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Shiner A, Kiss A, Saednia K, Jerzak KJ, Gandhi S, Lu FI, Emmenegger U, Fleshner L, Lagree A, Alera MA, Bielecki M, Law E, Law B, Kam D, Klein J, Pinard CJ, Shenfield A, Sadeghi-Naini A, Tran WT. Predicting Patterns of Distant Metastasis in Breast Cancer Patients following Local Regional Therapy Using Machine Learning. Genes (Basel) 2023; 14:1768. [PMID: 37761908 PMCID: PMC10531341 DOI: 10.3390/genes14091768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Up to 30% of breast cancer (BC) patients will develop distant metastases (DM), for which there is no cure. Here, statistical and machine learning (ML) models were developed to estimate the risk of site-specific DM following local-regional therapy. This retrospective study cohort included 175 patients diagnosed with invasive BC who later developed DM. Clinicopathological information was collected for analysis. Outcome variables were the first site of metastasis (brain, bone or visceral) and the time interval (months) to developing DM. Multivariate statistical analysis and ML-based multivariable gradient boosting machines identified factors associated with these outcomes. Machine learning models predicted the site of DM, demonstrating an area under the curve of 0.74, 0.75, and 0.73 for brain, bone and visceral sites, respectively. Overall, most patients (57%) developed bone metastases, with increased odds associated with estrogen receptor (ER) positivity. Human epidermal growth factor receptor-2 (HER2) positivity and non-anthracycline chemotherapy regimens were associated with a decreased risk of bone DM, while brain metastasis was associated with ER-negativity. Furthermore, non-anthracycline chemotherapy alone was a significant predictor of visceral metastasis. Here, clinicopathologic and treatment variables used in ML prediction models predict the first site of metastasis in BC. Further validation may guide focused patient-specific surveillance practices.
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Affiliation(s)
- Audrey Shiner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Alex Kiss
- Institute of Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Khadijeh Saednia
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, Toronto, ON M3J 1P3, Canada
| | - Katarzyna J. Jerzak
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Fang-I Lu
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lauren Fleshner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Andrew Lagree
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Marie Angeli Alera
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Mateusz Bielecki
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Ethan Law
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Brianna Law
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Dylan Kam
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Christopher J. Pinard
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Alex Shenfield
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, Toronto, ON M3J 1P3, Canada
| | - William T. Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.S.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A8, Canada
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2
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Paterson C, Roberts C, Li J, Chapman M, Strickland K, Johnston N, Law E, Bacon R, Turner M, Mohanty I, Pranavan G, Toohey K. What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01401-5. [PMID: 37256499 DOI: 10.1007/s11764-023-01401-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.
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Affiliation(s)
- C Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia.
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Canberra Health Services and ACT Health, Garran, Canberra, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - J Li
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - M Chapman
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- Department of Palliative Care, Canberra Health Services, Garran, Canberra, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - K Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT, Auckland, New Zealand
| | - N Johnston
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - E Law
- Icon Cancer Centre, Canberra, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - I Mohanty
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - G Pranavan
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
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Wright L, Hernlund E, Fjordbakk C, Ytrehus B, Law E, Uhlhorn M, Rhodin M. Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’). Comparative Exercise Physiology 2022. [DOI: 10.3920/cep220011] [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
Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.
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Affiliation(s)
- L. Wright
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - E. Hernlund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - C.T. Fjordbakk
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens vei 24, 1432 Ås, Norway
| | - B. Ytrehus
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, P.O. Box 7028, 750 07 Uppsala, Sweden
| | - E. Law
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Uhlhorn
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Rhodin
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
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Law E, McKenzie L, Blair H, Szoltysek K, Singh M, Bomken S, Lunec J, Irving J, Vormoor J, Heidenreich O. Ex vivo and in vivo complex drug combination analysis for improved
efficacy and specificity in high-risk childhood acute lymphoblastic
leukaemia. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748740] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E Law
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - L McKenzie
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - H Blair
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - K Szoltysek
- Princess Máxima Center for Pediatric Oncology, Utrecht, the
Netherlands
| | - M Singh
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - S Bomken
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - J Lunec
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - J Irving
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
| | - J Vormoor
- Princess Máxima Center for Pediatric Oncology, Utrecht, the
Netherlands
| | - O Heidenreich
- Centre for Cancer, Newcastle University, Newcastle upon Tyne, United
Kingdom
- Princess Máxima Center for Pediatric Oncology, Utrecht, the
Netherlands
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5
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Lagree A, Shiner A, Alera MA, Fleshner L, Law E, Law B, Lu FI, Dodington D, Gandhi S, Slodkowska EA, Shenfield A, Jerzak KJ, Sadeghi-Naini A, Tran WT. Assessment of Digital Pathology Imaging Biomarkers Associated with Breast Cancer Histologic Grade. Curr Oncol 2021; 28:4298-4316. [PMID: 34898544 PMCID: PMC8628688 DOI: 10.3390/curroncol28060366] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/17/2021] [Accepted: 10/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Evaluating histologic grade for breast cancer diagnosis is standard and associated with prognostic outcomes. Current challenges include the time required for manual microscopic evaluation and interobserver variability. This study proposes a computer-aided diagnostic (CAD) pipeline for grading tumors using artificial intelligence. Methods: There were 138 patients included in this retrospective study. Breast core biopsy slides were prepared using standard laboratory techniques, digitized, and pre-processed for analysis. Deep convolutional neural networks (CNNs) were developed to identify the regions of interest containing malignant cells and to segment tumor nuclei. Imaging-based features associated with spatial parameters were extracted from the segmented regions of interest (ROIs). Clinical datasets and pathologic biomarkers (estrogen receptor, progesterone receptor, and human epidermal growth factor 2) were collected from all study subjects. Pathologic, clinical, and imaging-based features were input into machine learning (ML) models to classify histologic grade, and model performances were tested against ground-truth labels at the patient-level. Classification performances were evaluated using receiver-operating characteristic (ROC) analysis. Results: Multiparametric feature sets, containing both clinical and imaging-based features, demonstrated high classification performance. Using imaging-derived markers alone, the classification performance demonstrated an area under the curve (AUC) of 0.745, while modeling these features with other pathologic biomarkers yielded an AUC of 0.836. Conclusion: These results demonstrate an association between tumor nuclear spatial features and tumor grade. If further validated, these systems may be implemented into pathology CADs and can assist pathologists to expeditiously grade tumors at the time of diagnosis and to help guide clinical decisions.
