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Dhiman A, Kothary V, Witmer HDD, Bregio C, Sood D, Ong CT, Polite B, Eng OS, Shergill A, Turaga KK. Role of Tumor-informed Personalized Circulating Tumor DNA Assay in Informing Recurrence in Patients With Peritoneal Metastases From Colorectal and High-grade Appendix Cancer Undergoing Curative-intent Surgery. Ann Surg 2023; 278:925-931. [PMID: 36994703 DOI: 10.1097/sla.0000000000005856] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To investigate the role of a personalized, tumor-informed circulating tumor DNA (ctDNA) assay in informing recurrence in patients with peritoneal metastases (PM) from colorectal (CRC) and high-grade appendix (HGA) cancer after curative cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). BACKGROUND Over 50% of patients with CRC/HGA-PM recur after optimal CRS-HIPEC. The limited sensitivity of axial imaging and diagnostic biomarkers is a significant cause of delay in the detection of recurrence and initiation of further therapies. Plasma ctDNA has a promising role in monitoring response to treatment and/or recurrence after primary cancer resection. METHODS Patients with CRC/HGA-PM who underwent curative CRS-HIPEC and serial postresection ctDNA assessments were included. Patients with rising postoperative ctDNA levels were compared with those with stable, undetectable ctDNA levels. Primary outcomes were the percentage of patients with recurrence and disease-free survival (DFS). Secondary outcomes were overall survival, ctDNA sensitivity, lead time, and performance of ctDNA compared with carcinoembryonic antigen. RESULTS One hundred thirty serial postresection ctDNA assessments [median 4, interquartile range (IQR), 3 to 5] were performed in 33 patients (n = 13 CRC, n = 20 HGA) who underwent completeness of cytoreduction-0/1 CRS with a median follow-up of 13 months. Of the 19 patients with rising ctDNA levels, 90% recurred versus 21% in the stable ctDNA group (n = 14, < 0.001). Median DFS in the rising ctDNA cohort was 11 months (IQR, 6 to 12) and not reached in the stable ( P = 0.01). A rising ctDNA level was the most significant factor associated with DFS (hazard ratio: 3.67, 95% CI: 1.06-12.66, P = 0.03). The sensitivity and specificity of rising ctDNA levels in predicting recurrence were 85% and 84.6%, respectively. The median ctDNA lead time was 3 months (IQR, 1 to 4). Carcinoembryonic antigen was less sensitive (50%) than ctDNA. CONCLUSIONS This study supports the clinical validity of serial ctDNA assessment as a strong prognostic biomarker in informing recurrence in patients with CRC/HGA-PM undergoing curative resection. It also holds promises for informing future clinical trial designs and further research.
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Affiliation(s)
- Ankit Dhiman
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, Chicago, IL
| | - Vishesh Kothary
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL
| | - Hunter D D Witmer
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, Chicago, IL
| | - Celyn Bregio
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Divya Sood
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, Chicago, IL
| | - Cecilia T Ong
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, Chicago, IL
| | - Blase Polite
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL
| | - Oliver S Eng
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Orange, CA
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL
| | - Kiran K Turaga
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, Chicago, IL
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Sood D, Mayo SC. Understanding Barriers to Enrollment in Adjuvant Clinical Trials: Insights into Patient Eligibility Criteria from the Adjuvant S-1 for Cholangiocarcinoma Trial (JCOG1202, ASCOT). Ann Surg Oncol 2023; 30:6967-6969. [PMID: 37684366 DOI: 10.1245/s10434-023-14272-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Divya Sood
- Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Skye C Mayo
- Division of Surgical Oncology, Department of Surgery, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
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Nguyen CGT, Hamid A, Chen A, Sood D, Jou J. Low grade appendiceal mucinous neoplasm metastatic to the ovary: A case report and intraoperative assessment guide. Int J Surg Case Rep 2023; 109:108563. [PMID: 37524024 PMCID: PMC10400853 DOI: 10.1016/j.ijscr.2023.108563] [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: 06/19/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Incidence of low grade appendiceal mucinous neoplasm is increasing. Preoperatively, it may present similarly to primary ovarian malignancy. This case report describes a case of presumed ovarian malignancy with final pathologic diagnosis of low grade appendiceal mucinous neoplasm. We also propose several surgical strategies to approach this conundrum. PRESENTATION OF CASE A postmenopausal woman with abdominal pain was found to have a 30 cm abdominopelvic mass with elevated CA-125 and CEA presumably a primary ovarian malignancy. During surgical staging, intraoperative findings were notable for an appendiceal mass. Intraoperative surgical oncology consultation recommended appendectomy for diagnostic purposes. Following primary surgery and final pathologic diagnosis, she underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. DISCUSSION Low grade appendiceal mucinous neoplasm should be within the differential diagnosis of gynecologic surgeons when presented with a patient with large volume ascites and biopsy of acellular mucin. Intraoperatively, an abnormal appearing appendix with normal appearing gynecologic structures should trigger suspicion for appendiceal rather than ovarian origin. Preoperative symptoms, imaging studies, tumor markers, and frozen section pathology may not be able to differentiate between appendiceal and epithelial ovarian malignancies. CONCLUSION A recognition of mucinous material and abnormal appearing appendix should prompt the surgeon to consider performing an appendectomy to obtain primary pathologic diagnosis. A high level of suspicion could better optimize the patient for a joint case with the appropriate surgeons. Given the documented disguise of low grade appendiceal mucinous neoplasm as primary ovarian cancer and its increasing incidence, diagnosis and general understanding of treatment should be understood.
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Affiliation(s)
- Christine G T Nguyen
- Oregon Health and Sciences University, Department of Obstetrics and Gynecology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Anam Hamid
- Oregon Health and Sciences University, Department of Pathology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Athena Chen
- Oregon Health and Sciences University, Department of Pathology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Divya Sood
- Oregon Health and Sciences University, Department of Surgery, Division of Surgical Oncology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - Jessica Jou
- Oregon Health and Sciences University, Department of Obstetrics and Gynecology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
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Morgan RB, Dhiman A, Sood D, Ong CT, Wu X, Shergill A, Polite B, Turaga KK, Eng OS. Mutational profiles and prognostic impact in colorectal and high-grade appendiceal adenocarcinoma with peritoneal metastases. J Surg Oncol 2023; 127:831-840. [PMID: 36636792 DOI: 10.1002/jso.27203] [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: 03/16/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Next-generation sequencing (NGS) personalizes cancer treatments. In this study, we analyze outcomes based on NGS testing for colorectal cancer (CRC) and high-grade appendiceal adenocarcinoma (HGA) with peritoneal metastases. METHODS Retrospective review of genomic analyses and outcomes in patients with CRC or HGA with peritoneal metastases at a high-volume center from 2012 to 2019. RESULTS Ninety-two patients (57 CRC, 35 HGA) were identified. Overall survival was longer for CRC (52.8 vs. 30.5 months, p = 0.03), though rates of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) were similar. Multiple genes were more frequently mutated in CRC, including KRAS (51% vs. 29%, p = 0.04), TP53 (47% vs. 20%, p < 0.01), and APC (46% vs. 6%, p < 0.01). For CRC, multivariate regression showed an increased hazard ratio (HR) with increasing peritoneal cancer index (1.06 [1.01-1.11], p = 0.02) and a decreased HR following CRS/HIPEC (0.30 [0.11-0.80], p = 0.02). PIK3CA mutation associated with significantly increased HR (3.62 [1.06-12.41], p = 0.04), though only in non-CRS/HIPEC patients. Multivariate analysis in the HGA group showed a benefit following CRS/HIPEC (0.18 [0.06-0.61], p = 0.01) and for mucinous disease (0.38 [0.15-0.96], p = 0.04), while there was an increased HR with TP53 mutation (6.89 [2.12-22.44], p < 0.01). CONCLUSION CRC and HGA with peritoneal spread have distinct mutational profiles. PIK3CA and TP53 mutations are associated with survival for CRC or HGA with peritoneal metastases, respectively.
