1
|
Shukla G, Matur AV, Tao X, Khalid S, Garner R, Gibson J, Cass D, Wu A, Street S, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Motley B, Cheng J, Adogwa O. Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions. Spine (Phila Pa 1976) 2024; 49:615-620. [PMID: 37661823 DOI: 10.1097/brs.0000000000004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. SUMMARY OF BACKGROUND DATA Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized. PATIENTS AND METHODS Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications. RESULTS 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort. CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
Collapse
Affiliation(s)
- Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
2
|
Bamat T, Gula A, Sieke EH, Newby B, Mehta J, Barnes A, Weiss A, Szalda D. Implementation of a Trauma-Informed Challenging Interactions Reporting Tool to Improve our Clinical Learning Environment. Acad Pediatr 2024:S1876-2859(24)00144-X. [PMID: 38609014 DOI: 10.1016/j.acap.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
PROBLEM Workplace mistreatment is a contributor to resident burnout; understanding and intervening against mistreatment is one key tool in mitigating burnout. While ACGME survey data alerts programs to general mistreatment trends, those data are not detailed enough to inform local interventions. Our team designed and implemented a Challenging Interactions Reporting Tool (CIRT) to characterize the experiences of our trainees at a granular level and to inform targeted interventions for improvement. APPROACH Our CIRT was offered to 158 residents in August 2020 via REDCap. Residents submit electronic reports that are reviewed weekly by program leaders who develop action plans for each report. Reporters can identify themselves or can choose to remain anonymous. When "hot spots" for mistreatment are identified in our hospital, we implement a targeted systems-level intervention. OUTCOMES Residents filed 275 reports between August 2020 and December 2022. Reports represented all training environments and involved all interprofessional members of clinical teams. Residents reported awareness of, use of, and satisfaction with the tool. NEXT STEPS Our program created the CIRT as a tool to inform local interventions for improving the safety of our clinical learning environment. We continue to disseminate our tool across our hospital's GME programs and are now measuring the impact of our interventions.
Collapse
Affiliation(s)
- Tara Bamat
- Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Attending Physician, Division of General Pediatrics, Associate Designated Institutional Official of Trainee Wellbeing, Children's Hospital of Philadelphia.
| | - Annie Gula
- Pediatric Critical Care Medicine, Children's Hospital of Philadelphia
| | - Erin H Sieke
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia
| | - Brittney Newby
- Pediatric Rheumatology, Children's Hospital of Philadelphia
| | - Jay Mehta
- Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Attending Physician, Division of Pediatric Rheumatology, Fellowship Program Director, Pediatric Rheumatology, Children's Hospital of Philadelphia
| | - Adelaide Barnes
- Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Attending Physician, Division of General Pediatrics, Associate Program Director and Director of Intern Recruitment, Pediatric Residency Program, Children's Hospital of Philadelphia
| | - Anna Weiss
- Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Attending Physician, Division of Emergency Medicine, Associate Program Director, Pediatric Residency Program, Children's Hospital of Philadelphia
| | - Dava Szalda
- Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Attending Physician, Division of Oncology, Program Director, Internal Medicine - Pediatrics Residency Program, Children's Hospital of Philadelphia
| |
Collapse
|
3
|
Shirodkar K, Iyengar KP, Mehta J, Azzopardi CA, Botchu R. Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma. J Ultrasound 2024:10.1007/s40477-024-00883-y. [PMID: 38573474 DOI: 10.1007/s40477-024-00883-y] [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: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.
Collapse
Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - K P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - J Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham, UK
| | - C A Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| |
Collapse
|
4
|
Chaudhary K, Gala R, Mehta J. Micronodular thymoma with lymphoid stroma: As benign as it sounds. INDIAN J PATHOL MICR 2024:00004270-990000000-00156. [PMID: 38587095 DOI: 10.4103/ijpm.ijpm_585_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024] Open
Abstract
ABSTRACT Micronodular thymoma (MNT) is a rare subtype of thymoma (reported incidence is approximately 1-5%). We report a case received as a core biopsy from the "right lung mass" of a 31-year-old female. CT scan showed an 8.1 cm large well-defined mass lesion in the right middle lobe, causing indentation and mild compression of the right atrium. Microscopically, the biopsy showed a thymic neoplasm comprised of multiple discrete and coalescing nodules of bland epithelioid tumor cells separated by an epithelial cell-free lymphocyte-rich stroma. On immunohistochemistry, cytokeratin highlighted the thymic epithelial cells. The lymphoid cells showed a naive T-cell phenotype (TdT+ CD 3+). It is worthwhile recognizing this rare variant of thymoma as almost all the patients present with localized low stage disease with rare/no reports of recurrences or distant metastases.