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Affiliation(s)
- Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, ON M5S 1A8, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Audrey Shiner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Marie Angeli Alera
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Lauren Fleshner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Ethan Law
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Brianna Law
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
| | - Fang-I Lu
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (D.D.); (E.A.S.)
| | - David Dodington
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (D.D.); (E.A.S.)
| | - Sonal Gandhi
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada;
| | - Elzbieta A. Slodkowska
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (D.D.); (E.A.S.)
| | - Alex Shenfield
- Department of Engineering and Mathematics, Sheffield Hallam University, Howard St, Sheffield S1 1WB, UK;
| | - Katarzyna J. Jerzak
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada;
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Department of Electrical Engineering and Computer Science, York University, Toronto, ON M3J 2S5, Canada
| | - William T. Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (A.L.); (A.S.); (M.A.A.); (L.F.); (E.L.); (B.L.); (A.S.-N.)
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, ON M5S 1A8, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (F.-I.L.); (S.G.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Correspondence: ; Tel.: +1-416-480-6100 (ext. 3746)
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Meti N, Saednia K, Lagree A, Tabbarah S, Mohebpour M, Kiss A, Lu FI, Slodkowska E, Gandhi S, Jerzak KJ, Fleshner L, Law E, Sadeghi-Naini A, Tran WT. Machine Learning Frameworks to Predict Neoadjuvant Chemotherapy Response in Breast Cancer Using Clinical and Pathological Features. JCO Clin Cancer Inform 2021; 5:66-80. [PMID: 33439725 DOI: 10.1200/cci.20.00078] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) is used to treat locally advanced breast cancer (LABC) and high-risk early breast cancer (BC). Pathological complete response (pCR) has prognostic value depending on BC subtype. Rates of pCR, however, can be variable. Predictive modeling is desirable to help identify patients early who may have suboptimal NAC response. Here, we test and compare the predictive performances of machine learning (ML) prediction models to a standard statistical model, using clinical and pathological data. METHODS Clinical and pathological variables were collected in 431 patients, including tumor size, patient demographics, histological characteristics, molecular status, and staging information. A standard multivariable logistic regression (MLR) was developed and compared with five ML models: k-nearest neighbor classifier, random forest (RF) classifier, naive Bayes algorithm, support vector machine, and multilayer perceptron model. Model performances were measured using a receiver operating characteristic (ROC) analysis and statistically compared. RESULTS MLR predictors of NAC response included: estrogen receptor (ER) status, human epidermal growth factor-2 (HER2) status, tumor size, and Nottingham grade. The strongest MLR predictors of pCR included HER2+ versus HER2- BC (odds ratio [OR], 0.13; 95% CI, 0.07 to 0.23; P < .001) and Nottingham grade G3 versus G1-2 (G1-2: OR, 0.36; 95% CI, 0.20 to 0.65; P < .001). The area under the curve (AUC) for the MLR was AUC = 0.64. Among the various ML models, an RF classifier performed best, with an AUC = 0.88, sensitivity of 70.7%, and specificity of 84.6%, and included the following variables: menopausal status, ER status, HER2 status, Nottingham grade, tumor size, nodal status, and presence of inflammatory BC. CONCLUSION Modeling performances varied between standard versus ML classification methods. RF ML classifiers demonstrated the best predictive performance among all models.
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Affiliation(s)
- Nicholas Meti
- Division of Medical Oncology, Department of Medicine, University of Toronto, ON, Canada.,Temerty Centre for AI Research and Education in Medicine, University of Toronto, ON, Toronto, Canada
| | - Khadijeh Saednia
- Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, Toronto, ON, Canada
| | - Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Sami Tabbarah
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Majid Mohebpour
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Alex Kiss
- Institute of Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fang-I Lu
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elzbieta Slodkowska
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Department of Medicine, University of Toronto, ON, Canada.,Division of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Katarzyna Joanna Jerzak
- Division of Medical Oncology, Department of Medicine, University of Toronto, ON, Canada.,Division of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lauren Fleshner
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Ethan Law
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Ali Sadeghi-Naini
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, ON, Toronto, Canada.,Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, Toronto, ON, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - William T Tran
- Temerty Centre for AI Research and Education in Medicine, University of Toronto, ON, Toronto, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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7
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Sokolov E, Abdoul Bachir DH, Sakadi F, Williams J, Vogel AC, Schaekermann M, Tassiou N, Bah AK, Khatri V, Hotan GC, Ayub N, Leung E, Fantaneanu TA, Patel A, Vyas M, Milligan T, Villamar MF, Hoch D, Purves S, Esmaeili B, Stanley M, Lehn-Schioler T, Tellez-Zenteno J, Gonzalez-Giraldo E, Tolokh I, Heidarian L, Worden L, Jadeja N, Fridinger S, Lee L, Law E, Fodé Abass C, Mateen FJ. Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea. Eur J Neurol 2020; 27:1570-1577. [PMID: 32359218 DOI: 10.1111/ene.14291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility. RESULTS There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.