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Affiliation(s)
- Ryan B Morgan
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Ankit Dhiman
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Divya Sood
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Cecilia T Ong
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Xiaoyang Wu
- Ben May Department of Cancer Research, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Ardaman Shergill
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Blase Polite
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
| | - Kiran K Turaga
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois, USA.,Department of Surgery, Division of Surgical Oncology, Yale University, Hew Haven, CT, USA
| | - Oliver S Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
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Sneider AP, Dhiman A, Sood D, Ong C, Tun S, Malec M, Levine S, Turaga KK, Eng OS. Palliative Care and Characterization of Symptoms in Patients Undergoing Cytoreductive Surgery/Hyperthermic Intraperitoneal Chemotherapy. J Surg Res 2023; 283:1154-1160. [PMID: 36915007 DOI: 10.1016/j.jss.2022.11.061] [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: 04/26/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Palliative care for advanced cancer patients has been associated with improvements in symptom management and quality of life (QoL). Patients with peritoneal metastases undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often report symptoms adversely affecting QoL. We characterized and compared symptoms elucidated by palliative care versus surgical providers in this setting. METHODS CRS/HIPEC patients who saw both surgical oncology and palliative care providers from 2016 to 2020 at a tertiary care center were identified from a retrospective database. Documentation of QoL-associated symptoms in surgical oncology and palliative care visits was recorded and analyzed. RESULTS A total of 118 patients were included in this study. The most common primary histologies were appendiceal (36.4%) and colorectal (28.8%). Symptoms most frequently reported by palliative care were pain (60.2%) and fatigue (54.2%). The median number of symptoms documented was three (2, 5) in palliative care notes and two (0, 3) in surgical oncology notes (P < 0.001). Palliative care providers documented most symptoms statistically more frequently than surgical oncology providers. CONCLUSIONS Patients who underwent CRS/HIPEC experienced various QoL-associated symptoms. Palliative care providers elicited more symptoms than surgical oncology providers. Additional studies are needed to explore the impact on outcomes of perioperative palliative care in this challenging patient population.
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Affiliation(s)
- Abigail P Sneider
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Ankit Dhiman
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Cecilia Ong
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Sandy Tun
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Monica Malec
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Stacie Levine
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, Illinois; Department of Surgery, Yale University, New Haven, Connecticut
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, Illinois; Division of Surgical Oncology, University of California, Irvine, Orange, California.
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Sood D, Kuchta K, Paterakos P, Schwarz JL, Rojas A, Choi SH, Vining CC, Talamonti MS, Hogg ME. Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach. J Surg Oncol 2023; 127:413-425. [PMID: 36367398 DOI: 10.1002/jso.27135] [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: 07/04/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is associated with increased venous thromboembolism (VTE). We sought to compare rates of bleeding complications and VTE in patients receiving extended postoperative thromboprophylaxis (EPT) to those who did not, and identify risk factors for VTE after pancreatectomy for PDAC. METHODS This is a retrospective review of pancreatectomies for PDAC. EPT was defined as 28 days of low molecular weight heparin. Multivariable analysis (MVA) was performed to identify independent risk factors of VTE. RESULTS Of 269 patients included, 142 (52.8%) received EPT. Of those who received EPT, 7 (4.9%) suffered bleeding complications, compared to 6 (4.7%) of those who did not (p = 0.938). There was no significant difference in VTE rate at 90 days (2.8% vs. 2.4%, p = 0.728) or at 1 year (6.3% vs. 7.9%, p = 0.624). On MVA, risk factors for VTE included worse performance status, lower preoperative hematocrit, R1/R2 resection, and minimally invasive (MIS) approach. Among those who received EPT, there was no difference in VTE rate between MIS and open approach. CONCLUSIONS EPT was not associated with a difference in VTE risk or bleeding complications. MIS approach was associated with a higher risk of VTE; however, this was significantly lower among those who received EPT.
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Affiliation(s)
- Divya Sood
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Pierce Paterakos
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jason L Schwarz
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Aram Rojas
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Sung H Choi
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Charles C Vining
- Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
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Ong CT, Dhiman A, Smith A, Jose A, Kallakuri P, Belanski J, Sood D, Witmer HDD, Morgan RB, Turaga KK, Eng OS. ASO Visual Abstract: Insurance Authorization Barriers in Patients Undergoing Cytoreductive Surgery and HIPEC. Ann Surg Oncol 2023; 30:425. [PMID: 36071340 DOI: 10.1245/s10434-022-12502-3] [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: 12/13/2022]
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Ong CT, Dhiman A, Smith A, Jose A, Kallakuri P, Belanski J, Sood D, Witmer HDD, Morgan RB, Turaga KK, Eng OS. Insurance Authorization Barriers in Patients Undergoing Cytoreductive Surgery and HIPEC. Ann Surg Oncol 2023; 30:417-422. [PMID: 36112250 DOI: 10.1245/s10434-022-12437-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) exist across multiple histologies, but little data exist on the impact of insurance authorization on access to these therapies. Given the evolving role of CRS/HIPEC, we sought to characterize insurance approval and delays in patients undergoing these therapies. PATIENTS AND METHODS A retrospective review was performed at a high-volume tertiary center of patients who received CRS/HIPEC from 2017 to 2021. Collected data included patient demographics, tumor histologic characteristics, insurance type, approval/denial history, and time to prior authorization approval. Descriptive statistics were performed. RESULTS In total, 367 patients received CRS/HIPEC during the study period. They had a median age of 59 (IQR 49-67) years, 35% were male, and 76% were white. Of the patients requiring prior authorization, 14 of 104 (13%) patients were denied prior authorization and required appeal. Median time between authorization request and approval was 33 (IQR 28-36) days. These cases generated 410 insurance authorization requests, 94 (23%) of which were not initially approved and required appeal. The rate of upfront denial was 21.1% in patients with public insurance compared with 23.4% in patients with private insurance. Gastric cancer was the most common histology among denied cases (55%), followed by colorectal, appendiceal, and gynecologic malignancies. CONCLUSIONS Despite the broadening indications for and data supporting CRS/HIPEC, a significant proportion of patients still face hurdles in attaining insurance approval and coverage for these therapies. Addressing barriers to insurance approval is imperative to decrease therapeutic delay and improve access to data-driven care.
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Affiliation(s)
- Cecilia T Ong
- Department of Surgery, University of Chicago, Chicago, USA
| | - Ankit Dhiman
- Department of Surgery, University of Chicago, Chicago, USA
| | - Anthony Smith
- Department of Surgery, University of Chicago, Chicago, USA
| | - Angela Jose
- Department of Surgery, University of Chicago, Chicago, USA
| | | | | | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - Ryan B Morgan
- Department of Surgery, University of Chicago, Chicago, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine, Orange, USA.
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Dhiman A, Vining CC, Witmer HDD, Sood D, Shergill A, Kindler H, Roggin KK, Posner MC, Ahmed OS, Liauw S, Pitroda S, Liao CY, Karrison T, Weichselbaum R, Polite B, Eng OS, Catenacci DVT, Turaga KK. ASO Visual Abstract: Phase II Prospective Open-Label Randomized Controlled Trial Comparing Standard of Care Chemotherapy with and without Sequential Cytoreductive Interventions for Patients with Oligometastatic Foregut Adenocarcinoma and Undetectable Circulating Tumor-Deoxyribose Nucleic Acid (ctDNA) Levels. Ann Surg Oncol 2022; 29:616-617. [PMID: 35930113 DOI: 10.1245/s10434-022-11448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ankit Dhiman
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charles C Vining
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hunter D D Witmer
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Divya Sood
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Ardaman Shergill
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Hedy Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kevin K Roggin
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Mitchell C Posner
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | | | - Stanley Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Sean Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Chih-Yi Liao
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Blasé Polite
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel V T Catenacci
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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Khan S, Sharma S, Sood D, Garg B, Jaquish D, Mose E, Esparza E, Tiriac H, Lowy AM. Abstract B017: MICAL2 promotes pancreatic cancer growth and metastasis independent of MRTF-A signaling. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-b017] [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: 11/17/2022]
Abstract
Abstract
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer in large part due to its propensity for early metastasis. We used ChIP-seq to identify differentially tagged super-enhancer associated genes in PDAC and identified MICAL2 as a gene of interest. MICAL (molecule interacting with CasL) proteins are flavin monooyxgenases that induce actin depolymerization. MICAL2 canonically modulates nuclear actin to regulate SRF/MRTF-A (myocardin related transcription factor) mediated transcription to drive EMT (epithelial-mesenchymal transition) and fibrosis. In this study, we sought to determine the impact of MICAL2 on PDAC progression and its dependence on SRF/MRTF-A signaling. Methods: Studies were performed in human and murine PDAC models. MICAL2 and MRTF-A were knocked down with shRNA and gene expression quantitated with qPCR. In vitro cell viability was assessed by MTT colorimetric assay. Cell migration was tested with in vitro wound scratch assays. Cell cycle analysis was done with flow cytometry-based DNA content measurement. Subcutaneous, orthotopic, and intrasplenic injections of PDAC cells were performed to assess in vivo growth and metastasis. Protein expression was measured with Western blotting. Student’s t-test was used to confirm statistical significance of experimental results. Results: In human PDAC cell lines, MICAL2 knockdown decreased cell viability, reduced cell migration and wound healing, and induced cell cycle arrest at G0/G1. MICAL2 inhibition was associated with decreased p-AKT, c-Myc, and increased p27 by Western blot. Orthotopic and subcutaneous injections of KPC46 shMICAL2 cells were performed in syngeneic mice; orthotopic injections of shMICAL2 cells led to decreased tumor growth compared to control (0.26 gm vs. 1 gm, p = 0.008), not observed with shMRTF-A (1.032 gm vs. 1 gm, p = 0.95). Subcutaneous injections of MICAL2 knockdown cells led to no tumor growth; injections of MRTF-A knockdown cells again led to comparable tumor growth as control (3.02 gm vs. 1.72 gm, p = 0.24). GSEA (Gene Set Enrichment Analysis) of RNAseq data demonstrated a correlation between MICAL2 knockdown and downregulation of Hallmark EMT pathways. Intrasplenic injection studies in syngeneic mice revealed grossly decreased liver metastases after intrasplenic injection of shMRTF-A cells, with total abrogation of metastases after injection of shMICAL2 cells. Conclusions: MICAL2 promotes pancreatic cancer cell growth and metastasis. While MICAL2’s effect on metastasis appears largely dependent on SRF/MRTF-A, tumor growth appears to be MRTF-A independent, suggesting putative novel functions of MICAL2. Given its potentially targetable enzymatic domain and important role in promoting cell growth in vitro and tumor progression and metastasis in vivo, MICAL2 holds promise as a novel tractable therapeutic target in pancreatic cancer.
