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Hartman M, Debiec N, Kim E, Syed H, Adhya J, Giardino A, Hill J. Rad Path in a Flash: Creation of the First AMSER Sponsored Digital Flashcard Deck and a Review of Digital Flashcard Use among? Medical Students. Acad Radiol 2024; 31:426-430. [PMID: 38401988 DOI: 10.1016/j.acra.2023.12.039] [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: 09/12/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES Digital flashcards are an increasingly popular study method for medical students today. The purpose of this study is to assess students' opinions on digital flashcards and to evaluate the need for radiology-focused digital flashcards. We created the first official Radiology-Pathology (Rad-Path) Correlation course digital flashcard deck sponsored by the Alliance of Medical Student Educators in Radiology (AMSER), and evaluated its effectiveness in increasing medical students' confidence levels of understanding Rad-Path concepts. MATERIALS AND METHODS A 16-question survey was developed and publicly shared with medical students to assess the need for a high-quality radiology deck. In addition, students who trialed the AMSER Rad-Path Anki deck were assessed on their confidence of radiology pathology concepts prior to and after using these digital flashcards. RESULTS 185 survey responses were received for the first survey about digital flashcard use. Overall, 87.6% of medical student respondents had used digital flashcards during medical school, and 33.5% had used digital flashcards to study radiology topics specifically. 67.6% of respondents stated they would use a digital flashcard deck if sponsored by an academic radiology society. Regarding the survey of the students who used the AMSER Rad-Path flashcards, 31 responses were received in the pre- and follow-up survey. Mean confidence in understanding the radiology pathology learning objectives increased when the Rad-Path Anki deck was utilized, and students rated the flashcards favorably. CONCLUSION Students reported a high use of digital flashcards for studying topics in medical school. We identified a perceived need in students for a series of high-quality digital flashcards covering radiology topics. We created the first deck of AMSER Rad-Path flashcards which was well received by the medical students.
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Affiliation(s)
- Matthew Hartman
- Allegheny Health Network, 320 East North Avenue, Pittsburgh, Pennsylvania, 15212, USA.
| | - Nicholas Debiec
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, 16509, USA
| | - Esther Kim
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Hamid Syed
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, 16509, USA
| | - Julie Adhya
- Allegheny Health Network, 320 East North Avenue, Pittsburgh, Pennsylvania, 15212, USA
| | | | - Jeanne Hill
- Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Zhao AH, Zhao EE, Hartman M, Hill JG, Giardino A. AMSER Rad Path Case of the Month: Effect of Case-based Integration of Radiology and Pathology on Medical Student Education and Interdisciplinary Collaboration. Acad Radiol 2022; 29:1757-1762. [PMID: 35379530 DOI: 10.1016/j.acra.2022.02.014] [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: 10/10/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology and pathology are often underrepresented in undergraduate medical education. The Alliance of Medical Student Educators in Radiology (AMSER) hosts the AMSER Rad Path Case of the Month, an online archive of radiological case reports with pathology correlations submitted by medical students. The purpose of this study is to assess the value of preparing and submitting a case on medical students' educational experience. MATERIALS AND METHODS Students who had cases accepted for publication in AMSER Rad Path Case of the Month from July 2018 to December 2019 were contacted by email to request their participation in a voluntary, anonymous 22-question survey. Surveys were sent to 35 students from seven institutions. RESULTS Twenty three of the 35 students (65.7%) responded. Only five (21.7%) of respondents reported having previously followed a patient case through radiology and pathology during medical school, defined as interaction with a clinician in each specialty to discuss the case. When asked about their experience with AMSER Rad Path Case of the Month, most agreed or strongly agreed it was a valuable case-based learning experience (100%). Respondents also reported high satisfaction with improved understanding of disease process, increased understanding and ability to collaborate, and increased likelihood of participating in future academic work. CONCLUSION AMSER Rad Path Case of the Month is a valuable case-based educational experience that deepens students' understanding of disease processes while affording them an opportunity for interdisciplinary and scholarly collaboration.