Collapse
Affiliation(s)
- Kanica Chaudhary
- Department of Histopathology, Neuberg Oncopath Reference Laboratory, Mumbai, Maharashtra, India
| | | | | |
Collapse
|
5
|
Tao X, Matur AV, Khalid S, Shukla G, Vorster P, Childress K, Garner R, Gibson J, Cass D, Mejia Munne JC, McGrath K, Ivey N, Garcia-Vargas J, Wu A, Street S, Mehta J, Onyewadume L, Duah HO, Motley B, Cheng JS, Adogwa O. Cannabis Use is Associated With Higher Rates of Pseudarthrosis Following TLIF: A Multi-Institutional Matched-Cohort Study. Spine (Phila Pa 1976) 2024; 49:412-418. [PMID: 37417709 DOI: 10.1097/brs.0000000000004768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users. SUMMARY OF BACKGROUND DATA Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized. METHODS Patients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications. RESULTS A 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291-2.556, P <0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399-3.947, P =0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516-2.467, P <0.001). CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.
Collapse
Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- University of Texas Southwestern Medical School, Dallas, TX
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juan C Mejia Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kyle McGrath
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Natalie Ivey
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louisa Onyewadume
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Henry O Duah
- Institute of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
6
|
Street S, Matur AV, Tao X, Shukla G, Garcia-Vargas J, Mehta J, Childress K, Gibson J, Cass D, Wu A, Duah HO, Motley B, Webb D, Cheng J, Adogwa O. Correlation Between Rod Fracture and Shear Stress: A Novel Parameter. World Neurosurg 2024; 183:e268-e275. [PMID: 38128759 DOI: 10.1016/j.wneu.2023.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND We sought to assess the accuracy of a novel parameter proportional to the rod shear stress (RSS) in identifying patients at risk of rod fracture (RF) after surgery for correction of adult spinal deformity. METHODS We performed a retrospective medical record review of patients aged ≥18 years treated for adult spinal deformity between 2004 and 2014 with ≥24 months of follow-up. The primary outcome was RFs identified radiographically. Patient weight (w), number of instrumented levels (N), and minimum rod diameter (d) were recorded and used to calculate the RSS parameter (RSS=Nwd2). Receiver operating characteristic curves were produced and the area under the curve (AUC ± 95% confidence interval [CI]) was calculated to compare this parameter's discriminative accuracy to that of its constituent variables. The sensitivity, specificity, and likelihood ratios (LRs) were calculated. RESULTS A total of 28 RF-positive and 154 RF-negative patients were included. The average age was 59.2 ± 9.6 years, and 93.4% were women. The RSS parameter produced the greatest AUC (0.73 ± 0.11). At an RSS cutoff of 30.1, it achieved a sensitivity of 71.4% and specificity of 71.4% (LR, 2.5; 95% CI, 1.8-3.5). The number of instrumented levels produced the next-greatest AUC (0.65 ± 0.12), with a sensitivity of 78.6% and specificity of 50.0% at a cutoff of 15 (LR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS The RSS is calculated using easily obtainable information and shows potential as a tool for predicting patient-specific risk of RF after spinal fusion. The number of instrumented levels also correlates strongly with the occurrence of RFs and is not significantly less accurate than the RSS. A larger sample size and prospective validation would be useful in determining with greater confidence which parameter is superior for predicting RFs after spinal fusion.