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Affiliation(s)
- E Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - F Sakadi
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - J Williams
- Department of Neurology, Mater Misericordiae University Hospital and Dublin Neurological Institute, Dublin, Ireland
| | - A C Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - N Tassiou
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - A K Bah
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - V Khatri
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G C Hotan
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston, MA, USA
| | - N Ayub
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - E Leung
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, USA.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, USA
| | - T A Fantaneanu
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - A Patel
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - M Vyas
- Division of Neurology, University of Toronto, Toronto, ON, USA
| | - T Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M F Villamar
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - D Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Purves
- University of British Columbia, Vancouver, BC, Canada
| | - B Esmaeili
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M Stanley
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - J Tellez-Zenteno
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | | | - I Tolokh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - L Worden
- Children's Hospital of Philadelphia, PA, USA
| | - N Jadeja
- University of Massachusetts School of Medicine, Boston, MA, USA
| | - S Fridinger
- Children's Hospital of Philadelphia, PA, USA
| | - L Lee
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Law
- University of Waterloo, Waterloo, ON, Canada
| | - C Fodé Abass
- Department of Neurology, Ignace Deen Hospital, Conakry, Guinea
| | - F J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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de Placido S, Brucker S, Law E, Ajmera M, Mitra D, Davis K, Harbeck N, De Laurentiis M. 175P Real-world patient and practice characteristics associated with use of CDK4/6 inhibitors among patients receiving first therapy for HR+/HER2- advanced or metastatic breast cancer in Italy and Germany. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.275] [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: 10/24/2022] Open
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9
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Tran WT, Jerzak K, Lu FI, Klein J, Tabbarah S, Lagree A, Wu T, Rosado-Mendez I, Law E, Saednia K, Sadeghi-Naini A. Personalized Breast Cancer Treatments Using Artificial Intelligence in Radiomics and Pathomics. J Med Imaging Radiat Sci 2019; 50:S32-S41. [DOI: 10.1016/j.jmir.2019.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022]
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10
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Pender A, Hughesman C, Law E, Kristanti A, Mcneil K, Tucker T, Bosdet I, Young S, Laskin J, Karsan A, Yip S, Ho C. P1.01-40 EGFR ctDNA Detection: The Impact of Site of Progression and Burden of Progressive Disease. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.755] [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: 10/25/2022]
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11
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Dudeney J, Law E, Meyyappan M, Palermo T, Rabbitts J. Evaluating the psychometric properties of the widespread pain index to assess pain extent in youth with painful conditions. The Journal of Pain 2018. [DOI: 10.1016/j.jpain.2017.12.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Harris R, Law E, Sieuwerts A, LaPara K, Leonard B, Starrett G, Temiz NA, Sweep F, Span P, Foekens J, Martens J, Yee D. Abstract S4-07: Tamoxifen resistance driven by the DNA cytosine deaminase APOBEC3B in recurrent estrogen receptor positive breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s4-07] [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
Recent studies have implicated the DNA cytosine deaminase APOBEC3B as a major source of mutation in breast cancer. APOBEC3B explains a large proportion of both dispersed and clustered cytosine mutations, the latter of which are also called kataegis. APOBEC3B expression levels correlate with poor outcomes for patients with estrogen receptor positive breast cancer. While targeted therapies, such as tamoxifen, are available to treat these tumors, secondary drug resistance often develops. Here we suppressed endogenous APOBEC3B in the estrogen receptor positive breast cell line MCF-7L with shRNA. Lowered levels of APOBEC3B did not affect in vitro growth or sensitivity to estradiol. In a xenograft model of tamoxifen therapy, suppression of APOBEC3B associated with prolonged responses to tamoxifen (p<0.05). Furthermore, APOBEC3B over-expression did not affect in vitro cell growth but accelerated the development of tamoxifen-resistant tumors in vivo. In addition, we studied two separate cohorts of 285 breast cancer patients who received first line treatment with tamoxifen for recurrent disease. High APOBEC3B expression levels measured in the primary tumor associated significantly with unfavorable progression free survival in multivariate analysis that included the traditional predictive factors (age, dominant relapse site, disease-free interval, estrogen receptor and progesterone receptor, and adjuvant chemotherapy; HR=1.67, p=0.0001). The median period of progression free survival was 7.5 months for patients with APOBEC3B high primary tumors and 13.3 months for those with APOBEC3B low tumors (p<0.0.0001). These studies demonstrate that APOBEC3B drives resistance to endocrine treatment with tamoxifen in recurrent disease.
Citation Format: Harris R, Law E, Sieuwerts A, LaPara K, Leonard B, Starrett G, Temiz NA, Sweep F, Span P, Foekens J, Martens J, Yee D. Tamoxifen resistance driven by the DNA cytosine deaminase APOBEC3B in recurrent estrogen receptor positive breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S4-07.
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Affiliation(s)
- R Harris
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - E Law
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - A Sieuwerts
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - K LaPara
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - B Leonard
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - G Starrett
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - NA Temiz
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - F Sweep
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - P Span
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - J Foekens
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - J Martens
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - D Yee
- University of Minnesota, Minneapolis, MN; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
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King MR, Anderson NJ, Liu C, Law E, Cundiff M, Mixcoatl-Zecuatl TM, Jolivalt CG. Activation of the insulin-signaling pathway in sciatic nerve and hippocampus of type 1 diabetic rats. Neuroscience 2015; 303:220-8. [PMID: 26149351 DOI: 10.1016/j.neuroscience.2015.06.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 12/20/2022]
Abstract
Peripheral neuropathy is a major complication associated with diabetes and central neuropathy characterized by Alzheimer's disease-like features in the brain is associated with increased dementia risk for patients with diabetes. Although glucose uptake into the cells of the nervous system is insulin-independent, contribution of impaired insulin support is clearly recognized to play a role, however not yet fully understood, in the development of neuropathy. In this study, we assessed the direct role of insulin on the peripheral nervous system (PNS) and central nervous system (CNS) of insulin-dependent type 1 diabetic rats. Fresh sciatic nerve and hippocampus from control and diabetic rats were incubated with varied ex vivo concentrations of insulin and phosphorylation levels of insulin receptor and glycogen synthase kinase-3 (GSK3β) were assessed by Western blot analysis. Both the sciatic nerve and hippocampus from type 1 diabetic rats were highly responsive to exogenous insulin with a significantly increased phosphorylation of insulin receptor and GSK3 compared to tissues from control rats. Further, sustained in vivo insulin delivery, not sufficient to restore normal blood glucose, normalized the activation of both insulin receptor and GSK3 in both PNS and CNS tissues. These results suggest that the insulin-signaling pathway is responsive to exogenous insulin in the nervous system of insulin-deficient type 1 diabetic rats and that constant insulin delivery restore normal nerve function and may protect PNS and CNS from damage.
