowo AA, Tchogo A, Koledade AK, Barthelemy Yevide A, Bello A, Shehu Umar A, Lawal AT, Obiesie AE, Dieudonne Hirwa A, Domingo A, Mustapha A, Abdullahi A, Hada A, Ijeoma A, Adeleke AA, Adepiti AC, Ajao AE, Sanusi AT, Houndji A, Bernal Hernández A, González Ojeda A, Serrano García AG, Ohemu AA, Arekhandia AI, Yakubu A, Hepzibah A, Bhatt A, Muhammad Tukur A, Ingabire AJC, Okechukwu Ugwu A, Karekezi A, Maalekuu A, Imanishimwe A, Bruce-Adjei A, Obbeng A, Akosua A, Jeffery-Felix A, Mohammed-Durosinlorun AA, Jimoh AO, Umar AM, Umar AM, Mahajan A, Eziyi AK, Bennin A, Dasari A, Okedare A, Mathew AE, Florencia Casado-Zarate A, Calderón-Alvarado AB, Dominguez ACG, Cortés Flores AO, Dusabimana A, Kutma A, Byaruhanga A, Houndote A, Cueto Valadez AE, Alvarez Villaseñor AS, Bhangu A, Ortega Barreiro A, Mortola Lomeli AF, Luther A, Yahya A, Eseenam Agbeko A, Thomas A, Goyal A, Mkoh Dikao AS, Appiah AB, Gaou A, Bediako-Bowan AA, Ramos De la Medina A, Seidu AS, Munyaneza A, Ahounou A, Akoto-Ampaw A, Hadonou A, Alitonou A, Sambo A, Mathew AJ, Chaturvedi A, Gautham AK, Choudhrie AV, Attri AK, Kumar A, Sukumar A, Mehraj A, Shittu A, Mukasine A, Oppon-Acquah A, Kusiwaa A, Suroy A, Ezenwa AO, Takure AO, Akinniyi A, Ogunyemi AA, Makanjuola A, Dossou Yovo BB, Alhassan BAB, Hamza BK, Awoyinka BS, Koomson B, Aminu B, Abodunde Muideen B, Osunwusi B, García Reyna B, Oppong BA, Brimpong BB, Fenu BS, Ofori BA, Guzmán Ramírez BG, Nyadu BB, Shankar B, Lawal BK, Armstrong Alia B, Roy B, Kontor BE, Kovohouande B, Cakpo B, Enriquez Barajas BV, Crocco Quiros B, Kadir B, Mohammed C, Nwachukwu CU, Colunga Tinajero C, Ruiz Velasco CB, Zuloaga Fernández del Valle CJ, Noufuentes C, Solomi CV, Okunlola CK, Seneza C, Okafor CI, Nuño Escobar C, Banka C, Barimah CG, Chetana C, Nyatsambo C, Okeke CJ, Jeffrey Ede C, Nwosu CD, Victoria Mgbemena C, Onyeka CU, Gold CS, Faith Uche C, Chigoze Makwe C, Urimubabo CJ, Coompson CL, Ashley-Osuzoka C, Gbenga-Oke C, Bidemi Oyegbola C, Mukakomite C, Mpirimbanyi C, Asare C, Bode CO, Ugwunne C, Onyejiaka CC, Okoro C, Okereke CE, Mukangabo C, Sie-Broni C, Ballu C, Fuentes Orozco C, Kyeremeh C, Adumah CC, Ruelas Bravo C, Bokossa Kandokponou CM, Guerrero Ramírez CS, Teye-Topey C, Kpangon C, Chinyio D, Orozco Ramirez D, Mora Santana D, Nyirasebura D, Hérnandez Alva DA, Acquah DK, Prakash DD, Sale D, Olulana DI, Oruade D, Jayne D, Morales Iriarte DGI, Ogudi DKD, Olatola DO, Akinboyewa DO, Irabor DO, Nuwam D, Mukantibaziyaremye D, Jain D, Singla D, Garnaik DK, Singh DS, Gakpetor DA, Esssien D, Rubanguka D, Poonia DR, Ghosh D, Ahogni D, Morton D, Umuhoza D, Morel Seto D, Nepogodiev D, Enti D, Smith D, Osei-Poku D, Acheampong DO, Mellado DH, Ofosuhene D, Cortes Torres EJ, Efren Lozada E, Gómez Sánchez E, González Espinoza E, Osei E, Mensah E, Rwagahirima E, Quartson EM, Li E, Kurien EN, Bonilla Ahumada E, Kabanda E, Odame E, Izabiriza E, Hatangimana E, Osariemen E, Reyes Elizalde EA, Agbowada EA, Usam E, Sylvester Inyang E, Owie E, Ojo Williams E, Munyaneza E, Mutabazi E, Kojo Acquah E, Obiri EL, Ofori EO, Runigamugabo E, Yhoshu E, Malade E, Cervantes Perez E, Kobby E, Okwudiri Ohazurike E, Jerry Bara E, Agyemang E, Akoto E, Villanueva-Martínez EE, Mwungura E, Cueva Martinez E, Asabre E, Adjei-Acquah E, Abunimye E, Daluk EB, Daniel ER, Ike Okorie E, Ailunia EE, Abraham ES, Romo Ascencio EV, Harrison E, Kpatchassou E, Bakari F, González Ponce FY, Huda F, Abubakari F, Ntirenganya F, Ingabire F, Parray FQ, Brant F, Alakaloko FM, Diaz Samano F, Duque Zepeda F, Bello-Tukur F, Basirwa Musengo F, Dedey F, Adegoke F, Amponsah-Manu F, Mukaneza F, Chinonso Ezenwankwo F, Sanwo F, Dossou FM, Nwaenyi FC, Ibanez Ortiz F, Barbosa Camacho FJ, León-Frutos FJ, Plascencia Posada FJ, Nirere F, Owusu F, Gyamfi FE, Wuraola FO, Cervantes Guevara G, Ntwari G, Ambriz-González G, Hyman G, Umar GI, Thami G, Adeleye GTC, Limann G, Ajibola G, Ida G, Ihediwa GC, Brown GD, Bucyibaruta G, Gallardo Banuelos G, Lopez Arroyo G, Ndegamiye G, Naah G, Morgan Villela G, Edet G, Attepor GS, Akaba GO, Aziz G, Yeboah G, Mary G, Eke G, Castillo Cardiel G, Yanowsky Reyes G, Sanchez Villaseñor G, Cervantes Cardona GA, Singh G, Boateng GC, Kola H, Abdullahi HI, Olaide Raji H, Ahmed HI, Umaru-Sule H, Kaur H, Malechi H, Sunday H, Abiyere HO, Butana H, Agossou H, Samkelisiwe Nxumalo H, Maniraguha HL, Dewamon H, Yome H, Behanzin H, Ekwuazi HO, Oweredaba IT, Mohammed I, Sufyan I, Saidu IA, Abdul-Aziz IIA, Eseile IS, Ogolekwu IP, Adebara IO, Usman Takai I, Fidelis Okafor I, Kene IA, Enyinnaya Iweha I, Mutimamwiza I, Mantoo I, Duruewuru IO, Akpo I, Niyongombwa I, Brancaccio Pérez IV, Esparza Estrada I, Gundu I, Morkor Opandoh IN, Ncogoza I, Sibomana I, Bansal I, Cabrera-Lozano