Collapse
Affiliation(s)
- Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel Webb
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
7
|
Lorenzi L, Haferlach T, Mori L, Simbeni M, Walter W, Balzarini P, Meggendorfer M, Döring C, Lonardi S, Bugatti M, Agostinelli C, Mehta J, Borges A, Agaimy A, Simonitsch-Klupp I, Cabeçadas J, Campo E, Pileri SA, Facchetti F, Leo Hansmann M, Hartmann S. Massive parallel sequencing unveils homologous recombination deficiency in follicular dendritic cell sarcoma. Haematologica 2023. [PMID: 37994105 DOI: 10.3324/haematol.2023.283669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 11/24/2023] Open
Abstract
Standardized treatment options are lacking for patients with unresectable or multifocal follicular dendritic cell sarcoma (FDCS) and disease-related mortality is as high as 20%. Applying whole genome sequencing (WGS) in one case and whole exome sequencing (WES) in additional twelve, this study adds information on the molecular landscape of FDCS, expanding knowledge on pathobiological mechanisms and identifying novel markers of potential theragnostic significance. Massive parallel sequencing showed high frequency of mutations on oncosuppressor genes, particularly in RB1, CARS and BRCA2 and unveiled alterations on homologous recombination DNA damage repair related genes in 70% (9/13) of cases. This indicates that patients with high stage FDCS may be eligible for poly ADP ribose polymerase inhibition protocols. Low tumor mutational burden was confirmed in this study despite common PDL1 expression in FDCS arguing on the efficacy of immune checkpoint inhibitors. CDKN2A deletion, detected by WGS and confirmed by FISH in 41% of cases (9/22) indicates that impairment of cell cycle regulation may sustain oncogenesis in FDCS. Absence of mutations in the RAS/RAF/MAPK pathway and lack of clonal hematopoiesis related mutations in FDCS sanction its differences from dendritic cell-derived neoplasms of haematopoietic derivation. WGS and WES in FDCS provides additional information on the molecular landscape of this rare tumor, proposing novel candidate genes for innovative therapeutical approaches to improve survival of patients with multifocal disease.
Collapse
Affiliation(s)
- Luisa Lorenzi
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia.
| | | | - Luigi Mori
- Laboratory of Molecular Medicine, Department of Clinical and Experimental Science, University of Brescia, Brescia
| | - Matteo Simbeni
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | | | - Piera Balzarini
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | | | - Claudia Döring
- Dr Senckenberg Institute of Pathology, Goethe University, Frankfurt
| | - Silvia Lonardi
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Mattia Bugatti
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Claudio Agostinelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
| | | | | | - Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen
| | | | - José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Elias Campo
- Hematopathology Section, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Stefano Aldo Pileri
- Division of Haematopathology, European Institute of Oncology (IEO) IRCCS, Milan
| | - Fabio Facchetti
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Martin Leo Hansmann
- Institute for General Pharmacology and Toxicology, Goethe University, Frankfurt
| | - Sylvia Hartmann
- Dr Senckenberg Institute of Pathology, Goethe University, Frankfurt
| |
Collapse
|
8
|
Tao X, Matur AV, Street S, Shukla G, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Gibson J, Cass D, Wu A, Motley B, Cheng J, Adogwa O. No Difference in Surgical Outcomes between Stand-Alone Devices and Anterior Plating for 1-2 level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis. Spine (Phila Pa 1976) 2023:00007632-990000000-00452. [PMID: 37661800 DOI: 10.1097/brs.0000000000004813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Compare rates of all-cause surgical and medical complications between zero-profile (stand-alone) implants versus any graft type with anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy. SUMMARY OF BACKGROUND DATA Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. While ACDFs performed with a graft and plate has been the gold standard, more recently, zero-profile implants were developed to decrease implant related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of zero-profile (stand-alone) implants to grafts with plating systems. METHODS Data was extracted from the PearlDiver Mariner Database using CPT codes to classify patients into 1-level, 2-levels, and total 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. RESULTS 1:1 exact matching created two equal groups of 7,284 patients that underwent 1-2 level ACDF with either grafting with a plate or zero-profile (standalone) implant. There were no statistically significant difference in all-cause surgical complications, pseudarthrosis rate, dysphagia or need for revision surgery between both cohorts (RR 0.99, 95% CI 0.80-1.21, P = 0.95). Additionally, all-cause medical complications were similar between both cohorts (RR 1.07, 95% CI 0.862-1.330, P = 0.573) or any specific surgical or medical complication included in this study. CONCLUSION After 1:1 exact matching, the results of this study suggest that zero-profile (stand-alone) implants have similar outcomes compared to grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile.