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Affiliation(s)
- Anna H Zhao
- Department of Radiology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
| | - Elise E Zhao
- Department of Radiology, Medical University of South Carolina, Charleston, SC
| | | | - Jeanne G Hill
- Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Angela Giardino
- Department of Radiology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115
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Lof S, van der Heijde N, Abuawwad M, Al-Sarireh B, Boggi U, Butturini G, Capretti G, Coratti A, Casadei R, D'Hondt M, Esposito A, Ferrari G, Fusai G, Giardino A, Groot Koerkamp B, Hackert T, Kamarajah S, Kauffmann EF, Keck T, Marudanayagam R, Nickel F, Manzoni A, Pessaux P, Pietrabissa A, Rosso E, Salvia R, Soonawalla Z, White S, Zerbi A, Besselink MG, Abu Hilal M. Robotic versus laparoscopic distal pancreatectomy: multicentre analysis. Br J Surg 2021; 108:188-195. [PMID: 33711145 DOI: 10.1093/bjs/znaa039] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. METHODS A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above). RESULTS A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004). CONCLUSION The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
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Affiliation(s)
- S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - N van der Heijde
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abuawwad
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - U Boggi
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - G Capretti
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - A Coratti
- Department of Surgical Oncology and Robotics, Careggi University Hospital, Florence, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - A Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G Ferrari
- Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Fusai
- Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK
| | - A Giardino
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - B Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S Kamarajah
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - E F Kauffmann
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - T Keck
- Clinic for Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - R Marudanayagam
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Manzoni
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - P Pessaux
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil - IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - A Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - E Rosso
- Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France
| | - R Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - S White
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A Zerbi
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
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Gosangi B, Davids M, Somarouthu B, Alessandrino F, Giardino A, Ramaiya N, Krajewski K. Review of targeted therapy in chronic lymphocytic leukemia: what a radiologist needs to know about CT interpretation. Cancer Imaging 2018; 18:13. [PMID: 29669600 PMCID: PMC5907417 DOI: 10.1186/s40644-018-0146-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023] Open
Abstract
The last 5 years have been marked by profound innovation in the targeted treatment of chronic lymphocytic leukemia (CLL) and indolent lymphomas. Using CLL as a case study, we present a timeline and overview of the current treatment landscape for the radiologist, including an overview of clinical and radiological features of CLL, discussion of the targeted agents themselves, and the role of imaging in response and toxicity assessment. The goal is to familiarize the radiologist with multiple Food and Drug Administration (FDA)-approved targeted agents used in this setting and associated adverse events which are commonly observed in this patient population.
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MESH Headings
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiographic Image Interpretation, Computer-Assisted/methods
- Radiographic Image Interpretation, Computer-Assisted/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Affiliation(s)
- Babina Gosangi
- Thoracic Radiology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115 USA
| | - Matthew Davids
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Chronic Lymphocytic Leukemia, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, 02284 USA
| | | | - Francesco Alessandrino
- Emergency Radiology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115 USA
| | - Angela Giardino
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA 02284 USA
| | - Nikhil Ramaiya
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA 02284 USA
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Giardino A, Girelli R, Frigerio I, Regi P, Scopelliti F, Butturini G, Pederzoli P, Bassi C. Immunological profile of systemic effects after radiofrequency ablation of locally advanced pancreatic cancer: Study design and preliminary results. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.035] [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] Open
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Giardino A, Gupta S, Olson E, Sepulveda K, Lenchik L, Ivanidze J, Rakow-Penner R, Patel MJ, Subramaniam RM, Ganeshan D. Role of Imaging in the Era of Precision Medicine. Acad Radiol 2017; 24:639-649. [PMID: 28131497 DOI: 10.1016/j.acra.2016.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 07/01/2016] [Revised: 11/07/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022]
Abstract
Precision medicine is an emerging approach for treating medical disorders, which takes into account individual variability in genetic and environmental factors. Preventive or therapeutic interventions can then be directed to those who will benefit most from targeted interventions, thereby maximizing benefits and minimizing costs and complications. Precision medicine is gaining increasing recognition by clinicians, healthcare systems, pharmaceutical companies, patients, and the government. Imaging plays a critical role in precision medicine including screening, early diagnosis, guiding treatment, evaluating response to therapy, and assessing likelihood of disease recurrence. The Association of University Radiologists Radiology Research Alliance Precision Imaging Task Force convened to explore the current and future role of imaging in the era of precision medicine and summarized its finding in this article. We review the increasingly important role of imaging in various oncological and non-oncological disorders. We also highlight the challenges for radiology in the era of precision medicine.