I, Ishola Aremu I, Gandaho I, Lawani I, Ochoa Rodríguez I, Alasi IO, Alhassan J, Mends-Odro J, Osuna Rubio J, Orozco Perez J, González Bojorquez JL, Rodriguez Ramirez JA, Glasbey J, Emeka JJ, Lawal J, Acquaye J, Alfred J, Rugendabanga J, Mizero J, Ingabire JCA, Aimable Habiyakare J, Claude Uwimana J, de Dieu Haragirimana J, Yves Shyirakera J, Utumatwishima JN, Niyomuremyi JP, Majyabere JP, Masengesho JP, Nyirahabimana J, Vishnoi JR, Kalyanapu JA, Joseph JN, Makama JG, Pizarro Lozano J, Aguilar Mata JA, Morales JFM, Vega Gastelum JO, Oyekunle Bello J, Okechukwu Ugwu J, Amoako JK, Simoes J, Zirikana J, Nzuwa Nsilu J, Adze JA, Enaholo JE, Obateru JA, Chinda JY, Akunyam J, Boakye-Yiadom J, Cook J, Quansah JIK, Chejfec Ciociano JM, Jiménez Tornero J, Herrera-Esquivel J, Flores Cardoza JA, Sánchez Martínez JA, Guzmán Barba JA, Pesquera JAA, Orozco Navarro JE, Sandoval Pulido JI, Pérez Navarro JV, Igiraneza J, Ejimogu J, Awindaogo JK, Ugboajah JO, Ashong J, Nsaful J, Arthur J, Yakubu J, Mutuyimana J, Umuhoza J, Thomas J, Ibarrola Peña JC, Tijerina Ávila JJ, Oladayo Kuku J, Gyamfi JE, Brown J, Appiah J, Attinon J, Jacob J, Gimba J, Seyi-Olajide JO, Ngaguene J, Jyoti J, Leshiini K, Boukari KA, Kumar K, Mumuni K, Quarchey KND, Sanni K, Bozada-Gutierrez K, Mandrelle K, Atobatele KM, Awodele K, Bawa KG, Duromola KM, Egbuchulem KI, Ngaaso K, Onyekachi K, Ugwuanyi K, Okoduwa KO, Ado KA, Rathod KK, Nunoo-Ghartey K, Rautela K, Kennedy KK, Ascencio Díaz KV, Boakye-Yiadom K, Onahi Iji L, Magill L, Martinez Perez Maldonado L, Pena Baolboa LG, Montano Angeles LO, Barau Abdullahi L, Ismail L, Awere-Kyere LKB, Uzikwambara L, Adam-Zakariah L, Larbi-Siaw LA, Chukwuemeka Anyanwu LJ, Etchisse L, Abdulrasheed L, Agbanda L, García González LA, Suárez Carreón LO, Cifuentes Andrade LR, Pacheco Vallejo LR, Ramirez Gonzalez LR, Aniakwo LA, Olajide Abdur-Rahman L, Abdur-Rahman LO, Namur LDCM, Mukamazera L, Airede LR, Nontonwanou MB, Amoako-Boateng MP, Rodha MS, Kawu Magashi M, Abubakar M, Yigah M, Dayie MSCJK, Victorin Agbangla M, Pathak M, Aggarwal M, Lokavarapu MJ, Talla Timo M, Isikhuemen ME, Gbassi M, Uwizeye M, Akpla M, Adjei MNM, Picciochi M, Chávez M, Fourtounas M, Quirarte Hernández MA, Zarate Casas MF, Gloriose Nabada M, Kouroumta MC, De Cristo Gonzalez Calvillo M, Trejo-Avila M, Guzmán Ruvalcaba MJ, Monahan M, Jesudason MR, Zume M, Totin M, Djeto M, Awe M, Islas Torres M, Morna MT, Oluwadamilola Adebisi M, Adams MA, Oluwatobi Busari M, Lazo Ramirez M, Taingson MC, Ruhosha M, Dery MK, Batangana M, Mellado Tellez MP, Vicencio Ramirez ML, Agyapong MM, Nortey M, Amao M, Bahrami-Hessari M, Calderón Llamas MA, Calderon Vanegas MA, Azanlerigu M, Becerra Moscoso MR, Sethoana ME, Oludara MA, Moussa Alidou M, Mohammad MA, Bashir M, Usman M, Adnan M, Alhassan MS, Aliyu MS, Singh M, Muhindo M, Dusabeyezu M, Kichu M, Castillo MN, Gureh M, Hans MA, Hollo M, Hodonou MA, Sivakumar MV, Edena ME, Abdulsalam MA, Adebisi Ogunjimi M, Dusabe M, Dokurugu MA, Galadima MC, Agbulu MV, Agbadebo M, Eunice ME, Nosipho Mathe M, Moreno-Portillo M, Awaisu M, Daniyan M, Duke George M, Malik MA, Amadu M, Pai MV, Adetola Tolani M, Abdullahi M, Moussa N, Guessou NO, Saqib N, Christian NA, Essel N, Tabuanu NO, Olagunju N, Sam NB, Akhtar N, Oyelowo N, Bisimwa Mitima N, Adewole ND, Sharma N, Anthea Nhlabathi N, Mbajiekwe N, Mishra N, Pundir N, Winkles N, Smart N, Agboadoh N, Ndukwe NO, Aperkor NT, Adu-Aryee NA, Chowdri NA, Singh N, Peters NJ, Sharma N, Agrawal N, Syam N, Duru NJ, Sentholang N, Okoi N, Anyanwu N, Rene Hounsou N, Aliyu NU, Abiola Adeleke N, Egwuonwu OA, Okoye OA, Hyginus Ekwunife O, Olanrewaju O, Osagie OO, Adeyemo OT, Oshodi OA, Olaolu Ogundoyin O, Ogundoyin OO, Babalola OF, Olasehinde O, Ajai OT, Balogun OS, Lawal OO, Olayioye O, Sayomi O, Samuel O, Mwenedata O, Oluwaseyi Bakare O, Sowande OA, Ojewuyi OO, Omisanjo OA, Akintunde OP, Abiola OP, Abiola OP, Akande O, Elebute OA, Adewara OE, Ayankunle OM, Odesanya OJ, Alatise OI, Ajenifuja OK, Ogunsua OO, Banjo OO, Ojediran O, Oladele OO, Fatudimu OS, Ajagbe OA, Idowu OC, Ladipo-Ajayi OA, Taiwo OA, Olaleye OH, Oluseye OO, Ige O, Odutola OR, Atoyebi OA, Omar O, Ayandipo OO, Omotola O, Faboya OM, Williams OM, Irowa OO, Salami OS, Onu OA, Asafa OQ, Akinajo OR, Osemwegie O, Osagie OT, Olvera Flores O, Iribhogbe OI, Aisuodionoe-Shadrach O, Gbehade O, Ojo OD, Olubayo OO, Prabhu PS, Flores Becerril P, Kumar P, Yanto P, Mukherjee P, Haque PD, Koggoh P, Igwe PO, Trinity P, Aderemi Adegoke P, Wondoh P, Domínguez Barradas P, Ogouyemi P, Boakye P, Brocklehurst P, Elemile P, Egharevba PA, Agbonrofo PI, Okoro PE, Kumassah PK, Mensah P, Munda P, Mshelbwala PM, Alexander PV, Nyirangeri P, Muroruhirwe P, Hardy