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Affiliation(s)
- M R King
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - N J Anderson
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - C Liu
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - E Law
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - M Cundiff
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | | | - C G Jolivalt
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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14
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Bong J, Law E, Koshman S, Tymchak W, Moghrabi A, Ackman M. Evaluating Current Practice and Outcomes of Therapeutic Anticoagulation During Intra-Aortic Balloon Counterpulsation in a Coronary Care Unit JL Bong, EH Law, SL Koshman, WJ Tymchak, AM Moghrabi, ML Ackman. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.387] [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: 11/29/2022] Open
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15
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Tom A, Bennett A, Rothenstein D, Milgrom S, Law E, Mangarin E, Wu A, Goodman K. Prevalence of Patient-Reported Gastrointestinal Symptoms and Concordance With Clinician Toxicity Assessments in Radiation Therapy for Anal Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1513] [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: 10/26/2022]
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16
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Son C, Law E, Oh J, Apte A, Yang T, Deasy J, Goodman K. Dosimetric Predictors of Radiation-induced Vaginal Stenosis in Rectal and Anal Cancer Patients. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Law E, Lu S, Kieffer TJ, Warnock GL, Ao Z, Woo M, Marzban L. Differences between amyloid toxicity in alpha and beta cells in human and mouse islets and the role of caspase-3. Diabetologia 2010; 53:1415-27. [PMID: 20369225 DOI: 10.1007/s00125-010-1717-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/10/2010] [Indexed: 12/31/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is characterised by decreased beta cell mass and islet amyloid formation. Islet amyloid formed by aggregation of human islet amyloid polypeptide (hIAPP) is associated with beta cell apoptosis. We used human and transgenic mouse islets in culture to examine whether deletion of caspase-3 protects islets from apoptosis induced by endogenously produced and exogenously applied hIAPP and compared hIAPP toxicity in islet alpha and beta cells. METHODS Human and wild-type or caspase-3 knockout mouse islet cells were treated with hIAPP. Rat insulinoma INS-1 cells were similarly cultured with hIAPP and the amyloid inhibitor Congo Red or caspase-3 inhibitor. Human and hIAPP-expressing caspase-3 knockout mouse islets were cultured to form amyloid fibrils and assessed for beta and alpha cell apoptosis, beta cell function and caspase-3 activation. RESULTS hIAPP-treated INS-1 cells had increased caspase-3 activation and apoptosis, both of which were reduced by inhibitors of amyloid or caspase-3. Similarly, hIAPP-treated human and mouse islet beta cells had elevated active caspase-3- and TUNEL-positive cells, whereas mouse islet cells lacking caspase-3 had markedly lower beta cell but comparable alpha cell apoptosis. During culture, human islets that formed amyloid had higher active caspase-3- and TUNEL-positive beta cells than those without detectable amyloid. Finally, cultured hIAPP-expressing mouse islets lacking caspase-3 had markedly lower beta cell apoptosis than those expressing caspase-3, associated with an increase in islet beta cell/alpha cell ratio, insulin content and glucose response. CONCLUSIONS/INTERPRETATION Prevention of caspase-3 activation protects islet beta cells from apoptosis induced by fibrillogenesis of endogenously secreted and exogenously applied hIAPP. Islet beta cells are more susceptible to hIAPP toxicity than alpha cells cultured under the same conditions.
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Affiliation(s)
- E Law
- Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Batchu SN, Law E, Brocks DR, Falck JR, Seubert JM. Epoxyeicosatrienoic acid prevents postischemic electrocardiogram abnormalities in an isolated heart model. J Mol Cell Cardiol 2008; 46:67-74. [PMID: 18973759 DOI: 10.1016/j.yjmcc.2008.09.711] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/22/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022]
Abstract
Cytochrome P450 epoxygenases metabolize arachidonic acid (AA) to epoxyeicosatrienoic acids (EETs) which are in turn converted to dihydroxyeicosatrienoic acids (DHETs) by soluble epoxide hydrolase (sEH). The main objective of this study was to investigate the protective effects of EETs following ischemic injury using an ex vivo electrocardiogram (EKG) model. Hearts from C57Bl/6, transgenic mice with cardiomyocyte-specific overexpression of CYP2J2 (Tr) and wildtype (WT) littermates were excised and perfused with constant pressure in a Langendorff apparatus. Electrodes were placed superficially at the right atrium and left ventricle to assess EKG waveforms. In ischemic reperfusion experiments hearts were subjected to 20 min of global no-flow ischemia followed by 20 min of reperfusion (R20). The EKG from C57Bl/6 hearts perfused with 1 microM 14,15-EET showed less QT prolongation (QTc) and ST elevation (STE) (QTc=41+/-3, STE=2.3+/-0.3; R20: QTc=42+/-2 ms, STE=1.2+/-0.2mv) than control hearts (QTc=36+/-2, STE=2.3+/-0.2; R20: QTc=53+/-3 ms; STE=3.6+/-0.4mv). Similar results of reduced QT prolongation and ST elevation were observed in EKG recording from CYP2J2 Tr mice (QTc=35+/-1, STE=1.9+/-0.1; R20: QTc=38+/-4 ms, STE=1.3+/-0.2mv) compared to WT hearts. The putative epoxygenase inhibitor MS-PPOH (50 microM) and EET antagonist 14,15-EEZE (10 microM) both abolished the cardioprotective response, implicating EETs in this process. In addition, separate exposure to the K(ATP) channel blockers glibenclamide (1 microM) and HMR1098 (10 microM), or the PKA protein inhibitor H89 (50 nM) during reperfusion abolished the improved repolarization in both the models. Consistent with a role of PKA, CYP2J2 Tr mice had an enhanced activation of the PKAalpha regulatory II subunit in plasma membrane following IR injury. The present data demonstrate that EETs can enhance the recovery of ventricular repolarization following ischemia, potentially by facilitating activation of K(+) channels and PKA-dependent signaling.
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Affiliation(s)
- S N Batchu
- Faculty of Pharmacy and Pharmaceutical Sciences, 3126 Dentistry/Pharmacy Centre, University of Alberta, Edmonton, AB, Canada
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Dallalio G, Law E, Means RT. 193 PLACENTAL GROWTH FACTOR PROTECTS ERYTHROID CELLS FROM CYTOKINE-MEDIATED APOPTOSIS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.192] [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: 11/18/2022]
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Livera G, Xie F, Garcia MA, Jaiswal B, Chen J, Law E, Storm DR, Conti M. Inactivation of the mouse adenylyl cyclase 3 gene disrupts male fertility and spermatozoon function. Mol Endocrinol 2005; 19:1277-90. [PMID: 15705663 DOI: 10.1210/me.2004-0318] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mammalian spermatids and spermatozoa express functional G protein-coupled receptors. However, bicarbonate-regulated soluble adenylyl cyclase (AC), the major AC present in these cells, is not directly coupled to G proteins. To understand how G protein-coupled receptors signal in spermatozoa, we investigated whether a conventional transmembrane cyclase is present and biologically active in these cells. Here, we provide evidence for expression of type 3 AC (AC3) in male germ cells and describe the effects of disruption of the AC3 gene on fertility and function of mouse spermatozoa. As previously reported in rat, AC3 mRNA is expressed in mouse testes and localized, together with soluble AC mRNA, mainly in postmeiotic germ cells. AC3 protein was detected by immunolocalization in round and elongating spermatids in a region corresponding to the developing acrosome and was retained in the mature spermatozoa of the epididymis. Forskolin caused a small increase in cAMP production in mouse spermatozoa, but this increase could not be detected in the AC3(-/-) mice. Inactivation of the AC3 gene did not have overt effects on spermatogenesis; however, AC3(-/-) males were subfertile with only three litters generated by 11 males over a period of 6 months. When used in in vitro fertilization, spermatozoa from these AC3(-/-) mice produced few embryos, but their fertilizing ability was restored after removal of the zona pellucida. Despite an apparently normal structure, these spermatozoa had decreased motility and showed an increase in spontaneous acrosome reactions. These data support the hypothesis that AC3 is required for normal spermatid or spermatozoa function and male fertility.