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Affiliation(s)
- Angela Giardino
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Supriya Gupta
- Department of Radiology and Imaging, Medical College of Georgia, 1120 15th St, Augusta, GA 30912.
| | - Emmi Olson
- Radiology Resident, University of California San Diego, San Diego, California
| | | | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jana Ivanidze
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, San Diego, California
| | - Midhir J Patel
- Department of Radiology, University of South Florida, Tampa, Florida
| | - Rathan M Subramaniam
- Cyclotron and Molecular Imaging Program, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
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7
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Giardino A, Spolverato G, Regi P, Frigerio I, Scopelliti F, Girelli R, Pawlik Z, Pederzoli P, Bassi C, Butturini G. C-Reactive Protein and Procalcitonin as Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery. J Gastrointest Surg 2016; 20:1482-92. [PMID: 27206502 DOI: 10.1007/s11605-016-3171-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 03/24/2016] [Accepted: 05/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between postoperative inflammatory markers and risk of complications after pancreaticoduodenectomy (PD) is controversial. We sought to assess the diagnostic value of perioperative C-reactive protein (CRP) and procalcitonin (PCT) levels in the early identification of patients at risk for complications after PD. METHODS In 2014, 84 patients undergoing elective PD were enrolled in a prospective database. Clinicopathological characteristics, CRP and PCT, as well as short-term outcomes, such as complications and pancreatic fistula, were analyzed. Complications and pancreatic fistula were defined based on the Clavien-Dindo classification and the International Study Group on Pancreatic Fistula (ISGPF) classification, respectively. High CRP and PCT were classified using cut-off values based on ROC curve analysis. RESULTS The majority (73.8 %) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 postoperative days (POD) were higher among patients who experienced a complication versus those who did not (p < 0.001). Postoperative CRP and PCT levels were also higher among patients who developed a grade B or C pancreatic fistula (p < 0.05). A CRP concentration >84 mg/l on POD 1 (AUC 0.77) and >127 mg/l on POD 3 (AUC 0.79) was associated with the highest risk of overall complications (OR 6.86 and 9.0, respectively; both p < 0.001). Similarly patients with PCT >0.7 mg/dl on POD 1 (AUC 0.67) were at higher risk of developing a postoperative complication (OR 3.33; p = 0.024). On POD 1, a CRP >92 mg/l (AUC 0.72) and a PCT >0.4 mg/dl (AUC 0.70) were associated with the highest risk of pancreatic fistula (OR 5.63 and 5.62, respectively; both p < 0.05). CONCLUSIONS CRP and PCT concentration were associated with an increased risk of developing complications and clinical relevant pancreatic fistula after PD. Use of these biomarkers may help identify those patients at highest risk for perioperative morbidity and help guide postoperative management of patients undergoing PD.
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Affiliation(s)
- A Giardino
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy.