P, Kwabena PW, Zechariah P, Nayak P, Dummala P, Singh P, Solanki P, Yeboah Owusu P, Mary P, Chowdhury P, Luri PT, Pareek P, Prakash P, Kumari P, Lillywhite R, Moore R, Tinuola Afolabi R, Williams R, Alpheus RA, Sharma R, Seenivasagam RK, Vakil R, Armah R, Samujh R, Chaudhary R, John RE, Gunny RJ, Wani RA, Verma R, Thind RS, Dar RA, Eghonghon RA, Acquah R, Rajappa R, Kpankpari R, Ofosu-Akromah R, Romaric Soton R, Jain R, Guinnou R, Munyaneza R, Mares País R, Delano-Alonso R, Miranda Ackerman RC, Bello R, Kour R, Guadalupe Cano Arias RG, Uwayezu R, Nájar Hinojosa R, Mittal R, Ranjan R, Goudou R, Cethorth Fonseca RK, Hussey R, Tubasiime R, Dukuzimana R, Varghese R, Boateng RA, Pswarayi R, Ojewola RW, Abdus-Salam RA, Abdus-Salam RA, Sarfo Kantanka R, Manu R, Abdul-Hafiz S, Oyewale S, Yussif S, Abolade Lawal S, Kanyarukiko S, Abeku Yusuf S, Suleiman S, Tabara S, Mbonimpaye S, Kanyesigye S, Joshua S, Tamou SB, Gupta S, Muhammad SS, Abdulai S, Olori S, Mensah S, Asirifi SA, Sani SA, Ajekwu SC, Nwokocha SU, Quaicoo S, Tsatsu SE, Philips S, Gupta S, Misra S, Kaur S, Omorogbe SO, Eniola SB, Kwarteng SM, Tobome SR, Emmanuel Hedefoun S, Adams SM, Singh S, Duniya SAN, Yahaya S, Mohammed S, Rajan S, Adekola Adebayo S, Ibarra Camargo SA, Cousens S, Hinvo S, Kapoor S, Singh S, Nindopa S, Jacob SE, Laurberg S, Chakrabortee S, Chowdhury S, Mathai S, Prasad S, Tchati SV, Habumuremyi S, Habumuremyi S, Hamadou S, Lawani S, Veetil SK, D S, D S, Sharma S, Doe S, Mathew S, Emeka Nwabuoku S, Ideh SN, Laurent Loupeda S, Tabiri S, Olutola S, Kache SA, Bature SB, Garba SE, Gana SG, Soni SC, Raul S, Kanchodu S, Daneji SM, Sallau SB, P T S, Saluja SS, Goyal S, Surendran S, Joseph S, John S, Obiechina SO, Hounsa S, Lawal TA, Badmus TA, Bakare TIB, Mohammed TO, Cueto Valadez TA, Dhar T, Agida TE, Arkorful TE, Atim T, Orewole TO, Wordui T, Okonoboh TO, Mavoha T, Hessou TK, Agyen T, Pinkney T, Olajide TO, Odunafolabi TA, Sholadoye TT, Kumar U, Kingsley Oriji V, Varsheney VK, Samuel VM, Agyekum-Gyimah VO, Ifeanyichukwu Modekwe V, Ojo V, Abhulimen V, Pérez Bocanegra VH, Avalos Herrera VJ, Etwire VK, Ibukunoluwa Adeyeye V, Kumar V, Ismavel VA, John V, Sehrawat V, Kudoh V, Kanna V, Mukanyange V, Michael V, Adobea V, Sam VD, Ghansah WW, Asman WK, Bhatti W, Kagomi WY, Mehounou Y, Mustapha Y, Oyewole Y, Edwin Y, Oshodi YA, Adofo-Asamoah Y, Ally Z, Imam ZO, Shah ZA, Lara Pérez ZM, Robertson Z. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400:1767-1776. [PMID: 36328045 DOI: 10.1016/s0140-6736(22)01884-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI. METHODS ChEETAh was a multicentre, cluster randomised trial in seven low-income and middle-income countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, South Africa). Any hospitals (clusters) doing abdominal surgery in participating countries were eligible. Clusters were randomly assigned to current practice (42) versus intervention (39; routine change of gloves and instruments before wound closure for the whole scrub team). Consecutive adults and children undergoing emergency or elective abdominal surgery (excluding caesarean section) for a clean-contaminated, contaminated, or dirty operation within each cluster were identified and included. It was not possible to mask the site investigators, nor the outcome assessors, but patients were masked to the treatment allocation. The primary outcome was SSI within 30 days after surgery (participant-level), assessed by US Centers for Disease Control and Prevention criteria and on the basis of the intention-to-treat principle. The trial has 90% power to detect a minimum reduction in the primary outcome from 16% to 12%, requiring 12 800 participants from at least 64 clusters. The trial was registered with ClinicalTrials.gov, NCT03700749. FINDINGS Between June 24, 2020 and March 31, 2022, 81 clusters were randomly assigned, which included a total of 13 301 consecutive patients (7157 to current practice and 6144 to intervention group). Overall, 11 825 (88·9%) of 13 301 patients were adults, 6125 (46·0%) of 13 301 underwent elective surgery, and 8086 (60·8%) of 13 301 underwent surgery that was clean-contaminated or 5215 (39·2%) of 13 301 underwent surgery that was contaminated-dirty. Glove and instrument change took place in 58 (0·8%) of 7157 patients in the current practice group and 6044 (98·3%) of 6144 patients in the intervention group. The SSI rate was 1280 (18·9%) of 6768 in the current practice group versus 931 (16·0%) of 5789 in the intervention group (adjusted risk ratio: 0·87, 95% CI 0·79-0·95; p=0·0032). There was no evidence to suggest heterogeneity of effect across any of the prespecified subgroup analyses. We did not anticipate or collect any specific data on serious adverse events. INTERPRETATION This trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world. FUNDING National Institute for Health Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, Mölnlycke Healthcare.