Citation Format: Sohini Khan, Shweta Sharma, Divya Sood, Bharti Garg, Dawn Jaquish, Evangeline Mose, Edgar Esparza, Herve Tiriac, Andrew M. Lowy. MICAL2 promotes pancreatic cancer growth and metastasis independent of MRTF-A signaling [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B017.
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Affiliation(s)
- Sohini Khan
- 1University of California San Diego, La Jolla, CA,
| | | | | | - Bharti Garg
- 1University of California San Diego, La Jolla, CA,
| | - Dawn Jaquish
- 1University of California San Diego, La Jolla, CA,
| | | | | | - Herve Tiriac
- 1University of California San Diego, La Jolla, CA,
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Sood D, Dhiman A, Ong CT, Liu AY, Belanski J, Turaga KK, Eng OS. The Impact of COVID-19-Related Delays on Surgical Management of Peritoneal Surface Malignancies. Ann Surg Oncol 2022; 29:5377-5378. [PMID: 35503391 PMCID: PMC9063612 DOI: 10.1245/s10434-022-11814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Divya Sood
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Ankit Dhiman
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Cecilia T Ong
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Andrea Y Liu
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jennifer Belanski
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Division of Surgical Oncology, Department of Surgery, University of California - Irvine, 333 City Boulevard, West, Suite 1600, Orange, CA, USA.
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Vining CC, Kuchta K, Al Abbas AI, Hsu PJ, Paterakos P, Schuitevoerder D, Sood D, Roggin KK, Talamonti MS, Hogg ME. Bile leak incidence, risk factors and associated outcomes in patients undergoing hepatectomy: a contemporary NSQIP propensity matched analysis. Surg Endosc 2022; 36:5710-5723. [PMID: 35467144 DOI: 10.1007/s00464-021-08938-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite advances in surgical technique, bile leak remains a common complication following hepatectomy. We sought to identify incidence of, risk factors for, and outcomes associated with biliary leak. STUDY DESIGN This is an ACS-NSQIP study. Distribution of bile leak stratified by surgical approach and hepatectomy type were identified. Univariate and multivariate factors associated with bile leak and outcomes were evaluated. RESULTS Robotic hepatectomy was associated with less bile leak (5.4% vs. 11.4%; p < 0.001) compared to open. There were no significant differences in bile leak between robotic and laparoscopic hepatectomy (5.4% vs. 5.3%; p = 0.905, respectively). Operative factors risk factors for bile leak in patients undergoing robotic hepatectomy included right hepatectomy [OR 4.42 (95% CI 1.74-11.20); p = 0.002], conversion [OR 4.40 (95% CI 1.39-11.72); p = 0.010], pringle maneuver [OR 3.19 (95% CI 1.03-9.88); p = 0.044], and drain placement [OR 28.25 (95% CI 8.34-95.72); p < 0.001]. Bile leak was associated with increased reoperation (8.7% vs 1.7%, p < 0.001), 30-day readmission (26.6% vs 6.8%, p < 0.001), 30-day mortality (2% vs 0.9%, p < 0.001), and complications (67.2% vs 23.4%, p < 0.001) for patients undergoing MIS hepatectomy. CONCLUSION While MIS confers less risk for bile leak than open hepatectomy, risk factors for bile leak in patients undergoing MIS hepatectomy were identified. Bile leaks were associated with multiple additional complications, and the robotic approach had an equal risk for bile leak than laparoscopic in this time period.
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Affiliation(s)
- Charles C Vining
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building-Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Amr I Al Abbas
- Department of Surgery, University of Texas Southwestern, Dallas, USA
| | - Phillip J Hsu
- Department of Surgery, University of Chicago, Chicago, USA
| | - Pierce Paterakos
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building-Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | | | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago, Chicago, USA
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building-Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA
| | - Melissa E Hogg
- Department of Surgery, NorthShore University HealthSystem, Walgreens Building-Floor 2, 2650 Ridge Road, Evanston, IL, 60201, USA.
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Sood D, Fefferman ML, Reizine NM, Morgan RB, Ong CT, Dhiman A, Turaga K, Catenacci DV, Eng O. Impact of hyperthermic intraperitoneal chemotherapy on genomic heterogeneity of peritoneal metastases in stage IV gastroesophageal adenocarcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
312 Background: Programmed death ligand 1 (PD-L1) expression and tumor mutational burden (TMB) are potential biomarkers for response to therapy. Heterogeneity of PD-L1 and TMB has been demonstrated in gastroesophageal adenocarcinoma (GEA) in response to systemic chemotherapy. With the increased use of hyperthermic intraperitoneal chemotherapy (HIPEC) for GEA peritoneal metastases (PM), we aimed to determine the effects of HIPEC on genomic heterogeneity of PM. Methods: This is a retrospective review of a prospectively maintained database of patients with stage IV GEA who underwent iterative laparoscopic HIPEC (mitomycin C 30 mg + cisplatin 200 mg, 60 minutes) between 2017 and 2021. PD-L1 status and TMB levels were reviewed from peritoneal tumor specimens collected prior to each HIPEC. PD-L1 status was defined as positive if combined positive score (CPS) was 1 or greater using the 22C3 pharmDx assay. TMB levels were defined as low, intermediate, or high for up to 5, 5 to 15, or over 15 mutations per megabase (m/MB), respectively. Potentially actionable and biologically relevant variants were reviewed, as well as overall survival, defined as time from diagnosis with stage IV disease to death from any cause. Results: 16 patients completed at least one HIPEC during the study period. Median age was 55.5 years (range 43-79), 50% were female, and 62.5% were Caucasian. All patients received at least one line of systemic chemotherapy after stage IV diagnosis and prior to first HIPEC. Median peritoneal cancer index at first HIPEC was 15 (range 3-39). Three patients completed only one HIPEC. Of the 13 who completed at least two HIPECs, 5 had sufficient tumor tissue for genomic analysis at two timepoints. Of those 5 patients, one exhibited a change in PD-L1 expression from positive to negative after HIPEC, and one exhibited an increase in TMB from low to intermediate. All 5 patients exhibited a change in the profile of potentially actionable or biologically relevant genetic variants, including gain or loss of mutations in DNA repair genes (RAD51), proto-oncogenes (MET), and tumor suppressor genes (ERBB3, IRS2). Median overall survival amongst the full cohort was 27.4 months, with median follow-up of 26.1 months. Overall survival was higher amongst those who underwent at least 2 HIPECs compared to only one, but this was not statistically significant. Conclusions: Amongst our cohort, only one patient exhibited a change in PD-L1 expression and one in TMB after HIPEC. However, HIPEC was associated with a change in genetic variant profiles in all evaluable patients. If confirmed in larger studies, this temporal genomic heterogeneity could inform the role of PD-L1, TMB, and other genetic variants as predictive biomarkers for therapy after HIPEC. Iterative laparoscopic HIPEC warrants further investigation as a treatment option after systemic therapy for GEA with peritoneal metastases.