| | - G Spolverato
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - P Regi
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - I Frigerio
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - F Scopelliti
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - R Girelli
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - Z Pawlik
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Pederzoli
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
| | - C Bassi
- Department of Surgery - Pancreas Institute, University of Verona, Verona, Italy
| | - G Butturini
- Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy
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8
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Armand P, Redd R, Bsat J, Mayuram S, Giardino A, Fisher DC, LaCasce AS, Jacobson C, Davids MS, Brown JR, Weng L, Wilkins J, Faham M, Freedman AS, Joyce R, Jacobsen ED. A phase 2 study of Rituximab-Bendamustine and Rituximab-Cytarabine for transplant-eligible patients with mantle cell lymphoma. Br J Haematol 2016; 173:89-95. [PMID: 26729345 DOI: 10.1111/bjh.13929] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 09/19/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022]
Abstract
Chemoimmunotherapy followed by autologous stem cell transplantation (ASCT) is a standard therapy for transplant-eligible patients with newly diagnosed mantle cell lymphoma (MCL). The achievement of complete remission (CR) and minimal residual disease (MRD) negativity are associated with better outcomes. We tested an induction regimen of rituximab/bendamustine followed by rituximab/high-dose cytarabine (RB/RC). This phase 2 study (NCT01661881) enrolled 23 transplant-eligible patients aged 42-69, of whom 70% were MCL international prognostic index low-risk. Patients received three cycles of RB followed by three cycles of RC. The primary endpoint of the trial was the rate of CR after six cycles of therapy, with a rate of 75% considered promising. 96% of patients achieved a CR/unconfirmed CR after treatment, meeting the primary objective. One patient progressed on study, one declined ASCT in CR, and the remaining 21 underwent successful stem cell collection and ASCT. After a median follow-up of 13 months, the progression-free survival rate was 96%. Among 15 MRD-evaluable patients who completed treatment, 93% achieved MRD negativity after RB/RC. In conclusion, RB/RC achieves very high CR and MRD negativity rates in transplant-eligible patients, with a favourable safety profile. RB/RC warrants further comparative studies, and may become a useful alternative to RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)-based induction regimens in this patient population.
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Affiliation(s)
- Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert Redd
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jad Bsat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sangeetha Mayuram
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Angela Giardino
- Department of Radiology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caron Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Li Weng
- Sequenta Inc, South San Francisco, CA, USA
| | | | | | - Arnold S Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robin Joyce
- Department of Medical Oncology, Beth Israel-Deaconess Medical Center, Boston, MA, USA
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Giardino A, Girelli R, Frigerio I, Regi P, Scopelliti F, Borin A, Bassi C, Pederzoli P. Two hundred consecutive patients treated with radiofrequency ablation for stage III pancreatic cancer: Results from a single institution. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Cooley C, Davids M, Giardino A. Fatty intra-abdominal lymph nodes in chronic lymphocytic leukemia. Am J Hematol 2014; 89:234-5. [PMID: 24123185 DOI: 10.1002/ajh.23606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/22/2013] [Accepted: 09/30/2013] [Indexed: 11/11/2022]
Affiliation(s)
- C.L. Cooley
- Department of Imaging; Dana-Farber Cancer Institute; Boston Massachusetts
- Department of Radiology; Brigham and Women's Hospital; Boston Massachusetts
| | - M.S. Davids
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - A. Giardino
- Department of Imaging; Dana-Farber Cancer Institute; Boston Massachusetts
- Department of Radiology; Brigham and Women's Hospital; Boston Massachusetts
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11
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Frigerio I, Giardino A, Grielli R, Regi P, Scopelliti F. RFA and pancreatic cancer: 5 years experience from a single center. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The purpose of this article is to illustrate the imaging findings of typical and atypical metastatic sites of recurrent endometrial carcinoma. Typical sites include local pelvic recurrence, pelvic and para-aortic nodes, peritoneum, and lungs. Atypical sites include extra-abdominal lymph nodes, liver, adrenals, brain, bones and soft tissue. It is important for radiologists to recognize the typical and atypical sites of metastases in patients with recurrent endometrial carcinoma to facilitate earlier diagnosis and treatment.
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Affiliation(s)
- Vikram Kurra
- Department of Imaging, Brigham & Women's Hospital, Boston, MA 02115, USA.