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Qualls K, Cunningham D, Brown S, Ahmed S, Laack N, Mahajan A. Modern Outcomes of Pediatric and Young Adult Patients with Parotid Gland Tumors Treated with Highly-Conformal Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1753] [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: 11/24/2022]
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Ajithkumar T, Avanzo M, Yorke E, Tsang D, Milano M, Olch A, Merchant T, Dieckmann K, Mahajan A, Fuji H, Paulino A, Timmermann B, Bentzen S, Jackson A, Constine L. Brain and Brainstem Necrosis after Re-Irradiation for Recurrent Childhood Central Nervous System (CNS) Tumors: A Report from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) Task Force. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cunningham D, Qualls K, Brown S, Ruff M, Kizilbash S, Uhm J, Laack N, Mahajan A. Descriptive Statistics for Patients with Glioblastoma Associated with Germline Mismatch Repair Gene Mutation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.826] [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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Aboian M, Bousabarah K, Kazarian E, Zeevi T, Holler W, Merkaj S, Cassinelli Petersen G, Bahar R, Subramanian H, Sunku P, Schrickel E, Bhawnani J, Zawalich M, Mahajan A, Malhotra A, Payabvash S, Tocino I, Lin M, Westerhoff M. Clinical implementation of artificial intelligence in neuroradiology with development of a novel workflow-efficient picture archiving and communication system-based automated brain tumor segmentation and radiomic feature extraction. Front Neurosci 2022; 16:860208. [PMID: 36312024 PMCID: PMC9606757 DOI: 10.3389/fnins.2022.860208] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/22/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Personalized interpretation of medical images is critical for optimum patient care, but current tools available to physicians to perform quantitative analysis of patient’s medical images in real time are significantly limited. In this work, we describe a novel platform within PACS for volumetric analysis of images and thus development of large expert annotated datasets in parallel with radiologist performing the reading that are critically needed for development of clinically meaningful AI algorithms. Specifically, we implemented a deep learning-based algorithm for automated brain tumor segmentation and radiomics extraction, and embedded it into PACS to accelerate a supervised, end-to- end workflow for image annotation and radiomic feature extraction. Materials and methods An algorithm was trained to segment whole primary brain tumors on FLAIR images from multi-institutional glioma BraTS 2021 dataset. Algorithm was validated using internal dataset from Yale New Haven Health (YHHH) and compared (by Dice similarity coefficient [DSC]) to radiologist manual segmentation. A UNETR deep-learning was embedded into Visage 7 (Visage Imaging, Inc., San Diego, CA, United States) diagnostic workstation. The automatically segmented brain tumor was pliable for manual modification. PyRadiomics (Harvard Medical School, Boston, MA) was natively embedded into Visage 7 for feature extraction from the brain tumor segmentations. Results UNETR brain tumor segmentation took on average 4 s and the median DSC was 86%, which is similar to published literature but lower than the RSNA ASNR MICCAI BRATS challenge 2021. Finally, extraction of 106 radiomic features within PACS took on average 5.8 ± 0.01 s. The extracted radiomic features did not vary over time of extraction or whether they were extracted within PACS or outside of PACS. The ability to perform segmentation and feature extraction before radiologist opens the study was made available in the workflow. Opening the study in PACS, allows the radiologists to verify the segmentation and thus annotate the study. Conclusion Integration of image processing algorithms for tumor auto-segmentation and feature extraction into PACS allows curation of large datasets of annotated medical images and can accelerate translation of research into development of personalized medicine applications in the clinic. The ability to use familiar clinical tools to revise the AI segmentations and natively embedding the segmentation and radiomic feature extraction tools on the diagnostic workstation accelerates the process to generate ground-truth data.