Collapse
Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
9
|
Shukla GG, Matur AV, Childress K, Tao X, Garcia-Vargas J, Mehta J, Garner RM, Gibson J, Cass D, Vorster P, Wu A, Street S, Duah HO, Motley B, Cheng J, Adogwa O. Surgeon Experience Matters: An Exact Matched Analysis of TLIF Outcomes Demonstrates No Difference in Surgical Outcomes Between Experienced Neurosurgeons and Orthopedic Surgeons. Spine (Phila Pa 1976) 2023:00007632-990000000-00394. [PMID: 37432901 DOI: 10.1097/brs.0000000000004758] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare surgical and medical complications profile between neurosurgeons and orthopedic surgeons after transforaminal lumbar interbody fusion (TLIF) procedures. BACKGROUND Studies comparing the impact of spine surgeon specialty (neurosurgery vs. orthopedic spine) on TLIF outcomes have been inconclusive and failed to control for operative learning curves and surgical maturity. Orthopedic spine surgeons perform fewer spine procedures in residency, although these differences may be attenuated by mandatory fellowship before starting practice. Any observed differences are likely attenuated with increasing surgeon experience. MATERIALS AND METHODS Using an all-payer claims database, PearlDiver Mariner, 120 million patient records were analyzed between 2010 and 2022, to identify individuals with lumbar stenosis or spondylolisthesis who underwent index one- to three-level TLIF procedures. International Classification of Diseases-Ninth Edition (ICD-9), International Classification of Diseases-10th Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to query the database. Only Neurosurgeons and Orthopedic spine surgeons who had performed at least 250 procedures were included in the study. Patients undergoing surgery for tumor, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with all-cause surgical or medical complications in a linear regression model. RESULTS 1:1 exact matching created two equal groups of 18,195 patients without baseline differences who underwent TLIF procedures by neurosurgeons or orthopedic surgeons. There was no difference in all-cause surgical complications between neurosurgeons and orthopedic spine surgeons (relative risk=1.008, 95% CI: 0.850-1.195, P =0.965). All-cause medical complication rate was higher in the neurosurgery cohort (relative risk=1.144, 95% CI: 1.042-1.258, P =0.005). CONCLUSION The results of this study suggest that after accounting for surgical maturity, neurosurgeons and orthopedic spine surgeons have similar surgical outcomes. However, neurosurgeons have higher all-cause medical complication rates compared with orthopedic spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.
Collapse
Affiliation(s)
- Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Rebecca M Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
10
|
Bakhai A, McCauley L, Stones L, Khalil S, Mehta J, Price N, Krishnamurthy V, Parker LHH, Hughes D. Shining a light on an additional clinical burden: work-related digital communication survey study - COVID-19 impact on NHS staff wellbeing. Humanit Soc Sci Commun 2022; 9:414. [PMID: 36439048 PMCID: PMC9676904 DOI: 10.1057/s41599-022-01427-7] [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] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Work-related communication volume within the United Kingdom's National Health Service (NHS) has had little systematic research previously. The impact of communication volume on work-life balance of healthcare staff in the NHS is also not known and has not been an area of focus or governance. COVID-19 led to a shift to non-physical work, with greater reliance on digital communication for clinical decision making. We sought to elucidate the relationship between communication, work-life balance, and COVID-19. An online survey was conducted to assess the platforms used to communicate professionally, the volume of and time spent on work-related communications, how this has changed from before to during COVID-19, and the effect on work-life balance. A total of 3047 healthcare staff provided consent and evaluable data. Emails were reported as the most frequently used communication tool, and the majority of staff asked, reported increased work-related communications due to COVID-19. Staff estimated receiving 14 emails on an average day before COVID-19. During the pandemic, staff estimated getting approximately 17 emails on an average day and 29 emails on a busy day. Work communications reportedly took up increased amounts of family and home time during COVID-19. A large proportion (36%) of staff were unable to switch off from work-related communications already before COVID-19, worsening (57%) during the pandemic. Work-related digital communication is a vital component of working in the NHS. We provide the first detailed data on the types, volume, and impact of such communication on NHS staff during the COVID-19 pandemic, compared to pre-pandemic levels. We found that 82% of staff support the need for NHS guidance on work-related communications to help manage overload, protect emotional wellbeing, and increase resilience. Further work is urgently needed in this area to tackle the negative impact of communication technologies (technostress) on work-life balance to reduce staff stress, burnout, and turnover or early retirement of some staff.