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13
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Cantore M, Girelli R, Mambrini A, Frigerio I, Boz G, Salvia R, Giardino A, Orlandi M, Auriemma A, Bassi C. Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma. Br J Surg 2012; 99:1083-8. [PMID: 22648697 DOI: 10.1002/bjs.8789] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an emerging treatment for patients with locally advanced pancreatic carcinoma, and can be combined with radiochemotherapy and intra-arterial plus systemic chemotherapy. METHODS This observational study compared two groups of patients with locally advanced pancreatic carcinoma treated with either primary RFA (group 1) or RFA following any other primary treatment (group 2). RESULTS Between February 2007 and May 2010, 107 consecutive patients were treated with RFA. There were 47 patients in group 1 and 60 in group 2. Median overall survival was 25·6 months. Median overall survival was significantly shorter in group 1 than in group 2 (14·7 versus 25·6 months; P = 0·004) Patients treated with RFA, radiochemotherapy and intra-arterial plus systemic chemotherapy (triple-approach strategy) had a median overall survival of 34·0 months. CONCLUSION RFA after alternative primary treatment was associated with prolonged survival. This was further extended by use of a triple-approach strategy in selected patients. Further evaluation of this approach seems warranted.
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Affiliation(s)
- M Cantore
- Oncological Department, Carrara Hospital, Carrara, Italy.
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14
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Abstract
Amyloidosis comprises a rare spectrum of protein deposition diseases that diffusely or focally affect any organ. Amyloid's variable clinical presentation and nonspecific disease course often cause it to evade early diagnosis. This pictorial essay aims to familiarize radiologists with the pathophysiology of amyloidosis, to describe the basic classifications of amyloidosis, and to use multimodality imaging to illustrate its varied appearance throughout the body. This review highlights the diagnostic challenge of interpreting radiographic studies in patients with hematologic malignancies and concurrent amyloidosis. Radiologists should consider amyloid in chronically ill patients or patients with hematologic malignancies who have unusual/unexpected imaging findings.
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Affiliation(s)
- Stephanie Howard
- Department of Radiology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
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15
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Howard S, Jagannathan J, Krajewski K, Giardino A, Zukotynski K, O'Regan K, Ghobrial I, Ramaiya N. Multimodality imaging in amyloidosis. Cancer Imaging 2012. [DOI: 10.1102/1470-5206.2012.0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Saboo SS, Krajewski KM, O'Regan KN, Giardino A, Brown JR, Ramaiya N, Jagannathan JP. Spleen in haematological malignancies: spectrum of imaging findings. Br J Radiol 2011; 85:81-92. [PMID: 22096219 DOI: 10.1259/bjr/31542964] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Imaging morphology and metabolic activity of splenic lesions is of paramount importance in patients with haematological malignancies; it can alter tumour staging, treatment protocols and overall prognosis. CT, MRI and positron emission tomography (PET)/CT have been shown to be powerful tools for the non-invasive assessment of splenic involvement in various haematological malignancies. Since many haematological malignancies and non-neoplastic conditions can involve the spleen and imaging manifestations can overlap, imaging and clinical findings outside of the spleen should be looked for to narrow the differential diagnosis; confirmation can be obtained by pathological findings. Radiologists should be familiar with the cross-sectional imaging patterns of haematological malignancies involving the spleen as well as non-neoplastic splenic findings common in these patients to facilitate their care and follow-up. This pictorial review provides the common and uncommon imaging appearances and complications of various haematological malignancies involving the spleen on CT, MRI and PET/CT, and common pitfalls in diagnosis.
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Affiliation(s)
- S S Saboo
- Department of Radiology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA.
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17
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Giardino A, O'Regan KN, Hargreaves J, Jagannathan J, Park D, Ramaiya N, Fisher D. Primary pleural lymphoma without associated pyothorax. J Clin Oncol 2011; 29:e413-5. [PMID: 21383302 DOI: 10.1200/jco.2010.33.5323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Secchi F, Giardino A, Nardella VG, Sardanelli F. [MRI and CT in the evaluation of congenital heart diseases]. Pediatr Med Chir 2010; 32:260-269. [PMID: 21462447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Magnetic resonance imaging (MRI) allows a static and cinetic study of congenital heart diseases avoiding patient exposure to ionizing radiation. It allows for evaluating cardiac morphology, heart function with accurate ventricular volume estimation, flow quantification with gradient and regurgitant fraction estimation, and vascular anatomy (aortic, pulmonary and proximal coronary vessels). Computed tomography (CT), with greater spatial resolution, allows for evaluating proximal and distal coronary arteries, vascular and pericardial calcifications, metal structures such as stents and prosthetic valves. The use of MRI or CT in young and adult patients with congenital heart diseases should be assessed case by case through a close collaboration between cardiologists and radiologists, aiming at an optimal tradeoff between expected diagnostic gain and biological cost in terms of ionizing radiation exposure and contrast material administration.