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Affiliation(s)
- Mariam Aboian
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
- *Correspondence: Mariam Aboian,
| | | | - Eve Kazarian
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Sara Merkaj
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Gabriel Cassinelli Petersen
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Ryan Bahar
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Harry Subramanian
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Pranay Sunku
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Elizabeth Schrickel
- Department of Radiology and Biomedical Imaging, Brain Tumor Research Group, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Jitendra Bhawnani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Mathew Zawalich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Sam Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Irena Tocino
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - MingDe Lin
- Department of Radiology, Yale University and Visage Imaging, New Haven, CT, United States
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Affiliation(s)
- Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Benchetrit L, Mehra S, Mahajan A, Rahmati RW, Judson BL, Edwards HA. Major Salivary Gland Cancer With Distant Metastasis Upon Presentation: Patterns, Outcomes, and Imaging Implications. Otolaryngol Head Neck Surg 2022; 167:305-315. [PMID: 34784258 DOI: 10.1177/01945998211058354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/30/2022]
Abstract
OBJECTIVES Given limited data availability on distant metastasis (DM) in major salivary gland (MSG) malignancy presentation, we aimed to evaluate the rate, histologic patterns, location, and predictors of DM at first MSG cancer presentation and suggest potential implications on diagnostic workup. STUDY DESIGN Retrospective cohort. SETTING Commission on Cancer-accredited hospitals. METHODS We included patients in the National Cancer Database (2010-2016) with MSG malignancy. Site and rate of DM were stratified by histologic subtype. Factors predictive of DM at presentation were determined by multivariate regression analysis. Survival analyses were conducted via the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS Of 5776 patients with MSG carcinoma, 333 (5.8%) presented with DM. The most common DM site was the lung (57.1%), followed by bone (46.8%) and liver (19.5%). DM was most common in adenocarcinoma-not otherwise specified (15.1%, 132/874) and salivary duct carcinoma (10.4%, 30/288). High-grade mucoepidermoid carcinoma had the highest rate of lung metastases (81.6%, 31/38). Conversely, myoepithelial carcinoma had the highest rate of bone metastases (85.7%, 6/7). DM at presentation was independently associated with an increased mortality risk (hazard ratio, 1.62; 95% CI, 1.40-1.90). CONCLUSION We identified a DM rate of 5.8% in MSG malignancy at presentation. Overall 43% of patients presented without DM to the lung but with DM to the bones, liver, and/or brain. The most common metastatic sites differed by tumor histology. Staging with computed tomography neck and chest alone may fail to detect sites of DM; this work can be used for patient counseling in the clinical setting.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Saral Mehra
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rahmatullah W Rahmati
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA.,School of Medicine, Boston University, Boston, Massachusetts, USA
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Lovegrove CE, Wiberg A, Allen N, Littlejohns T, Mahajan A, McCarthy M, Hannan F, Thakker R, Holmes M, Furniss D, Howles S. O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.
Methods
Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.
Results
Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P<0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P<0.001 and OR=1.41, 95%CI=1.17–1.69, P<0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.
Conclusion
Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.
Take-home message
Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.