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Affiliation(s)
- Divya Sood
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Marie L. Fefferman
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Natalie Marie Reizine
- Department of Medicine, Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL
| | - Ryan B. Morgan
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Cecilia T. Ong
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Ankit Dhiman
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Kiran Turaga
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Daniel V.T. Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Oliver Eng
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
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Morgan RB, Yan A, Dhiman A, Sood D, Ong CT, Wu X, Shergill A, Polite BN, Turaga K, Eng O. Survival in total preoperative verus perioperative chemotherapy for patients with metastatic high-grade appendiceal adenocarcinoma undergoing CRS/HIPEC. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.090] [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
90 Background: Due to the relative infrequency of high grade appendiceal adenocarcinoma with peritoneal metastases, there is limited data to guide treatment strategies. Current practices for this disease are largely extrapolated from colon cancer patients with peritoneal metastases, who typically undergo six months of systemic chemotherapy in conjunction with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). The optimal timing of chemotherapy in relation to CRS/HIPEC remains unknown. In this study, we compare the efficacy of peri-operative chemotherapy to pre-operative chemotherapy alone. Methods: This is a retrospective review of patients who underwent CRS/HIPEC for high grade appendiceal cancers from a tertiary referral center from 2014-2020. Outcomes were compared between patients who underwent planned 6 months of chemotherapy followed by CRS/HIPEC (pre-operative group) versus planned 3 months of chemotherapy both pre- and post-operatively (peri-operative group). Results: 85 patients were treated for metastatic high-grade appendiceal cancers during the study period, of whom24 were eligible for inclusion. Of those included, 16 were in the peri-operative group and 8 in the pre-operative group. Most patients were white (75%), non-Hispanic (96%) and female (54%). Patients in the pre-operative group tended to be older (65 vs. 56 years, p = 0.02). For patients with specified histologic grading, poorly differentiated tumors were common (50%). Signet ring cell histology (42%) and mucinous features (67%) were frequent as well. Median overall survival was similar between the pre-operative and peri-operative groups (32.3 vs. 31.6 months, p = 0.97), although patients undergoing peri-operative treatment received fewer total cycles of chemotherapy on average (14.1 vs. 9.5 cycles, p < 0.01). Half of the patients in the peri-operative group (8/16) did not complete their chemotherapy regimen, with 75% discontinuing therapy due to chemotherapy-related toxicities. Within the peri-operative group, a non-significant decrease in median survival was observed for those who did not complete chemotherapy (27.8 vs > 53.6 months, p = 0.22). Conclusions: Peri-operative and total pre-operative chemotherapy strategies are associated with similar survival in patients with high grade appendiceal cancers undergoing CRS/HIPEC. Peri-operative administration may be limited by chemotherapy-related toxicities.
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Affiliation(s)
- Ryan B. Morgan
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Allie Yan
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Ankit Dhiman
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Divya Sood
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Cecilia T. Ong
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Xiaoyang Wu
- Ben May Department of Cancer Research, University of Chicago, Chicago, IL
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Blase N. Polite
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL
| | - Kiran Turaga
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | - Oliver Eng
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
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Childers BG, Sood D, Patel R, Mose ES, Hosseini M, Kato S, Baumgartner JM, Lowy AM. Palbociclib as a Novel Therapy for Low-Grade Mucinous Carcinomatosis Peritonei of Appendiceal Origin. JCO Precis Oncol 2022; 5:1069-1072. [PMID: 34994628 DOI: 10.1200/po.20.00503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Betzaira G Childers
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
| | - Divya Sood
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
| | - Rohini Patel
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
| | - Evangeline S Mose
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
| | | | - Shumei Kato
- Division of Hematology-Oncology, Department of Medicine, UC San Diego, La Jolla, CA
| | - Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
| | - Andrew M Lowy
- Division of Surgical Oncology, Department of Surgery, UC San Diego, La Jolla, CA
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16
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Dhiman A, Vining CC, Witmer HDD, Sood D, Shergill A, Kindler H, Roggin KK, Posner MC, Ahmed OS, Liauw S, Pitroda S, Liao CY, Karrison T, Weichselbaum R, Polite B, Eng OS, Catenacci DVT, Turaga KK. Phase II Prospective, Open-Label Randomized Controlled Trial Comparing Standard of Care Chemotherapy With and Without Sequential Cytoreductive Interventions for Patients with Oligometastatic Foregut Adenocarcinoma and Undetectable Circulating Tumor Deoxyribose Nucleic Acid (ctDNA) Levels. Ann Surg Oncol 2022; 29:10.1245/s10434-021-11249-7. [PMID: 34988836 PMCID: PMC8730296 DOI: 10.1245/s10434-021-11249-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metastatic adenocarcinomas of foregut origin are aggressive and have limited treatment options, poor quality of life, and a dismal prognosis. A subset of such patients with limited metastatic disease might have favorable outcomes with locoregional metastasis-directed therapies. This study investigates the role of sequential cytoreductive interventions in addition to the standard of care chemotherapy in patients with oligometastatic foregut adenocarcinoma. METHODS This is a single-center, phase II, open-label randomized clinical trial. Eligible patients include adults with synchronous or metachronous oligometastatic (metastasis limited to two sites and amenable for curative/ablative treatment) adenocarcinoma of the foregut without progression after induction chemotherapy and having undetectable ctDNA. These patients will undergo induction chemotherapy and will then be randomized (1:1) to either sequential curative intervention followed by maintenance chemotherapy versus routine continued chemotherapy. The primary endpoint is progression-free survival (PFS), and a total of 48 patients will be enrolled to detect an improvement in the median PFS in the intervention arm with a hazard ratio (HR) of 0.5 with 80% power and a one-sided alpha of 0.1. Secondary endpoints include disease-free survival (DFS) in the intervention arm, overall survival (OS), ctDNA conversion rate pre/post-induction chemotherapy, ctDNA PFS, PFS2, adverse events, quality of life, and financial toxicity. DISCUSSION This is the first randomized study that aims to prospectively evaluate the efficacy and safety of surgical/ablative interventions in patients with ctDNA-negative oligometastatic adenocarcinoma of foregut origin post-induction chemotherapy. The results from this study will likely develop pertinent, timely, and relevant knowledge in oncology.
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Affiliation(s)
- Ankit Dhiman
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charles C Vining
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hunter D D Witmer
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Divya Sood
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Ardaman Shergill
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Hedy Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kevin K Roggin
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Mitchell C Posner
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | | | - Stanley Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Sean Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Chih-Yi Liao
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Blase Polite
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel V T Catenacci
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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17
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Sood D, Kuchta KM, Paterakos P, Vining CC, Talamonti MS, Hogg ME. Extended Postoperative Thromboprophylaxis after Pancreatic Resection for Pancreatic Cancer Is Associated with Decreased Risk of Venous Thromboembolism in the Minimally Invasive Approach. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.317] [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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18
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Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. ASO Visual Abstract: Differences in Sociodemographic Disparities in Patients Undergoing Surgery for Advanced Colorectal and Ovarian Cancer. Ann Surg Oncol 2021. [PMID: 33978887 DOI: 10.1245/s10434-021-10130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ellen M Goldberg
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
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19
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Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. Differences in Sociodemographic Disparities Between Patients Undergoing Surgery for Advanced Colorectal or Ovarian Cancer. Ann Surg Oncol 2021; 28:7795-7806. [PMID: 33959831 DOI: 10.1245/s10434-021-10086-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/16/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) for ovarian cancer with peritoneal metastases (OPM) is an established treatment, yet access-related racial and socioeconomic disparities are well documented. CRS for colorectal cancer with peritoneal metastases (CRPM) is garnering more widespread acceptance, and it is unknown what disparities exist with regards to access. METHODS This retrospective cross-sectional multicenter study analyzed medical records from the National Cancer Database from 2010 to 2015. Patients diagnosed with CRPM or ORP only and either no or confirmed resection were included. Patient- and facility-level characteristics were analyzed using uni- and multivariable logistic regressions to identify associations with receipt of CRS. RESULTS A total of 6634 patients diagnosed with CRPM and 14,474 diagnosed with OPM were included in this study. Among patients with CRPM, 18.1% underwent CRS. On multivariable analysis, female gender (odds ratio [95% CI] 2.04 [1.77-2.35]; P < 0.001) and treatment at an academic or research facility (OR 1.55 [1.17-2.05]; P = 0.002) were associated with CRS. Among patients with OPM, 87.1% underwent CRS. On multivariable analysis, treatment at facilities with higher-income patient populations was positively associated with CRS, while age (OR 0.97 [0.96-0.98]; P < .0001), use of nonprivate insurance (OR 0.69 [0.56-0.85]; P = 0.001), and listed as Black (OR 0.62 [0.45-0.86]; P = 0.004) were negatively associated with CRS. CONCLUSION There were more systemic barriers to CRS for patients with OPM than for patients with CRPM. As CRS becomes more widely practiced for CRPM, it is likely that more socioeconomic and demographic barriers will be elucidated.