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Affiliation(s)
- F Secchi
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia.
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19
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Ottonello C, Giardino A, Sardanelli F. Solución del caso 15. Síndrome de Mayer-Rokitansky-Küster-Hauser atípico (tipo B). Radiología 2010; 52:178-80. [DOI: 10.1016/j.rx.2009.02.011] [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] [Received: 08/26/2008] [Accepted: 02/25/2009] [Indexed: 11/27/2022]
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20
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Ottonello C, Giardino A, Sardanelli F. Caso 15. Radiología 2009. [DOI: 10.1016/j.rx.2009.02.010] [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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21
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Franciosi C, Romano F, Giardino A, Piacentini MG, Ferrari Bravo A, Motta V, Uggeri F. Mesenteric cyst neoformation. A case report. MINERVA CHIR 2002; 57:509-12. [PMID: 12145584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Mesenteric cysts are rare lesions, with 1 case per 100,000 hospital admission reported. They have to be differentiated from ovarian cysts, gastrointestinal duplications and desmoid cysts. The symptoms are variable, ranging from asymptomatic cases with incidental discovery to chronic abdominal discomfort and acute abdomen. They are usually correlated to the location and the size of the lesion. Abdominal ultrasonography and computed tomography may lead to a correct diagnosis, which is regularly made at the time of abdominal exploration. Surgery is the treatment of choice, consisting with the removal of the cyst, eventually associated with bowel resection. It has to be radical in order to prevent the recurrence of the disease. A case of mesenteric cyst in a sixty-nine-years-old woman hospitalized for chronic abdominal pain is reported. In this case the cyst has been enucleated from the mesentery with open surgery without the need for bowel resection.
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Affiliation(s)
- C Franciosi
- Department of General Surgery, San Gerardo Hospital, II University of Milan, Bicocca Milan, Italy
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22
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Affiliation(s)
- H Dubowitz
- University of Maryland School of Medicine, Baltimore, MD, USA
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23
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Ebersole JL, Bauman GR, Cox O'Dell SE, Giardino A. Evidence for serum immunoglobulin G (IgG) antibody responses in Macaca fascicularis identified by monoclonal antibodies to human IgG subclasses. Oral Microbiol Immunol 1997; 12:193-203. [PMID: 9467387 DOI: 10.1111/j.1399-302x.1997.tb00379.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This investigation determined the capacity of murine monoclonal antibodies directed to human immunoglobulin G (IgG) subclasses to identify molecules with conserved epitopes in the serum of the nonhuman primate, Macaca fascicularis. We subsequently utilized this cross-reactivity to document the characteristics of IgG subclass antibody responses in M. fascicularis to parenteral immunization with intact oral microorganisms, antigens from oral microorganisms, and finally a defined protein toxin, tetanus toxoid. The IgG response in nonhuman primates immunized with tetanus toxoid showed a 40-fold and 110-fold increase after primary and secondary immunizations, respectively. The major IgG subclass responses were IgG1 and IgG3, with little, though significant, responses in the IgG4 and IgG2 subclasses. Seventy-five to 94% of the natural IgG antibody in nonhuman primate sera to Porphyromonas gingivalis, Prevotella intermedia and Campylobacter rectus was IgG1. IgG2 and IgG3 predominated to Bacteroides fragilis, IgG4 to Actinomyces viscosus and an equal distribution among the subclasses was noted in response to Fusobacterium nucleatum. Parenteral immunization of nonhuman primates with intact P. gingivalis elicited primarily IgG3 and IgG4, while the post-immunization IgG response to P. intermedia was largely IgG1. Nonhuman primates were also parenterally immunized with cell envelope antigens of P. gingivalis, P. intermedia, or a combination of cell envelope antigen from C. rectus and F. nucleatum and cell wall antigens of A. viscosus. The greatest IgG antibody response seen post-immunization was reactive with anti-human IgG1 for all of these antigens except to C. rectus which bound nonhuman primate antibody reactive with anti-human IgG2. It appears that the bacteria and their products exhibit unique differences in their induction of serum IgG subclass antibody responses. The characteristics of their immunogenicity as detected by the nonhuman primate may contribute to the ability of the immune responses to effectively interact with these pathogens.