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Affiliation(s)
- CE Lovegrove
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | - A Wiberg
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - D Furniss
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | - S Howles
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
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Jadhav KB, Shah V, Mahajan A, Malhotra P, Parmar G, Shah J. Salivary and tumour tissue miR-21 for prediction of cervical lymph node metastasis in patients with oral squamous cell carcinoma: an observational study. Lancet Oncol 2022. [DOI: 10.1016/s1470-2045(22)00425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bellinger C, Bernstein M, Lee H, Wahidi MM, Mahajan A, Chen A, Shu CA, Hao Y, Cao M, Griscom B, Huang J, Walsh PS, Lofaro L, Wilde J, Bulman W, Kennedy G. Molecular profiling of dedicated lung cancer biopsy tissue sample collected at time of diagnostic bronchoscopy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20587 Background: The combined use of molecular biomarker testing and targeted precision therapeutics has led to improved survival in lung cancer. Broadening access to national guideline recommended comprehensive molecular testing requires overcoming the challenges of inadequate tissue biopsies, which can lead to the need for additional procedures and ultimately, delays in initiation of care. We show Percepta Genomic Atlas identifies key molecular alterations in transbronchial needle aspirate (TBNA) and transbronchial biopsy (TBB) samples of lung or lymph node collected during the initial diagnostic bronchoscopy. Methods: Percepta Genomic Atlas combines the whole exome TruSeq RNA Exome and targeted AmpliSeq Focus DNA assays (Illumina) for a comprehensive gene panel including ALK, RET, ROS1, NTRK1/3, MET, EGFR, BRAF, KRAS and HER2. TruSight Oncology 500 DNA and AmpliSeq Focus RNA assays (Illumina) were used as reference assays. DNA and RNA were extracted from samples with the AllPrep Micro kit (Qiagen) and analyzed by Percepta Genomic Atlas and reference assays. 94 biopsy samples (73 TBNA and 21 TBB from 71 patients undergoing a diagnostic bronchoscopy for suspected lung cancer were collected into RNAprotect (Qiagen) under an IRB approved protocol. Local molecular testing results from FFPE biopsy samples taken during the same bronchoscopy procedure were collected. Results: RNA and DNA in sufficient amounts to run the Percepta Genomic Atlas and reference assays was obtained from 85 of 94 lung biopsies from 63 of 71 patients. Percepta Genomic Atlas identified pathogenic variants in 29 bronchoscopy biopsy samples from 23 patients including single nucleotide variants in EGFR, KRAS, BRAF and PIK3CA, an EGFR exon 19 deletion/insertion and copy number amplications in AR, EGFR, CDK4, CCND1, MYC, MYCN and PIK3CA. No fusions were identified. This results in a 100% sensitivity for detecting pathogenic alterations when compared to reference assay results. When comparing Percepta Genomic Atlas results to local molecular testing of bronchoscopy samples performed as part of routine clinical care, we found 100% concordance with 7 of 7 alterations detected in 7 patients, including mutations in EGFR, KRAS and BRAF. In a further 4 patients, Percepta Genomic Atlas and local multi-gene NGS testing results agreed, with neither assay identifying guideline recommended alterations. Conclusions: Using a combination of whole exome RNA and targeted DNA sequencing, Percepta Genomic Atlas detects the clinically actionable mutations in patients with non-small cell lung cancer using fresh tissue specimens collected during bronchoscopic tissue sampling, with high concordance to standard of care testing. By initiating broad molecular testing at the time of the bronchoscopy, Percepta Genomic Atlas may provide timelier results for patients with lung cancer.
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Affiliation(s)
| | | | - Hans Lee
- Johns Hopkins School of Medicine, Department of Medicine Pulmonary Division, Baltimore, MD
| | | | - Amit Mahajan
- Inova Schar Cancer Institute, Inova Fairfax Hospital, Falls Church, VA
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Jessel S, Weiss SA, Austin M, Mahajan A, Etts K, Zhang L, Aizenbud L, Perdigoto AL, Hurwitz M, Sznol M, Herold KC, Kluger HM. Immune Checkpoint Inhibitor-Induced Hypophysitis and Patterns of Loss of Pituitary Function. Front Oncol 2022; 12:836859. [PMID: 35350573 PMCID: PMC8958012 DOI: 10.3389/fonc.2022.836859] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/11/2022] [Indexed: 12/11/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICI) are clinically active across multiple tumor types but the associated immune-related adverse events (irAEs) lead to treatment delays or discontinuation and negatively impact quality-of-life. Hypophysitis is often a permanent irAE that may affect multiple pituitary hormonal axes. Here we comprehensively characterize our institution's clinical experience with ICI-induced hypophysitis and the associated patterns of pituitary function loss. Methods Patients with solid tumors, mostly melanoma and renal cell carcinoma (RCC), treated with ICI at Yale Cancer Center were prospectively enrolled from October 2016-May 2021. Demographics and clinical data were obtained from the medical record including type and timing of irAEs. Patients were included in this cohort if hypophysitis was diagnosed by pre-specified biochemical and clinical parameters. Results The overall incidence of hypophysitis was 69/490 (14%) in patients with melanoma (n=58, 84%), RCC (n=10,14%), and merkel cell carcinoma (n=1, 1%) who received ipilimumab plus nivolumab (77%; 53/69), anti-PD-(L)1 (17%; 12/69), or ipilimumab monotherapy (6%; 4/69). Of the 69 patients analyzed, median time to hypophysitis on combination ICI versus anti-PD-1 was 2.8 vs. 4.1 months. The incidence of hypophysitis in patients with melanoma was 25% (46/187) with ipilimumab plus nivolumab and 5% (7/129) with anti-PD-(L)1 compared to 9% (7/77) and 8% (3/37), respectively, in patients with RCC. Patients who developed hypophysitis on combination ICI had a higher rate of headache (p=0.05) and co-occurring irAEs (p=0.01) compared anti-PD-(L1)1 monotherapy. At a median follow-up of 2.2 years, 77% of patients were alive. Objective response rates to ICI in melanoma patients were higher than previously reported for unselected populations. Central hypothyroidism and hypogonadism were the most common pituitary axes affected after the adrenal axis. In select cases, there was evidence of spontaneous rebound in free testosterone levels after an initial decline. Conclusions We demonstrate a higher rate of ICI-induced hypophysitis than previously reported, which may be reflective of real-world practice due to increased awareness as experience with ICI has grown. In select cases, there was evidence of rebound in free testosterone and/or gonadotropins but not in adrenal axis hormones.