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Affiliation(s)
- G Livera
- Division of Reproductive Biology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Room A344, Stanford, CA 94305-5317, USA
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Law E. Training for women. Br Dent J 2002; 192:362. [PMID: 12017450] [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: 02/25/2023]
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Monaghan N, Law E, Raven G, Jolley P, Quant J, Baker S, Sanders H, Stillman-Lowe C, Bray S. Facial aesthetics. Br Dent J 2002. [DOI: 10.1038/sj.bdj.4801377a] [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: 11/09/2022]
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Still JM, Law E, Friedman B, Gates CE. A patient with an electrical burn treated by modified bilateral hemipelvectomy and disarticulation of the right arm. J Burn Care Rehabil 2001; 22:321-4. [PMID: 11570531 DOI: 10.1097/00004630-200109000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
A 23-year-old Hispanic worker sustained an electrical injury to 45% of his body when a crane hit a power line. Amputations of both legs, with bilateral partial hemipelvectomies, were required. A disarticulation of the right arm at the shoulder was also preformed. Resection of necrotic bowel, debridement of 95% of the abdominal wall, and resection of the genitalia was eventually required, with later reconstruction of the abdominal wall. After wound healing was complete, the patient was fitted with Jobst garments. A customized bucket prosthesis with a temperature control, to allow sitting upright, was provided. An electric wheel chair and a myoelectronic prosthetic arm were supplied. Rehabilitation was begun early.
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Affiliation(s)
- J M Still
- Joseph M. Still Burn Center, Doctors Hospital, Augusta, Georgia, USA
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Abstract
A small but significant number of adults admitted to our burn center were assaulted by burning. Eighty-five such cases were identified at our burn center. Fifteen deaths were caused by these assaults. These cases are in one sense unique in that in addition to the burn victim, society is also obliged to expend resources dealing with the assailant.
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Affiliation(s)
- T W Dorn
- Joseph M. Still Burn Center, Doctors Hospital, Augusta, Georgia, USA
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Still J, Law E, Friedman B, Fuhrman S, Newton T. Vancomycin-resistant organisms on a burn unit. South Med J 2001; 94:810-2. [PMID: 11549193] [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: 02/21/2023]
Abstract
The incidence of infections due to vancomycin-resistant organisms has significantly increased during the past several years. This is important because vancomycin has been the drug of choice for treatment of infections due to methicillin-resistant Staphylococcus aureus (MRSA). Enterococci resistant to vancomycin are now emerging, and MRSA organisms with intermediate resistance to vancomycin have been identified in some centers. Cross transfer of resistance will eventually lead to the widespread development of organisms that are more difficult to eradicate. In our burn unit, we have encountered six patients (five with burns, one with necrotizing fasciitis) who had wound infections with vancomycin-resistant enterococci. Four patients died, and two recovered after prolonged hospital stays. Attempts to limit development of vancomycin-resistant enterococci are important.
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Affiliation(s)
- J Still
- Joseph M. Still Burn Center, Doctors Hospital, Augusta, GA, USA
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28
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Abstract
Injuries due to accidental contact with steam are occasionally encountered. They can be quite severe, especially when associated respiratory problems are present. Thirteen patients with burns resulting from exposure to steam were admitted to the Joseph M. Still Burn Center during a 2-year period. All injuries were employment related. Twelve burns resulted from the rupture of pipes carrying steam. One additional case was due to a cooking accident. There were 12 males and one female. Burn size ranged from 1 to 57% (mean 26.2%). Age ranged from 26 to 53 years (mean 33). Seven had inhalation injuries with blistering and slough of bronchial mucosa. The hospital stay ranged from 2 to 41 days. One patient died of respiratory problems. From one to five operations were required by the survivors; two required later reconstructive surgery. Closer supervision of industrial plants in which pipes carrying steam are present may have prevented some of these accidents.
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Affiliation(s)
- J Still
- Joseph M. Still Burn Center, Physician's Multispeciality Group, Doctor's Hospital, 1220 George C. Wilson Drive, Augusta, GA 30909, USA
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29
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Abstract
Cancers of various sorts are occasionally encountered in burn scars. These lesions are usually squamous cell carcinomas, and the burn scars are usually old. Very rarely, malignant melanoma is encountered. An 87-year-old nursing home patient who had been burned by a lightening strike at age 16 was evaluated. She had sustained a wound covering 2% or 3% of her body surface involving her neck and the upper portion of her anterior trunk that had required several grafts. A lesion was noted over the suprasternal notch approximately 3 months before admission. The biopsy was reported as malignant melanoma. She was subsequently treated by wide reexcision with an associated Z-plasty for neck release. Because of the patient's age and the presence of four areas of regional lymph nodes nearby into which metastasis might spread, no lymph node dissections were carried out. The specimen from the reexcision was reported as squamous cell carcinoma in situ, melanoma in situ, and multinucleated giant cell reaction, acute and chronic infiltrates. The wound margins were clear.
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Affiliation(s)
- H K Orlet
- The Joseph M. Still Burn Center, Augusta, GA, USA
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30
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Abstract
Lawn mower-related injuries are fairly common and are usually caused by the mower blades. Burns may also be associated with the use of power lawn mowers. We describe 27 lawn mower-related burn injuries of 24 male patients and 3 female patients. Three of the patients with burn injuries were children. Burn sizes ranged from 1% to 99% of the total body surface area (mean, 18.1%). Two of the patients died. The hospital stay ranged from 1 day to 45 days. Twenty-six injuries involved gasoline, which is frequently associated with refueling accidents. Safety measures should involve keeping children away from lawn mowers that are being used. The proper use and storage of gasoline is stressed.