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Affiliation(s)
- J L Ebersole
- Department of Periodontics, University of Texas Health Science Center at San Antonio 78284, USA
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24
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Giardino A, Ebersole JL, Holt SC. Characteristics of systemic antibody responses of nonhuman primates following active immunization with Porphyromonas gingivalis, Prevotella intermedia and Bacteroides fragilis. Oral Microbiol Immunol 1996; 11:79-87. [PMID: 8941758 DOI: 10.1111/j.1399-302x.1996.tb00340.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodontal disease is an infectious disease manifested by the progressive change of a healthy resident commensal microbiota to a pathogenic one characterized by a specific microbiota. Thus, the prospect for the use of selected bacteria or their antigens as a vaccine to interfere with the microbial changes and resulting progression of periodontal tissue destruction has been proposed. As a first step in examining the use of bacterial antigens as immunogens in periodontitis, this study characterized the humoral immune response in Macaca fascicularis after systemic immunization with intact Porphyromonas gingivalis, Prevotella intermedia and Bacteroides fragilis. Parental immunization of the nonhuman primate with the intact bacteria resulted in the production of specific and significantly elevated levels of antibodies to P. gingivalis and P. intermedia, with the predominant isotype being immunoglobulin G (IgG). In contrast, the principal response to the nonoral, intestinal bacterium, B. fragilis, was of the IgM isotype. Immunization increased IgG, IgM, and IgA antibody by 14-227 fold to P. gingivalis and 8-108 fold to P. intermedia. The level of serum IgA antibody increased (77-227 fold). The kinetics of the antibody response post-immunization and post-ligation differed with respect to each of the bacteria tested. IgG antibody to P. gingivalis increased through week 16 of the experiment and remained elevated above baseline through week 32. The IgG antibody level to P. intermedia peaked at 4 weeks following the third immunization and decreased post-ligation to near baseline levels by week 16. Characterization of the immune response after active immunization in the nonhuman primate has demonstrated a substantial and specific increase in antibody response which was sustained for several weeks. The insights obtained from these studies should help optimize the potential for immunologic interference with progressing periodontitis.
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Affiliation(s)
- A Giardino
- Department of Periodontics, University of Texas Health Science Center at San Antonio 78284, USA
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25
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Abstract
Collaborative efforts among health care professionals and institutions at all levels will be essential to the increased production of generalist physicians. There have been many successful collaborations in education and patient care among certifying boards, faculty, physicians in practice, specialists, generalists, and non-physician health professionals, as well as among the three generalist specialties. Recommended strategies to encourage collaboration in the preparation of generalist physicians include: creation of an institutional collaborative curriculum committee; design of a longitudinal curriculum on collaboration for physicians-in-training and other health professionals; implementation of collaborative patient care in ambulatory care teaching clinics; development of integrated systems of care that link inpatient, outpatient, and community-based health services; and education of physicians-in-training in these and other collaborative and co-practice models of patient care.