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Affiliation(s)
- Ellen M Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
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20
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Khan MS, Dogra R, Miriyala LKV, Salman FNU, Ishtiaq R, Patti DK, Kumar A, Sandho G, Jacob K, Luthra K, Sharma R, Ravikumar R, Edara D, Pittampalli S, Sood D, Khatri V, Mahajan V, Avasthi S, Auoad A, Katragadda S. Clinical characteristics and outcomes of patients with Corona Virus Disease 2019 (COVID-19) at Mercy Health Hospitals, Toledo, Ohio. PLoS One 2021; 16:e0250400. [PMID: 33886663 PMCID: PMC8061926 DOI: 10.1371/journal.pone.0250400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/06/2021] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE The ongoing pandemic of the novel Corona Virus Disease 2019 (COVID-19) is an unprecedented challenge to global health, never experienced before. OBJECTIVE This study aims to describe the clinical characteristics and outcomes of patients with COVID-19 admitted to Mercy Hospitals. DESIGN AND METHODS Retrospective, observational cohort study designed to include every COVID-19 subject aged 18 years or older admitted to Mercy Saint (St) Vincent, Mercy St Charles, and Mercy St Anne's hospital in Toledo, Ohio from January 1, 2020 through June 15th, 2020. Primary Outcome Measure was mortality in the emergency department or as an in-patient. RESULTS 470 subjects including 224 males and 246 females met the inclusion criteria for the study. Subjects with the following characteristics had higher odds (OR) of death: Older age [OR 8.3 (95% CI 1.1-63.1, p = 0.04)] for subjects age 70 or more compared to subjects age 18-29); Hypertension [OR 3.6 (95% CI 1.6-7.8, p = 0.001)]; Diabetes [OR 3.1 (95% CI 1.7-5.6, p<0.001)]; COPD [OR 3.4 (95% CI 1.8-6.3, p<0.001)] and CKD stage 2 or greater [OR 2.5 (95% CI 1.3-4.9, p = 0.006)]. Combining all age groups, subjects with hypertension had significantly greater odds of the following adverse outcomes: requiring hospital admission (OR 2.2, 95% CI 1.4-3.4, p<0.001); needing respiratory support in 24 hours (OR 2.5, 95% CI: 1.7-3.7, p<0.001); ICU admission (OR 2.7, 95% CI 1.7-4.4, p<0.001); and death (OR 3.6, 95% CI 1.6-7.8, p = 0.001). Hypertension was not associated with needing vent in 24 hours (p = 0.07). CONCLUSION Age and hypertension were associated with significant comorbidity and mortality in Covid-19 Positive patients. Furthermore, people who were older than 70, and had hypertension, diabetes, COPD, or CKD had higher odds of dying from the disease as compared to patients who hadn't. Subjects with hypertension also had significantly greater odds of other adverse outcomes.
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Affiliation(s)
- Muhammad Shayan Khan
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Ratika Dogra
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Leela K. V. Miriyala
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - F. N. U. Salman
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Rizwan Ishtiaq
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Dilnoor K. Patti
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Aakash Kumar
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Gaurav Sandho
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Karim Jacob
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Kritika Luthra
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Ravina Sharma
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Rekha Ravikumar
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Dharmakaruna Edara
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Shanti Pittampalli
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Divya Sood
- Internal Medicine Residency, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Vinod Khatri
- Pulmonary and Critical Care, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Vijay Mahajan
- Pulmonary and Critical Care, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Salil Avasthi
- Pulmonary and Critical Care, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Arlette Auoad
- Infectious Diseases, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
| | - Srinivas Katragadda
- Pulmonary and Critical Care, Mercy St Vincent Medical Centre, Toledo, Ohio, United States of America
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21
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Neppala P, Chau HS, Sood D, Berumen J, Mekeel KL. Renal Autotransplantation for Nutcracker Kidney after Prior Right Nephrectomy. Am Surg 2020. [DOI: 10.1177/000313482008600217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pushpa Neppala
- University of California San Diego School of Medicine La Jolla, California
| | - Harrison S. Chau
- Department of Surgery University of California, San Diego La Jolla, California
| | - Divya Sood
- Department of Surgery University of California, San Diego La Jolla, California
| | - Jennifer Berumen
- Division of Transplantation and Hepatobiliary Surgery Department of Surgery University of California, San Diego La Jolla, California
| | - Kristin L. Mekeel
- Division of Transplantation and Hepatobiliary Surgery Department of Surgery University of California, San Diego La Jolla, California
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Neppala P, Chau HS, Sood D, Berumen J, Mekeel KL. Renal Autotransplantation for Nutcracker Kidney after Prior Right Nephrectomy. Am Surg 2020; 86:e88-e89. [PMID: 32106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Childers BG, Sood D, Jaquish D, Lowy AM. Abstract A07: Mst1r inhibition with LY2801653 increases survival in mice bearing aggressive pancreatic adenocarcinoma organoid model. Cancer Res 2019. [DOI: 10.1158/1538-7445.panca19-a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: RON/MST1R is a receptor tyrosine kinase variably expressed in epithelial cells and macrophages and overexpressed in epithelial cancers. It is involved in downstream signaling pathways that regulate cell survival, proliferation, and invasion. In efforts to understand the role of Mst1r in pancreatic cancer progression, genetically engineered mice were created with Mst1r loss of function or Mst1r overexpression. Those with Mst1r overexpression demonstrated earlier metastasis and overall decreased survival. Mst1r and several other kinases are the primary targets of LY2801653, a small-molecule inhibitor. Given the findings in genetically engineered models, we sought to evaluate the effects of Mst1r inhibition with LY2801653 in an immune-competent mouse bearing an aggressive orthotopic, organoid-derived pancreatic cancer.
Methods: All animal procedures were conducted with approval of the Institutional Animal Care and Use Committee at UCSD. Pancreatic adenocarcinoma organoid cell line KPC484 was derived from spontaneous growth in KRAS/p53 mice of B6.129S background. F1 hybrid male and female mice underwent orthotopic injection of the above-mentioned organoid line at 6-8 weeks of life. Daily dosing with Mst1r inhibitor LY2801653 was initiated one week after surgery for a total treatment time of two weeks or until meeting death criteria when evaluating for survival. Control groups received 10% Acacia Gum via oral gavage for the same duration. Mice were euthanized and the primary tumor was collected for weight, flow cytometric markers, histology, and immunohistochemistry.
Results: Mst1r inhibition with LY2801653 in F1 hybrid mice resulted in a significant reduction in primary tumor weight when compared to control groups (p-value = 0.007). Flow cytometry demonstrated significant differences in macrophage cell populations within the tumor microenvironment. Along a phenotypic continuum, macrophages may promote acute inflammation (M1), tissue rebuilding (M2), or some combination thereof. Mst1r inhibition in male mice led to a significant increase in the M1 macrophage phenotype and a significant decrease in the M2 macrophage phenotype with p-values of (0.004) and (0.008) respectively. Survival data were acquired from two separate experiments totaling thirty vehicle mice and thirty-two treatment mice. A significant survival benefit was observed in the treatment group (p-value = 0.01).
Conclusion: An urgent need persists to uncover alternative therapeutic options for pancreatic adenocarcinoma. Here, we utilize an aggressive KPC organoid model to test the in vivo effects of kinase inhibitor LY2801653. Data in our lab demonstrate a modulation of the macrophage phenotype toward M1, a significant reduction in primary tumor size, and a significant survival benefit with treatment. These findings urge the consideration of this drug as a candidate for combination therapy in pancreatic adenocarcinoma.
Citation Format: Betzaira G. Childers, Divya Sood, Dawn Jaquish, Andrew M. Lowy. Mst1r inhibition with LY2801653 increases survival in mice bearing aggressive pancreatic adenocarcinoma organoid model [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2019 Sept 6-9; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2019;79(24 Suppl):Abstract nr A07.
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Affiliation(s)
| | - Divya Sood
- 2University of California San Diego, San Diego, CA
| | - Dawn Jaquish
- 2University of California San Diego, San Diego, CA
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Said ET, Sztain JF, Swisher MW, Martin EI, Sood D, Lowy AM, Gabriel RA. Association of an acute pain service with postoperative outcomes following pancreaticoduodenectomy. J Perioper Pract 2019; 30:309-314. [PMID: 31524066 DOI: 10.1177/1750458919874616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective study was to evaluate the effect of implementing the combination of thoracic epidural analgesia and multimodal analgesia by a dedicated acute pain service on opioid consumption and postoperative outcomes in patients undergoing pancreaticoduodenectomy. Opioid consumption during postoperative days 0-3 was compared in the acute pain service versus non-acute pain service cohort. Between matched cohorts, the median (quartiles) total opioid consumption during postoperative days 0-3 was 114mg morphine equivalents (54.7, 212.4mg morphine equivalents) in the non-acute pain service cohort and 47.4mg morphine equivalents (38.1, 100.8mg morphine equivalents) in the acute pain service cohort; the median difference was 44.8mg morphine equivalents (95% CI 14.2-90.2mg morphine equivalents, p = 0.002). The median difference in hospital length of stay was 2.0 days (95% confidence interval 0.8-4.0, p = 0.01), favouring the acute pain service cohort. A dedicated acute pain service implementing thoracic epidural analgesia in conjunction with multimodal analgesia was associated with decreased opioid consumption and hospital length of stay.