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Affiliation(s)
- J Still
- Joseph M. Still Burn Center, Doctor's Hospital, Augusta, Georgia, USA
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31
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Still J, Friedman B, Furman S, Cohen H, Gates C, Dawson J, Law E. Experience with the insertion of vena caval filters in acutely burned patients. Am Surg 2000; 66:277-9. [PMID: 10759199] [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: 02/16/2023]
Abstract
The use of inferior vena caval filters in patients at high risk of pulmonary emboli is a standard practice in many types of patients. The usefulness of such filters in acutely burned patients has yet to be established. Twenty inferior vena caval filters were inserted in burn patients. Five were inserted because of preexisting thromboembolic disease. Fifteen were placed prophylactically because of high-risk states, including prolonged immobilization, old age, bleeding problems, and obesity. There were no complications due to filter insertion. No postinsertion emboli were recognized. There were no cases of postinsertion thrombophlebitis. In this small series, the procedure appears to be effective and safe.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center Burn Unit, Georgia, USA
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32
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Still J, Newton T, Friedman B, Furhman S, Law E, Dawson J. Experience with pneumonia in acutely burned patients requiring ventilator support. Am Surg 2000; 66:206-9. [PMID: 10695755] [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: 02/15/2023]
Abstract
Acutely burned patients requiring ventilatory support who developed pneumonia while in the hospital were retrospectively reviewed. The Centers for Disease Control and Prevention (CDC) clinical criteria for pneumonia are based on clinical findings, radiographic findings, and culture data. During an 18-month period, 784 burn patients were admitted. Of these, 145 (18.5%) were placed on ventilators for at least 1 day. Fifty-three (36.6%) patients on ventilators developed acute pneumonia based on CDC criteria. Identification of causative organisms was based on positive cultures from blood or endotracheal aspiration within 3 days of the diagnosis of pneumonia. Thirty-nine patients were diagnosed as having inhalation injury. Forty-seven patients were placed on ventilators before or on the day of admission. Ages ranged from 2 to 82 years (mean, 39). Burn size ranged from 2 to 85 per cent (mean, 29.7%) of total body surface area. The total number of ventilator days was 1310 for the 53 patients, with a mean of 27.7 days. Ten patients had positive blood cultures during the period in which pneumonia was present. Thirty-one different organisms were recovered from blood or tracheal aspirates. The most commonly recovered organism was Pseudomonas aeruginosa. In 30 incidences, polymicrobial cultures were encountered. Initiation of appropriate antimicrobial therapy was begun on the basis of clinical impression and current burn unit experience and revised on the basis of the culture data. Of the 53 patients, 13 (25.5%) died, all while still on ventilators. The other 40 patients survived. Thirty-four were weaned off their ventilators, and 6 were transferred while still on ventilator support.
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Affiliation(s)
- J Still
- Burn Unit, Columbia-Augusta Medical Center, Augusta, Georgia, USA
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33
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Abstract
Two patients, burned at ages 2 and 5, developed scars that required multiple reconstructive operations over a period of several years. Tissue expanders were used as part of their reconstructive procedures. After the expanders were removed, skeletal deformity was encountered in the area underlying the expander in each patient. Patient 1 had deformity of the rib cage, and Patient 2 had deformity of the outer table of the skull. No treatment was felt to be indicated. Surgeons should be aware of the possibility of the development of this problem.
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Affiliation(s)
- J M Still
- Columbia-Augusta Medical Center, GA, USA
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34
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Still JM, Law E, Pickens H. Burns caused by the ignition of propane gas by an automobile catalytic converter. J Burn Care Rehabil 1999; 20:216-7. [PMID: 10342474 DOI: 10.1097/00004630-199905000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An unusual accident is reported in which 2 patients were burned when propane gas draining from a tanker truck was ignited by the catalytic converter of a nearby parked car.
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Affiliation(s)
- J M Still
- Columbia-Augusta Medical Center, Augusta, Georgia, USA
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35
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Abstract
Two patients with extensive destruction of the full thickness of the abdominal wall and associated intra-abdominal injuries were encountered. One case resulted from burns to a patient pinned under an automobile in contact with the muffler; the other was injured as a result of penetration of the abdominal wall by a railroad coupling and was also burned in an associated welding accident at the same time. Extensive staged debridement and repair of intra-abdominal injuries in several procedures were required in case 1. Closure was eventually achieved with serial applications of mesh and split-thickness autografting. In case 2, an initial attempt at flap closure failed. Coverage initially was obtained with silicone mesh followed by split-thickness grafting. We report successful management of two of these difficult reconstructive challenges.
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Affiliation(s)
- J M Still
- Columbia-Augusta Medical Center, GA, USA
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36
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Still J, Law E, Dawson J, Bracci S, Island T, Holtz J. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 1999; 42:266-74. [PMID: 10096617 DOI: 10.1097/00000637-199903000-00007] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [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: 11/25/2022]
Abstract
A new method for evaluating the circulation in surgical flaps using laser-induced fluorescence of indocyanine green (ICG) images is reported. In clinical trials the authors found that ICG imaging demonstrated good circulation accurately in 16 of 21 flaps with no clinical manifestations of compromised circulation. In 3 patients in whom partial discoloration and cyanosis of the flaps were visible, the dye study indicated poor circulation in the identical areas. In 2 other patients in whom flaps appeared clinically satisfactory, the flaps were shown by ICG imaging to have greatly compromised circulation. In a patient in whom the flap was left in place, slough of almost the entire flap resulted. Another flap with questionable circulation was returned to its original location, where it healed. Thus, while it is a still a new approach and under continual evaluation, the use of ICG fluorescence shows promise as a valuable adjunct to current methods of flap evaluation.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, Augusta, GA, USA
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37
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Li CK, Yuen PM, Wong R, Pang CP, Lai WK, Law E, Shing MM, Chik KW, Leung TF. Busulphan level and early mortality in thalassaemia patients after BMT. Bone Marrow Transplant 1999; 23:307-10. [PMID: 10100572 DOI: 10.1038/sj.bmt.1701584] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/09/2022]
Abstract
The aim of the study was to correlate busulphan (BU) levels of thalassaemia patients with outcome of allogeneic transplant. BU levels were measured by gas chromatography mass fragmentography. All patients received a standardised dose of BU 16 mg/kg, and cyclophosphamide 150 or 200 mg/kg. For area-under-the-curve analysis (AUC), blood samples were obtained at 0, 1, 2, 3, 4 and 6 h after the first and fifth dose for all patients, and additional levels were measured after ninth and/or 13th dose in most patients. Outcome parameters examined included veno-occlusive disease of liver (VOD), idiopathic interstitial pneumonitis, chimerism, and day 90 survival. Twenty consecutive thalassaemia patients who underwent haematopoietic stem cell transplantation were studied. The median age at transplant was 11.2 years (range 3-21 years). Mean BU AUC levels were correlated with age at transplant (r = 0.58, P = 0.007). Nine patients developed VOD and six had mixed chimerism, but these did not correlate with mean BU AUC level. Four patients died before day 50 from VOD and interstitial pneumonitis. Patients with BU AUC levels greater than the median (908 micromol x min/l) had significantly lower probability of survival at day 90 (60%), whereas patients with BU AUC level less than the median all survived beyond day 90. No patient had graft rejection. In conclusion, a high BU AUC level was associated with a higher treatment-related mortality in thalassaemia patients after transplant.