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Affiliation(s)
- P P Reynolds
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-2676
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26
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Wade BM, Mealey BL, Giardino A, Hallmon WW. Microbial assessments and periodontal diagnosis. Compendium 1993; 14:682-90. [PMID: 8358760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- B M Wade
- Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas
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27
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Giardino A, Giardino E. Resident and nurse practitioners: responding to education and patient care needs. Am J Dis Child 1991; 145:843-5. [PMID: 1858712 DOI: 10.1001/archpedi.1991.02160080017002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Shulkin DJ, Giardino A. Clock ticking on resident work hours. Pa Med 1991; 94:16. [PMID: 2008307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D J Shulkin
- University of Pennsylvania School of Medicine
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29
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Borella P, Giardino A, Neri M, Andermarker E. Magnesium and potassium status in elderly subjects with and without dementia of the Alzheimer type. Magnes Res 1990; 3:283-9. [PMID: 2132676] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Magnesium status was evaluated in healthy elderly people, and in patients affected from dementia of the Alzheimer type. Magnesium levels were determined in plasma, erythrocytes (RBC), lymphocytes (MNC), and granulocytes (PMN), and were compared with measurements in young healthy adults. Significantly lower plasma Mg concentrations were found in elderly people compared to controls, with no difference between cognitively normal and demented subjects. Mg levels in healthy elderly people were higher in MNC and lower in PMN, compared to the younger group. No difference was observed between demented patients and young controls in Mg content of white blood cells, but the patients had higher Mg/K ratios. In addition, significant correlations were found between cognitive impairment and the Mg/K ratio in MNC. When we assessed the philothermal response of granulocytes, a significant correlation was observed in demented subjects between the migration rate of PMNs and the PMN Mg/K ratio.
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Affiliation(s)
- P Borella
- Istituto di Igiene dell'Universitá degli Studi, Universitá degli Studi, Modena, Italy
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30
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Borella P, Sala F, Giardino A. [A nutrition survey of a group of athletes with particular reference to magnesium, zinc and copper intake, and to the relative intra- and extra-cellular levels]. Ann Ig 1989; 1:769-87. [PMID: 2483648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of the present study was to evaluate the dietary habits in a group of athletes (footballers) compared with sedentary subjects matched for sex, age and body mass index. All subjects kept a record of food eaten for seven consecutive days using various models for portion sizes. Daily nutrient intake was then computed and was expressed as either total intake, or percent of the recommended daily dietary allowances (LARN). For each subject, a 20-ml blood sample and a 24h urine sample was collected for analysis of magnesium, zinc and copper. The three elements were measured both in plasma and in erythrocytes, monocytes and neutrophils. The athletes eat significantly more sheets than controls (22.5% of total kcal vs 15.2%, p less than 0.01) and significantly less cereals (22.5% vs 31.7%, p less than 0.01). Concerning the nutrient composition, in both groups the lipid intake was higher than that recommended and this trend was more pronounced in the athletes (+ 43.2% vs + 16.1% in the controls). In addition, the diet was particularly rich in animal fats with a mean intake of 21.0% of total kcal in the athletes and 20.9% in the sedentary group (recommended value was 12.5% and 14%, respectively). A parallel reduction in vegetal protein intake was observed in the trained group, and the difference was significant (4.3% of kcal in the athletes and 5.2% in the controls, p less than 0.01). Furthermore, in the athletes the soluble carbohydrate intake was higher than the recommended levels (+ 110%) and significantly higher than that eaten by the controls (21.0% vs 16.4% of kcal, p less than 0.01), with parallel decrease of polysaccharides intake.(ABSTRACT TRUNCATED AT 250 WORDS)
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31
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Abstract
Tablets with a central hole and a water-impermeable coating were prepared. These perforated coated tablets (PCTs) dissolve and release drug through the central hole only. In vitro release of the model drugs sodium benzoate and benzamide from PCTs occurred at a constant rate up to 80% release. The zero-order release rate varies with hole size, drug solubility, drug concentration, diluent solubility, and binder concentration. These results demonstrate that the PCT design can be used to prepare drug delivery devices which release at controllable constant rates.
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Affiliation(s)
- A G Hansson
- Pharmaceutical Research and Development, Pfizer Central Research, Groton, CT 06340
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