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Affiliation(s)
- Engy T Said
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, USA
| | - Jacklynn F Sztain
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, USA
| | - Matthew W Swisher
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, USA
| | - Erin I Martin
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, USA
| | - Divya Sood
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, USA
| | - Andrew M Lowy
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, USA.,Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, USA
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Sharma M, Sood D, Singh Chauhan N, Verma N, Kapila P. Inferior right hepatic vein on routine contrast-enhanced CT of the abdomen: prevalence and correlation with right hepatic vein size. Clin Radiol 2019; 74:735.e9-735.e14. [PMID: 31235284 DOI: 10.1016/j.crad.2019.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
AIM To determine the prevalence of the inferior right hepatic vein (IRHV) in patients undergoing routine contrast-enhanced computed tomography (CECT) of the abdomen and to compare it with the size of the right hepatic vein (RHV). MATERIALS AND METHODS Two hundred and twenty-four consecutive patients who underwent routine CECT abdomen, with adequate venous opacification, were included in the study. The number and diameter of IRHVs and the diameter of the RHV was noted in each case. RESULTS A total of 214 IRHVs were detected in 126 cases (56.2%) with a mean diameter of 4.15±1.44 mm. The number of IRHVs ranged from one to four (more than one IRHV was present in 39.7% [50/126] of cases). In approximately one-third of cases (46/126), an IRHV ≥5 mm was found. A weak negative correlation was found between size of the RHV and IRHV (Pearson's correlation coefficient -0.222; p=0.01). The RHV was smaller in size in patients with an IRHV (7.34±1.88 mm) than in patients without an IRHV (8.47±1.99 mm) on CECT abdomen. A larger IRHV was associated with a smaller RHV (6.91±2.05 mm). CONCLUSION The presence of IRHV on routine CECT abdomen is frequent, and it is not uncommon to encounter more than one IRHV. The diameter of the IRHV has a weak negative correlation with the diameter of the RHV, and a smaller RHV is found in patients with an IRHV.
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Affiliation(s)
- M Sharma
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India.
| | - D Sood
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
| | - N Singh Chauhan
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
| | - N Verma
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
| | - P Kapila
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
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Weiss A, Parina R, Tapia VJ, Sood D, Lee KC, Horgan S, Freischlag JA, Blair SL, Ramamoorthy SL. Assessing the domino effect: Female physician industry payments fall short, parallel gender inequalities in medicine. Am J Surg 2018; 216:723-729. [PMID: 30093089 DOI: 10.1016/j.amjsurg.2018.07.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/17/2018] [Revised: 04/09/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physician-industry relationships have been complex in modern medicine. Since large proportions of research, education and consulting are industry-backed, this is an important area to consider when examining gender inequality in medicine. METHODS The Open Payments Program (OPP) database from August 2013 to December 2016 was analyzed. In order to identify physicians' genders, the OPP was matched with the National Provider Index dataset. Descriptive statistics of payments to female compared to male surgeons were obtained and stratified by payment type, subspecialty, geographic location and year. RESULTS 3,925,707 transactions to 136,845 physicians were analyzed. Of them, 31,297 physicians were surgeons with an average payment per provider of $131,252 to male surgeons compared to $62,101 to female surgeons. Significantly fewer women received consultant, royalty/licensure, ownership and speaker payments. However, women received a higher average amount per surgeon compared to their male counterparts within research payments. Overall payments to women trended upwards over time. CONCLUSION Gender inequality still exists in medicine, and in industry-physician payments. Industry should increasingly consider engaging women in consultancies, speaking engagements, and research.
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Affiliation(s)
- Anna Weiss
- Brigham and Women's Hospital, Department of Surgical Oncology, Boston, MA, United States.
| | - Ralitza Parina
- Banner University Medical Center Phoenix, Department of Surgery, Phoenix, AZ, United States
| | - Viridiana J Tapia
- Harbor-UCLA Medical Center, Department of Surgery, Carson, CA, United States
| | - Divya Sood
- University of California San Diego, Department of Surgery, La Jolla, CA, United States
| | - Katherine C Lee
- University of California San Diego, Department of Surgery, La Jolla, CA, United States
| | - Santiago Horgan
- University of California San Diego, Department of Surgery, La Jolla, CA, United States
| | - Julie A Freischlag
- Wake Forest Baptist Medical Center, School of Medicine, Winston-Salem, NC, United States
| | - Sarah L Blair
- University of California San Diego, Department of Surgery, La Jolla, CA, United States
| | - Sonia L Ramamoorthy
- University of California San Diego, Department of Surgery, La Jolla, CA, United States
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Sood D, Comer-Hagans D, Anderson D, Basmajian D, Bohlen A, Grome M, Imanova I, Martin K. Discovering Perspectives on Health and Well-Being from Parents and Teachers of Preschool- Aged Children. Open J Occup Ther 2018; 6. [PMID: 30854264 DOI: 10.15453/2168-6408.1365] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background This study explores the concept of health and well-being as perceived by teachers and parents of preschool-aged children in the specific context of a child day care facility. The study also identifies the barriers parents and teachers encounter and the supports they require in promoting the health and well-being of preschool-aged children. Method A qualitative phenomenological research design combined with a projective technique of Photovoice was used for data collection. A total of eight participants, four teachers and four parents of preschool-aged children from a child day care facility, participated in the study. Results Several themes were identified related to barriers that parents and teachers face and the supports they require in promoting the health and well-being of preschool-aged children. Conclusions This study discusses a potential role for occupational therapy practitioners in collaborating with administrators and teachers and parents of preschool-aged children to develop a program to promote the health and well-being of preschool-aged children.
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Sood D, Rathore A, Sood I, Singh G, Sood NN. Long-term outcome of combined trabeculotomy-trabeculectomy by a single surgeon in patients with primary congenital glaucoma. Eye (Lond) 2017; 32:426-432. [PMID: 28983095 DOI: 10.1038/eye.2017.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/03/2017] [Indexed: 12/29/2022] Open
Abstract
PurposeAssess long-term outcome of combined trabeculotomy-trabeculectomy (CTT) in primary congenital glaucoma (PCG).MethodsData of PCG patients treated with CTT by a single surgeon between 1976 and 1993 were reviewed for reduction in intraocular pressure (IOP), visual acuities, surgical success rates, and need for repeat surgeries at last follow-up (FU). At the last FU, IOP<21 mm Hg without any topical antiglaucoma medication (TAM) was complete success and with 1-2 TAMs was qualified success. IOP reduction ≥30% without any TAM was modified complete success and with 1-2 TAMs was modified qualified success. IOP>21 mm Hg, IOP reduction <30%, or use of >2 TAM at last FU, or need for additional surgery was considered as failure.ResultsTwo hundred thirty eyes of 121 patients had been followed up for 21.5-38 years (mean 28.87±2.77 years). Eyes that were pthisical (3), had immeasurable IOP (2), or IOP<6 mm Hg (3) were excluded from the success analysis. At last FU, mean IOP reduction was 22.71±11.28 mm Hg and TAM score was 1.71 (0-4). Complete success was achieved in 14 (6.3%), modified complete success in 14 (6.3%), qualified success in 148 (66.7%), and modified qualified success in 140 (63.1%). Success probability was 95% till 25 years and 92, 90, 85, 79 and 68% at 26, 27, 28, 29, and 30 years, respectively. Severe visual impairment or functional blindness was found in only 13 (10.7%) patients.ConclusionCTT shows long-term success in PCG patients. All patients must be monitored for IOP control to avoid need for repeat surgeries.