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Affiliation(s)
- C K Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, China
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38
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Abstract
A study was carried out to evaluate burn nurses' attitudes toward do-not-resuscitate (DNR) orders. Questionnaires were submitted to 57 staff members, 52 of whom responded. Seventy-five percent of those responding ranged in age from 30 to 49 years. Seventy-one percent were registered nurses or licensed practical nurses. Sixty-five percent of the respondents had been in health care for more than 10 years; 25% had been in burn care for more than 10 years. Fifty percent were Protestants. Thirty-seven percent of the total described themselves as very religious. Ninety-four percent of respondents felt that DNR orders are sometimes appropriate. Eighty-eight percent felt that DNR decisions should not be made solely by the physician. Ninety-five percent felt that input from patients, family members, or both is essential. Having formal ethics committees make such decisions was opposed by 75% of the respondents. Fifty-six percent felt nurses should be involved in such decisions and 21% opposed such involvement. There was considerable uncertainty, disagreement, or both about whether a DNR order should include stopping all medical treatment, ventilators, intravenous fluids, gastric feedings, and medication. The study indicated statistically significant support for the view that DNR orders are appropriate in some cases. Which patients should be given DNR status and who should make the decision about writing DNR orders were more controversial questions.
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Affiliation(s)
- R J Purvis
- Columbia Augusta Medical Center, Augusta, Ga., USA
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39
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Law E. Women's health in Manchester. Nurs Manag (Harrow) 1998; 5:16-8. [PMID: 10036449] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- E Law
- Mancunian Community Health NHS Trust
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40
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Abstract
A 39 year old white male with a 55% total body surface burn who developed neuroleptic malignant syndrome (NMS) during his acute course is reported. The patient had several acute sinusitis and septic episodes during his acute course. On postburn day 31, he developed a temperature of 108.4 degrees F (42.4 degrees C). This responded promptly to Dantrolene and Bromocriptene. His recovery was uneventful. NMS is a drug-related response to various medications, such as Haloperidol, which the patient was receiving. NMS must be considered as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, Augusta, GA 30914-3726, USA
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41
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Abstract
During a 2-year period, eight patients sustained burns caused by the tipping over of electric stoves. In seven of these cases, children aged 2 to 4 years stood up on the open oven door of a stove. The stove then tipped forward, and a pot of boiling liquid on the stove spilled onto the child, who fell forward across the oven door. The general area of involvement was back and buttocks, with spattered areas elsewhere on the body. In one other case, an older child, aged 8, sat on the open oven door and was burned when a pot fell on him. The weight of the children ranged from 12.7 to 20 kilograms, with a mean of 15.2 kilograms. The 8-year old weighed 14.9 kilos. Burn size ranged from 3% to 30%, with a mean of 16.75%. All burns were second-degree and were treated by debridement and coverage with either porcine grafts or Biobrane (Dow Hickman Pharmaceuticals, Inc.). Healing was satisfactory in all cases. Hospital stay ranged from 2 to 20 days. The increase in the use of electric stove has led to a situation in which children, usually toddlers, can overbalance the stove and bring down the pots sitting on the heating elements. This represents another mechanism by which young children can be injured in the kitchen; the awareness of this should be disseminated.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, USA
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42
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Abstract
Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, Augusta, GA, USA
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43
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Still JM, Law E, Thiruvaiyaru D, Belcher K, Donker K. Central line-related sepsis in acute burn patients. Am Surg 1998; 64:165-70. [PMID: 9486891] [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: 02/06/2023]
Abstract
A retrospective review of all 443 burn patients admitted during a 13-month period from October 1, 1992 to October 31, 1993, was completed. Of these, 8 were transferred and eliminated from the study. Twenty-two patients who were felt to be terminal on admission and did not have blood cultures were included in the demographic data but were excluded from subsequent statistical analysis. One hundred ten patients had central venous lines (CVLs). Three patients with CVLs were transferred, thus leaving 107 patients with CVLs for statistical analysis. Additionally, 17 of the aforementioned terminal patients who had CVLs and 1 patient with a CVL who had documented sepsis before CVL insertion were excluded, leaving 89 patients with CVLs used in statistical analysis. Mean burn surface for those with central lines was 35.8 per cent, and for those without, 10.9 per cent. Sixty-four patients (59.8%) with a central line had inhalation injuries, as did 18 patients (5.5%) without. The number of lines per patient varied from 1 to 7. Sixty-one patients had one line, 46 had more than one. The total number of central line days for the entire group was 1749. The mean number of central line days per patient was 16.3. The mean number of line days per catheter was 8.48. The mortality rate for the 107 patients with a central line was 34 (32.7%). Mortality for all patients was 41 (9.4%). The incidence of sepsis increased with increasing number of central line days and increasing number of central line changes, but the effect of these two factors on the incidence of sepsis could not be studied separately, as they are highly correlated with each other. The most commonly recovered organisms were various types of Staphylococcus. Polymicrobial infections were common. There were 51 subclavian, 17 internal jugular, and 135 femoral catheters inserted. By logistic regression analysis, there was no statistically significant difference in the incidence of sepsis between upper- and lower-body CVL sites. Twenty-four patients (22.4%) with a CVL and one or more positive blood cultures were felt to have demonstrated sepsis. Some had more than one septic episode while lines were in place, reported as separate patients but not as separate septic episodes.