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Affiliation(s)
- Shlomit Jessel
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Sarah A. Weiss
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Matthew Austin
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Katrina Etts
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Lin Zhang
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Lilach Aizenbud
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Ana Luisa Perdigoto
- Department of Medicine (Endocrinology), Yale University School of Medicine, New Haven, CT, United States
| | - Michael Hurwitz
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Mario Sznol
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
| | - Kevan C. Herold
- Department of Medicine (Endocrinology), Yale University School of Medicine, New Haven, CT, United States
| | - Harriet M. Kluger
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, United States
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Mahajan A, Patil DJ, Shah V, Mulay M. Giant Osteochondroma of the mandibular condyle and temporomandibular joint - A case report. J Oral Maxillofac Pathol 2022; 26:290. [PMID: 35968160 PMCID: PMC9364630 DOI: 10.4103/jomfp.jomfp_112_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Osteochondroma is one of the common bone tumours but is rarely seen in the head and neck region. Osteochondroma of the mandibular condyle, extending to the temporomandibular joint (TMJ) is an infrequent occurrence. Patients commonly present with restricted mouth opening and malocclusion. Due to the significant overlap in features between chondromas and condylar hyperplasia, it is very likely to be misdiagnosed, resulting in treatment errors. In this report, an interesting case of a large osteochondroma of the mandibular condyle extending into the zygomatic and petrous part of the temporal bone involving the left TMJ in a 35-year-old female patient is described who presented with facial asymmetry and restricted mouth opening. This paper outlines the clinico-radiographic and histopathological features for diagnosis and appropriate treatment of osteochondroma.
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Affiliation(s)
- Amit Mahajan
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Gujarat, India
| | - Deepa J. Patil
- Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Gujarat, India,Address for correspondence: Dr. Deepa J. Patil, Departments of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Gujarat, India. E-mail:
| | - Vandana Shah
- Department of Oral and Maxillofacial Pathology K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Gujarat, India
| | - Mrudula Mulay
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Gujarat, India
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Mahajan A, Patel H, Surana M, Abhani V. Comparison of Vazirani-Akinosi and Kurt-Thoma technique for mandibular anesthesia: An observational clinical study. Natl J Maxillofac Surg 2022; 13:78-83. [PMID: 35911817 PMCID: PMC9326192 DOI: 10.4103/njms.njms_189_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/17/2020] [Accepted: 04/21/2021] [Indexed: 11/04/2022] Open
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Subramanian H, Dey R, Brim WR, Tillmanns N, Cassinelli Petersen G, Brackett A, Mahajan A, Johnson M, Malhotra A, Aboian M. Trends in Development of Novel Machine Learning Methods for the Identification of Gliomas in Datasets That Include Non-Glioma Images: A Systematic Review. Front Oncol 2021; 11:788819. [PMID: 35004312 PMCID: PMC8733688 DOI: 10.3389/fonc.2021.788819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Machine learning has been applied to the diagnostic imaging of gliomas to augment classification, prognostication, segmentation, and treatment planning. A systematic literature review was performed to identify how machine learning has been applied to identify gliomas in datasets which include non-glioma images thereby simulating normal clinical practice. Materials and Methods Four databases were searched by a medical librarian and confirmed by a second librarian for all articles published prior to February 1, 2021: Ovid Embase, Ovid MEDLINE, Cochrane trials (CENTRAL), and Web of Science-Core Collection. The search strategy included both keywords and controlled vocabulary combining the terms for: artificial intelligence, machine learning, deep learning, radiomics, magnetic resonance imaging, glioma, as well as related terms. The review was conducted in stepwise fashion with abstract screening, full text screening, and data extraction. Quality of reporting was assessed using TRIPOD criteria. Results A total of 11,727 candidate articles were identified, of which 12 articles were included in the final analysis. Studies investigated the differentiation of normal from abnormal images in datasets which include gliomas (7 articles) and the differentiation of glioma images from non-glioma or normal images (5 articles). Single institution datasets were most common (5 articles) followed by BRATS (3 articles). The median sample size was 280 patients. Algorithm testing strategies consisted of five-fold cross validation (5 articles), and the use of exclusive sets of images within the same dataset for training and for testing (7 articles). Neural networks were the most common type of algorithm (10 articles). The accuracy of algorithms ranged from 0.75 to 1.00 (median 0.96, 10 articles). Quality of reporting assessment utilizing TRIPOD criteria yielded a mean individual TRIPOD ratio of 0.50 (standard deviation 0.14, range 0.37 to 0.85). Conclusion Systematic review investigating the identification of gliomas in datasets which include non-glioma images demonstrated multiple limitations hindering the application of these algorithms to clinical practice. These included limited datasets, a lack of generalizable algorithm training and testing strategies, and poor quality of reporting. The development of more robust and heterogeneous datasets is needed for algorithm development. Future studies would benefit from using external datasets for algorithm testing as well as placing increased attention on quality of reporting standards. Systematic Review Registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209938, International Prospective Register of Systematic Reviews (PROSPERO 2020 CRD42020209938).
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Affiliation(s)
- Harry Subramanian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Rahul Dey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Waverly Rose Brim
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Niklas Tillmanns
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | | | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, CT, United States
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Michele Johnson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Mariam Aboian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: Mariam Aboian,
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Tu LH, Mahajan A, Minja FJ, Navaratnam D, Melnick ER. Pilot MRI-based strategies to improve the detection of stroke in patients with dizziness/vertigo. Clin Imaging 2021; 82:234-236. [PMID: 34902799 DOI: 10.1016/j.clinimag.2021.12.001] [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: 09/07/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Posterior strokes are frequently misdiagnosed as they present with non-specific complaints such as dizziness/vertigo. Emergency department (ED) practice often relies on CT/CTA to "exclude" infarct in such patients, providing false reassurance due to lower sensitivity of CT (42%) for stroke in the posterior circulation. We describe a pilot at our institution using a specialized MRI protocol with 95% sensitivity for posterior stroke, which may be used in place of CT/CTA or conventional MRI for stroke evaluation. Further development of this approach may help reduce the high rate of missed posterior stroke in patients presenting with dizziness.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St, New Haven, CT 06520, United States of America.