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Affiliation(s)
- D Sood
- Glaucoma Clinic New Delhi, New Delhi India.,SK Glaucoma Care Foundation, New Delhi India
| | - A Rathore
- Glaucoma Clinic New Delhi, New Delhi India
| | - I Sood
- SK Glaucoma Care Foundation, New Delhi India
| | - G Singh
- Glaucoma Clinic New Delhi, New Delhi India
| | - N N Sood
- Glaucoma Clinic New Delhi, New Delhi India.,SK Glaucoma Care Foundation, New Delhi India
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Sood D, Austgen K, Fiore C, Orlando D, Johnston B, Miljovska S, Collins C, French R, Lodie T, Lowy AM. Characterizing the Epigenetic Landscape Identifies Putative Therapeutic Targets in the Pancreatic Cancer Chimera. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.291] [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]
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Weiss A, Sood D, Greenway SE, Tomassi M. Value of gastrografin in adhesive small bowel obstruction. Langenbecks Arch Surg 2017; 402:1233-1239. [PMID: 28770343 DOI: 10.1007/s00423-017-1605-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/09/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) from adhesive disease presents great burden for the healthcare system. Some groups have reported water soluble contrast agents (WSCA) protocols, but published studies are underpowered. This study introduces a WSCA protocol to improve outcomes and streamline patient care. STUDY DESIGN The study ran July 1, 2013-June 30, 2015, at Kaiser Permanente San Diego; protocol started July 1, 2014. Data was collected prospectively, on an intention to treat basis. We excluded patients whose SBO were not due to adhesive disease. Protocol included nasogastric tube, intravenous resuscitation, liquid docusate, and gastrografin study if symptoms persisted at 24 h. Colon contrast determined resolution vs operative consideration. Primary outcomes were operative rates and hospital length of stay (LOS). RESULTS Seven hundred fifteen were patients admitted with SBO; after exclusions there were 261 pre-protocol and 243 protocol patients. One hundred sixty patients resolved within 24 h; 96% of remaining patients stayed on protocol (n = 154). After WSCA protocol began, 15.6% required an operation, compared to 19.8% of pre-protocol patients (NS). The WSCA protocol significantly decreased the time to surgery (2.8 vs 4.88 days, p = 0.03), and the LOS of operated patients (9.51 vs 15.78 days, p = 0.02). CONCLUSIONS A standardized SBO protocol using WSCA significantly decreased time to operation and hospital LOS. This approach improves utilization of resources and may improve outcomes. More work should be done to investigate the positive effects of WSCA protocol for patients with SBO.
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Affiliation(s)
- Anna Weiss
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Divya Sood
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Scott E Greenway
- Department of Surgery, Kaiser Permanente San Diego, San Diego, CA, USA
| | - Marco Tomassi
- Department of Surgery, Kaiser Permanente San Diego, San Diego, CA, USA
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Cazes A, Babicky ML, Chakedis J, Sood D, Jaquish D, Lowy AM. Abstract 2676: Role of the RON kinase in the regulation of the antitumor immune response in pancreatic cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
RON is a cell-surface receptor for the macrophage-stimulating protein expressed in tissue-resident macrophages and overexpressed in multiple epithelial neoplasms including pancreatic cancer. Our laboratory recently found that RON serves to mediate pancreatic duct carcinogenesis initiated by KRAS. We demonstrated that RON overexpression in the pancreas results in more rapid local and metastatic progression ultimately associated with decreased survival. We also discovered profound changes in the immunophenotype within the tumor microenvironment associated with RON expression. We notably established that RON expression drives the polarization of tumor-associated macrophages into an alternative, pro-tumorigenic state. We hypothesize that these unique activities help to shape the immunosuppressive milieu of the pancreatic cancer microenvironment and that RON directed therapy has the potential to serve as a novel immunomodulatory strategy in this disease. The aim of this work is to define how RON signaling contributes to shaping the pancreatic cancer microenvironment. In order to further interrogate the role of RON during pancreatic carcinogenesis, we bred kinase-dead RON mice (KD) to Pdx1-cre/LSL-KRASG12D mice. We observed a significant delay in the onset of pancreatic neoplasia and a significant decrease in tumor weight. The absence of functional RON kinase markedly reduced trafficking of CD11b+ cells to the pancreas and immunophenotyping in tumors showed a clear reduction of alternatively polarized macrophages when compared to RON overexpression or KRAS mutation alone. Because RON is expressed in both epithelial and stromal cell populations, we further sought to dissect the relevance of RON function to tumor growth within these cellular compartments. We performed orthotopic injections of organoïd-3D cells derived from tumors of KPC mice (LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx-1-Cre). These cells were injected in wild type (WT) or RON KD mice. Preliminary results show that tumor growth is impaired in KD mice, suggesting that RON activity in the host microenvironment influence tumor growth. In order to identify all immune populations regulated by RON, we will conduct an exhaustive immunophenotyping of murine pancreatic tumors. A transcriptomic analysis will then be conducted on selected cell populations to better define the molecular mechanisms associated with the RON regulation. Finally, given the effect of RON signaling on macrophage polarization, we will also dissect the effects of RON signaling from bone marrow derived myeloid cells versus resident tissue macrophages. Preliminary results and future experiments will significantly narrow the gap in our understanding of how RON signaling contributes to shaping the pancreatic cancer chimera and therefore how RON-directed therapies could be most successfully utilized to the benefit of those afflicted with this most deadly disease
Citation Format: Alex Cazes, Michele L. Babicky, Jeffery Chakedis, Divya Sood, Dawn Jaquish, Andrew M. Lowy. Role of the RON kinase in the regulation of the antitumor immune response in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2676. doi:10.1158/1538-7445.AM2017-2676
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Affiliation(s)
- Alex Cazes
- University of California San Diego, La Jolla, CA
| | | | | | - Divya Sood
- University of California San Diego, La Jolla, CA
| | - Dawn Jaquish
- University of California San Diego, La Jolla, CA
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Perng W, Oken E, Roumeliotaki T, Sood D, Siskos AP, Chalkiadaki G, Dermitzaki E, Vafeiadi M, Kyrtopoulos S, Kogevinas M, Keun HC, Chatzi L. Leptin, acylcarnitine metabolites and development of adiposity in the Rhea mother-child cohort in Crete, Greece. Obes Sci Pract 2016; 2:471-476. [PMID: 28090353 PMCID: PMC5192536 DOI: 10.1002/osp4.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aims to investigate relations of serum leptin at age 4 with development of adiposity and linear growth during 3 years of follow-up among 75 Greek children and to identify serum metabolites associated with leptin at age 4 and to characterize their associations with adiposity gain and linear growth. METHODS Linear regression models that accounted for maternal age, education and gestational weight gain and child's age and sex were used to examine associations of leptin and leptin-associated metabolites measured at age 4 with indicators of adiposity and linear growth at age 7. RESULTS Each 1-unit increment in natural log-(ln)-transformed leptin corresponded with 0.33 (95% CI: 0.10, 0.55) units greater body mass index-for-age z-score gain during follow-up. Likewise, higher levels of the leptin-associated metabolites methylmalonyl-carnitine and glutaconyl-carnitine corresponded with 0.14 (95% CI: 0.01, 0.27) and 0.07 (95% CI: -0.01, 0.16) units higher body mass index-for-age z-score gain, respectively. These relationships did not differ by sex or baseline weight status and were independent of linear growth. CONCLUSIONS These findings suggest that leptin, methylmalonyl-carnitine and possibly glutaconyl-carnitine are associated with weight gain during early childhood. Future studies are warranted to confirm these findings in other populations.
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Affiliation(s)
- W. Perng
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - E. Oken
- Department of Population MedicineHarvard Medical School/Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - T. Roumeliotaki
- Department of Social Medicine, Faculty of MedicineUniversity of CreteHeraklionGreece
| | - D. Sood
- Department of Surgery and Cancer, Faculty of MedicineImperial College LondonLondonUK
| | - A. P. Siskos
- Department of Surgery and Cancer, Faculty of MedicineImperial College LondonLondonUK
| | - G. Chalkiadaki
- Department of Social Medicine, Faculty of MedicineUniversity of CreteHeraklionGreece
| | - E. Dermitzaki
- Lab of Clinical Chemistry‐Biochemistry, Department of Laboratory Medicine, School of MedicineUniversity of CreteHeraklionCreteGreece
| | - M. Vafeiadi
- Department of Social Medicine, Faculty of MedicineUniversity of CreteHeraklionGreece
| | - S. Kyrtopoulos
- Institute of Biology, Medicinal Chemistry and BiotechnologyNational Hellenic Research FoundationAthensGreece
| | - M. Kogevinas
- Center for Environmental Research, CREALBarcelonaSpain
| | - H. C. Keun
- Department of Surgery and Cancer, Faculty of MedicineImperial College LondonLondonUK
| | - L. Chatzi
- Department of Social Medicine, Faculty of MedicineUniversity of CreteHeraklionGreece
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Weiss AC, Sood D, Tomassi MJ. Gastrografin-Based Treatment Protocol Reduces Time to Surgery in Adhesive Small Bowel Obstruction: Results of a Large Prospective Study. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.364] [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: 11/17/2022]
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Ward E, Schiavazzi D, Sood D, Lane J, Owens E, Marsden A, Barleben A. CT FFR Can Accurately Identify Culprit Lesions In Aorto-Iliac Occlusive Disease Using Minimally-Invasive Techniques. Ann Vasc Surg 2016. [DOI: 10.1016/j.avsg.2016.05.030] [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: 11/30/2022]
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Schranz C, Szymanski M, Sood D. Enriched Home Environment Program for Preschool Children With Autism Spectrum Disorders. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-po6072] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/18/2015
In this study, we discuss the impact of the Enriched Home Environment Program (EHEP) on participation in home activities between two preschool-aged children with autism spectrum disorder (ASD), using case study methodology.