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Affiliation(s)
- J M Still
- Columbia-Augusta Medical Center, Augusta, Georgia, USA
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44
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Abstract
Electrocution due to contact of construction equipment with power lines is not uncommon as a source of industrial injury. We report seven such cases. Two patients sustained cardiac arrest and were successfully resuscitated at the scene. Four patients lost consciousness and in two cases, amnesia for the event was encountered. No long-term cardiac or neurologic effects were noted. Surgery including amputation was sometimes required. In all cases, the patient was on the ground touching the machinery or touching cables connected to the machinery at the time of injury. The importance of exercising due care in industrial safety measures is stressed. Prompt CPR was life saving in two cases.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, Georgia, USA
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45
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Epperly NA, Still JT, Law E, Deppe SA, Friedman B. Supraglottic and subglottic airway injury due to deployment and rupture of an automobile airbag. Am Surg 1997; 63:979-81. [PMID: 9358786] [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: 02/05/2023]
Abstract
A 46-year-old white female with underlying interstitial lung disease and asthma was driving a pickup truck when it was struck broadside. The airbag inflated and then ruptured, forcing inhalation of its contents. This produced facial desquamation, productive cough, wheezing, and headache. Chest radiograph showed bilateral interstitial fibrosis. Pulmonary function tests demonstrated small airway obstruction, hyperinflation, and impaired diffusion. Computerized tomography showed extensive sinusitis. She improved following treatment with inhaled steroids, bronchodilators, and oral antibiotics. Inhalation of the airbag contents produced supraglottic and subglottic airway inflammation, resulting in sinusitis and exacerbation of her underlying asthma.
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Affiliation(s)
- N A Epperly
- Burn Center, Columbia Augusta Regional Medical Center, Georgia, USA
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46
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Abstract
A program of early excision, increased outpatient care, and aggressive discharge planning was introduced gradually over a 5 yr period from 1991 to 1995 with the goal of decreasing the length of stay for burn patients. Results from 1 January 1991, to 30 June 1993, were compared with results from 1 July 1993 to 31 December 1995. Burns under and over 25 percent were considered separately. There was a significant reduction in LOS of 51.4 percent for burns under 25 percent. There was also a significant reduction in LOS of 23.7 percent for burns over 25% TSA. There was no significant difference in age, burn size or mortality between the early and late groups.
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Affiliation(s)
- J Still
- Columbia-Augusta Medical Center, Georgia, USA
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47
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Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson WO. A randomized prospective trial of hyperbaric oxygen in a referral burn center population. Am Surg 1997; 63:205-8. [PMID: 9036884] [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: 02/03/2023]
Abstract
Various studies of the effect of hyperbaric oxygen (HBO) in a wide variety of disease entities have been carried out. In the treatment of burns, animal and human studies have yielded somewhat contradictory results. Controlled studies in humans are limited. A randomized study on the effect of HBO was conducted involving 125 burn patients admitted within 24 hours of injury who were matched by age, burn size, and presence or absence of inhalation injury. Patients in the treatment arm received oxygen at two atmospheres of pressure for 90 minutes twice a day for a minimum of 10 treatments and a maximum of one treatment per total body surface per cent burn. The control group was treated in a similar fashion, except for the absence of HBO. There were no statistically significant differences between the two groups for the outcome measures of mortality, number of operations, and length of stay for the survivors. In this large clinical trial, we were unable to demonstrate any significant benefit to burn patients from the use of HBO.
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Affiliation(s)
- A L Brannen
- Augusta Regional Medical Center, Georgia, USA
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48
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Still J, Law E, Orlet HK, Frye K, Luterman A, Pickens H, Minor PS. An unusual mechanism of burn injury due to flaming drinks. Am Surg 1997; 63:252-4. [PMID: 9036894] [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: 02/03/2023]
Abstract
Bars and cocktail lounges serve various forms of flaming drinks, usually made with very high-proof alcohol. The drinks are lit and then served. If additional alcohol from the bottle is added to a still-burning drink, flames may spread up the stream of alcohol into the bottle and cause a flash of flame out the bottle's neck. Injuries can require grafting. Three cases are reported. A 32-year-old white female sustained burns covering 10 per cent of her body surface, including the face. Surgery with split-thickness grafts were required. Pressure garments were prescribed for 6 months. A 34-year-old black female was burned by a "volcano" drink. Burns covered 20 per cent of her body surface, including the face. Split-thickness grafts were required on multiple occasions. Infected wounds healed slowly. Reconstructive surgery has so far required eight procedures. A 39-year-old white male sustained severe burns to 10 per cent of his body, including the face. Grafting was carried out. Pressure garments were required. Permanent visible facial scarring is present in all three cases. This type of accident is readily preventable.
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Affiliation(s)
- J Still
- Burn Unit, Augusta Regional Medical Center, Georgia, USA
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49
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Still J, Scheirer R, Law E. Acute cholecystectomy performed through cultured epithelial autografts in a patient with burn injuries: a case report. J Burn Care Rehabil 1996; 17:429-31. [PMID: 8889867 DOI: 10.1097/00004630-199609000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A teenaged white male, admitted with a 58% total body surface burn, was treated with extensive debridement and grafting. Cadaver skin was applied in preparation for grafting with cultured epithelial autograft (CEA). The abdomen and upper arms were then grafted with CEA applied over 6:1 meshed autograft with satisfactory take. The patient was discharged with his wounds healed on postburn day 67. Six months after this, he was readmitted with acute abdominal pain. A perforated gallbladder, diagnosed as acalculous cholecystitis, was found at exploratory laparotomy and removed. The laparotomy incision was made through the burned area grafted with CEA. The patient's recovery from his cholecystectomy and the healing of the postoperative cutaneous wound made through CEA were uneventful.
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Affiliation(s)
- J Still
- Physicians' Multispecialty Group, Augusta, GA 30909, USA
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50
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Chuah G, Law E, Chan WK, Ang CL. Case reports and mini review of bee stings of the cornea. Singapore Med J 1996; 37:389-91. [PMID: 8993139] [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: 02/03/2023]
Abstract
Bee stings of the eye are not uncommon. Quite a few clinical case reports have documented the various ocular reactions to the venom of the bee stings, which may range from mild conjunctivitis to sudden loss of vision. This report presents 2 patients who suffered bee stings to the cornea and their different outcomes. The properties of bee venom as well as the treatment of various possible complications are also discussed.
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Affiliation(s)
- G Chuah
- Singapore National Eye Centre, Singapore
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