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St, New Haven, CT 06520, United States of America.
| | - Frank J Minja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Dhasakumar Navaratnam
- Department of Emergency Medicine, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06519, United States of America.
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave # 260, New Haven, CT 06519, United States of America.
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Kalra M, Bakhshi S, Singh M, Seth R, Verma N, Jain S, Radhakrishnan V, Mandal P, Mahajan A, Arora R, Dinand V, Kapoor G, Sajid M, Thulkar S, Arora A, Taluja A, Chandra J. PET-CT vs CECT for response assessment in childhood Hodgkin Lymphoma - Subset analysis of InPOG HL-15-01 study. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Saad N, Mahajan A, Chin A, Stewart D, Kline GA. Prevalence of growth hormone deficiency in patients with unexplained chronic fatigue after undergoing bone marrow transplantation in adulthood. J Endocrinol Invest 2021; 44:2809-2817. [PMID: 34003462 DOI: 10.1007/s40618-021-01589-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Many patients who undergo bone marrow transplantation (BMT) in adulthood experience unexplained chronic fatigue which can have a major impact on their health-related quality of life (QoL). Pre-BMT treatment regimens increase the risk of developing acquired growth hormone deficiency (GHD), which results in a clinical syndrome with decreased energy and has additionally been linked to metabolic syndrome. METHODS Using the gold-standard insulin hypoglycemic test (IHT), we evaluated the prevalence of GHD in 18 post-BMT adult patients with unexplained chronic fatigue, as well as the correlation between peak serum GH response and QoL scores, the metabolic syndrome, and insulin resistance. Peak serum GH cut-point less than 3.0 ug/L was used for the diagnosis of severe GHD. The Fatigue Severity Scale and Quality of Life in Adult GHD Assessment questionnaires were used to quantify fatigue symptoms. RESULTS The prevalence of severe GHD within this sample of 18 patients was 50%. A trend between lower peak serum GH response and higher fatigue and QoL-AGHDA scores was observed. CONCLUSIONS GHD may represent a remediable contributor to post-BMT chronic fatigue in adults, further studies are needed to evaluate the potential role of screening and GH replacement therapy in this vulnerable patient population. IMPLICATIONS FOR CANCER SURVIVORS GHD may be a treatable explanation for disabling post-BMT fatigue pending results of intervention studies.
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Affiliation(s)
- N Saad
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada
| | - A Mahajan
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada
| | - A Chin
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - D Stewart
- Departments of Oncology and Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - G A Kline
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
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Cunningham D, Zaniletti I, Breen W, Leavitt T, Mahajan A, Keole S, Daniels T, Vern-Gross T, Ahmed S, DeWees T, Laack N. Lymphopenia in Pediatric Patients Following Proton Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Upadhyay R, Grosshans D, McGovern S, McAleer M, Woodhouse K, Zaky W, Chintagumpala M, Mahajan A, Paulino A. Quantifying the Risk and Dosimetric Variables of Symptomatic Brainstem Injury After Proton Beam Radiation in Pediatric Brain Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Breen W, Zaniletti I, Laack N, Cunningham D, Leavitt T, Mahajan A, Keole S, Daniels T, Vern-Gross T, Ahmed S, DeWees T. Pediatric Patient-Reported Quality of Life Before and after Radiotherapy: A Prospective Registry Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.631] [Citation(s) in RCA: 1] [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: 11/27/2022]
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Breen W, Youland R, Jacobson S, Pafundi D, Brown P, Hunt C, Mahajan A, Ruff M, Kizilbash S, Uhm J, Routman D, Jones J, Brinkmann D, Laack N. 18F-DOPA-PET-Guided Re-Irradiation for Recurrent High-Grade Glioma: Initial Results of a Phase II Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mahajan A, Czerniak C, Lamichhane J, Phuong L, Purnat T, Briand S, Nguyen T. Listening to community concerns in the COVID-19 infodemic: A WHO digital approach. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Infodemic (too much information including false or misleading information in digital and physical environments) during the COVID-19 pandemic has led to confusion, risk-taking and behaviors that can amplify outbreaks, and reduce effectiveness of pandemic response efforts. To address this challenge, the WHO Information Network for Epidemics (EPI-WIN), in collaboration with research partners, developed a public health Infodemic intelligence analysis methodology for weekly analysis of digital media data to identify, categorize, and understand key concerns expressed in online conversations.
Methods
Thirty-five keyword-based searches (per language) using Meltwater Explore and Google Trends were created and grouped according to a set of pandemic public health taxonomy categories developed specifically for this analysis. The taxonomy has five thematic categories of conversation about COVID-19 and public health response: (1) the cause of the illness, (2) the illness, (3) the treatment, (4) the interventions and (5) Information.
Results
The two most recurring topics to attract increasing interest were Vaccines and Asymptomatic transmission followed by Immunity, Cause of the virus, Vulnerable communities and Reduction of movement, and Risk factors based on demographics and risk of misinformation.
Conclusions
The application of this taxonomy to online social listening week-on-week resulted in a better in-time understanding of the evolution and dynamics of high velocity conversations about COVID-19 globally during the pandemic and proposes a quantifiable approach to support planning of risk communication response.
Key messages
Describe widespread innovation in social listening methods for greater accountability to affected populations. Formulate insights into how digital media can be better utilized for more rapidly responding to the evolving needs of communities.
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Affiliation(s)
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- European Centre for Disease Prevention and Control, Solna, Sweden
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