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Verburg H, Schranz C, Foley B, Kozy K, Casali V, Sood D. Influence of Culture on the Occupational Therapy Process in the Early Intervention System. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-po4085] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/17/2015
This qualitative research study discusses factors that influence the occupational therapy process as perceived by occupational therapists in the early intervention system who work with families from diverse cultures.
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Sood D, Subramaniam AV, Subramaniam T. Association and Correlation between Temporomandibular Disorders and Psychological Factors in a Group of Dental Undergraduate Students. ACTA ACUST UNITED AC 2014. [DOI: 10.3126/ijasbt.v2i4.11204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aims/Objectives: To evaluate the prevalence and severity of temporomandibular disorders (TMD) and presence of psychological factors (i.e.,anxiety and depression levels) in dental undergraduate students. Second purpose was to assess the association and correlation between TMD degree and psychological factors viz. anxiety and depression.Materials and methods: The sample comprised of 400 Dental undergraduatestudents aged 18- 25 years, including both the genders. TMD degree was evaluated using an anamnestic questionnaire (modified version of Helkimo’s anamnestic index). Morphologic occlusion was evaluated according to Angle classification. The Hospital Anxiety and Depression Scale (HADS) was used to assess of levels of anxiety (HADSa) and depression (HADSd) in the dental undergraduate students.Results: Onbasisof the TMD anamnestic index, 74% of students were TMD free. 24.5% of subjects presented with mild degree of TMD and only 1.5% of subjects presented with moderate degree of TMD. According to the results obtained from HADSa, 35.3% of subjects presented with mild anxiety level, 13.8% with moderate anxiety level, and only 1.3% with severe anxiety level. According to the results obtained from HADSd, 10.3% of subjects presented with mild depression level and only 2.3% with moderate depression level. A definite association between TMD degree and Anxiety level (HADSa) was found. A definite association between TMD degree and Depression level (HADSd) was found. Therewas significant association between TMD degree and occlusion.Conclusions: On the basis of anamnestic index, this study revealed a 26% TMD prevalence in the dental undergraduate students included in the study; majority of cases being of mild degree. Both anxiety and depression were found to be associated with TMD degree/severity. Both anxiety and depression are weakly correlated with TMD in the present study.DOI: http://dx.doi.org/10.3126/ijasbt.v2i4.11204 Int J Appl Sci Biotechnol, Vol. 2(4): 426-431
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Rao D, Sood D, Pathak P, Dongre S. A cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report. Emerg (Tehran) 2014; 2:12-7. [PMID: 26495335 PMCID: PMC4614613] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Incidence of sudden cardiac death (SCD) has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India. METHODS The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred. RESULTS A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127), followed closely by the age group 60-69 (28.43%; n-58). Male to female ratio was around 10:1. The maximum number of deaths (n=78) was within few hours (6 hours) after the onset of signs and symptoms. In 24 (11.8%) cases major narrowing was noted in both the main coronaries, in 87 (42.6%) cases in the left anterior descending coronary artery (LAD), and in 18 (51.5%) cases in the right coronary artery (RCA). The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86%) and myocardial infarction (n-104; 50.9%). most of the SCDs occurred in the place of residence (n-80; 39.2%) followed closely by death in hospital (n-49; 24.01%). CONCLUSION Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1.
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Affiliation(s)
- Dinesh Rao
- Executive Director and Chief of Forensic Pathologist, Legal Medicine Unit, Kingston, Jamaica,Corresponding Author: Dinesh Rao; Department of Forensic Medicine, No 15, Chikkasandra, Hesargatta Main Road, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India. Phone/Fax +9741360206;
| | - Divya Sood
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
| | - P. Pathak
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
| | - Sudhir.D Dongre
- Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, India
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Sonkusale P, Bhandarker A, Kurkare N, Ravikanth K, Maini S, Sood D. Hepatoprotective Activity of Superliv Liquid and Repchol in CCl4 Induced FLKS Syndrome in Broilers. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/ijps.2011.49.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Singh M, Sood D, Gupta R, Kumar R, Gautam P, Sewak B, Sharma A, Mathew T. Dynamic Yield Strength of Mild Steel under Impact Loading. DEFENCE SCI J 2008. [DOI: 10.14429/dsj.58.1647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Griffin C, Sharda N, Sood D, Nair J, McNulty J, Pandey S. Selective cytotoxicity of pancratistatin-related natural Amaryllidaceae alkaloids: evaluation of the activity of two new compounds. Cancer Cell Int 2007; 7:10. [PMID: 17550595 PMCID: PMC1892540 DOI: 10.1186/1475-2867-7-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [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: 03/01/2007] [Accepted: 06/05/2007] [Indexed: 11/18/2022] Open
Abstract
Background Pancratistatin (PST), a compound extracted from an Amaryllidaceae (AMD) family plant, has been shown to specifically induce apoptosis in cancer cells with no/minimal toxic effect on normal cells. A systematic synthetic approach has indicated that the minimum cytotoxic pharmacophore comprises the trans-fused b/c-ring system containing the 2, 3, 4-triol unit in the C-ring. To further explore the structure-activity relationship of this group of compounds we have investigated the anti-cancer efficacy and specificity of two PST-related natural compounds, AMD4 and AMD5. Both of these compounds lack the polyhydroxylated lycorane element of PST instead having a methoxy-substuituted crinane skeleton. Results Our results indicate that AMD5 has efficacy and selectivity similar to PST, albeit at a 10-fold increased concentration. Interestingly AMD4 lacks apoptotic activity. Conclusion Our results indicate that the phenanthridone skeleton in natural Amaryllidaceae alkaloids may be a significant common element for selectivity against cancer cells; furthermore, the configuration of the methoxy-side groups is responsible for higher binding affinity to the target protein/s thus making for a more efficient anti-cancer agent.
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Affiliation(s)
- Carly Griffin
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Natasha Sharda
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Divya Sood
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
| | - Jerald Nair
- Department of Chemistry, McMaster University, Hamilton, Ontario, Canada
| | - James McNulty
- Department of Chemistry, McMaster University, Hamilton, Ontario, Canada
| | - Siyaram Pandey
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada
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Narula N, Katyal S, Singh A, Kaul TK, Sood D. Deceptively well kept beard -- seeks attention. Anaesthesia 2002; 57:822-3. [PMID: 12180420 DOI: 10.1046/j.1365-2044.2002.02752_5.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sood NN, Sood D. Primary glaucomas: current concepts and management. J Indian Med Assoc 2000; 98:763-7. [PMID: 11394475] [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: 02/20/2023]
Abstract
Glaucoma is a leading cause of blindness. Delay in diagnosis of open angle glaucoma (OAG) results from lack of symptoms. In angle closure glaucoma (ACG) there is often neglect of symptoms. Creating awareness about the disease and screening the high risk groups would reduce the burden of irreversible blindness due to glaucoma. Adequate therapy in the form of drops, lasers and surgery is available. Close interaction with the physician is important as many topical antiglaucoma medications have adverse systemic side-effects and many drugs used for systemic diseases raise the intra-ocular pressure (IOP). All drugs currently available for glaucoma lower IOP but new drugs for neuroprotection may change the future management strategies. While drugs and surgery are the mainstay for OAG, laser iridotomy is the definitive treatment for ACG.
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Affiliation(s)
- N N Sood
- Glaucoma Service, Shroff Eye Centre, New Delhi
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Sood D, Honavar SG. Sterilisation of tonometers and gonioscopes. Indian J Ophthalmol 1998; 46:113-6. [PMID: 9847488] [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: 02/09/2023] Open
Abstract
Precautions to prevent spread of infection through tonometers and gonioscopes are described in this article. Tonometers and gonioscopes should not be used in the presence of clinically manifest conjunctivitis and keratitis. The Schiotz tonometer should be dipped in a 1:1000 merthiolate solution, and rinsed in saline/distilled water prior to use. The Goldmann applanation prism tip can be wiped with gauze soaked in 70% isopropyl alcohol and then dried before use. Gonioscopes should be cleaned in running water, wiped with gauze soaked in 70% isopropyl alcohol, and then dried before use. Koeppes and goniotomy lenses can be sterilized with ethylene oxide, prior to use in surgery.
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Affiliation(s)
- D Sood
- L.V. Prasad Eye Institute, Hyderabad, India
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