Collapse
Affiliation(s)
- Ameet Bakhai
- Royal Free London NHS Foundation Trust, London, UK
| | | | - Liba Stones
- Royal Free London NHS Foundation Trust, London, UK
| | - Saria Khalil
- Royal Free London NHS Foundation Trust, London, UK
| | - Jay Mehta
- Royal Free London NHS Foundation Trust, London, UK
| | | | | | | | | |
Collapse
|
11
|
Lazcano R, Barreto CM, Salazar R, Carapeto F, Traweek RS, Leung CH, Gite S, Mehta J, Ingram DR, Wani KM, Vu KAT, Parra ER, Lu W, Zhou J, Witt RG, Cope B, Thirasastr P, Lin HY, Scally CP, Conley AP, Ratan R, Livingston JA, Zarzour AM, Ludwig J, Araujo D, Ravi V, Patel S, Benjamin R, Wargo J, Wistuba II, Somaiah N, Roland CL, Keung EZ, Solis L, Wang WL, Lazar AJ, Nassif EF. The immune landscape of undifferentiated pleomorphic sarcoma. Front Oncol 2022; 12:1008484. [PMID: 36313661 PMCID: PMC9597628 DOI: 10.3389/fonc.2022.1008484] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/31/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Undifferentiated pleomorphic sarcoma (UPS) can be associated with a relatively dense immune infiltration. Immune checkpoint inhibitors (anti-PD1, anti-PDL1, and anti-CTLA4) are effective in 20% of UPS patients. We characterize the immune microenvironment of UPS and its association with oncologic outcomes. Material and methods Surgically resected UPS samples were stained by immunohistochemistry (IHC) for the following: tumor-associated immune cells (CD3, CD8, CD163, CD20), immune checkpoints (stimulatory: OX40, ICOS; inhibitory: PD-L1, LAG3, IDO1, PD1), and the adenosine pathway (CD73, CD39). Sections were reviewed for the presence of lymphoid aggregates (LA). Clinical data were retrospectively obtained for all samples. The Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare distributions. Correlations between biomarkers were measured by Spearman correlation. Univariate and multivariate Cox models were used to identify biomarkers associated with overall survival (OS) and disease-free survival (DFS). Unsupervised clustering was performed, and Kaplan-Meier curves and log-rank tests used for comparison of OS and DFS between immune clusters. Results Samples analyzed (n=105) included 46 primary tumors, 34 local recurrences, and 25 metastases. LA were found in 23% (n=10/43), 17% (n=4/24), and 30% (n=7/23) of primary, recurrent, and metastatic samples, respectively. In primary UPS, CD73 expression was significantly higher after preoperative radiation therapy (p=0.009). CD39 expression was significantly correlated with PD1 expression (primary: p=0.002, recurrent: p=0.004, metastatic: p=0.001), PD-L1 expression (primary: p=0.009), and CD3+ cell densities (primary: p=0.016, recurrent: p=0.043, metastatic: p=0.028). In recurrent tumors, there was a strong correlation between CD39 and CD73 (p=0.015), and both were also correlated with CD163+ cell densities (CD39 p=0.013; CD73 p<0.001). In multivariate analyses, higher densities of CD3+ and CD8+ cells (Cox Hazard Ratio [HR]=0.33; p=0.010) were independently associated with OS (CD3+, HR=0.19, p<0.001; CD8+, HR= 0.33, p=0.010) and DFS (CD3+, HR=0.34, p=0.018; CD8+, HR=0.34, p= 0.014). Unsupervised clustering of IHC values revealed three immunologically distinct clusters: immune high, intermediate, and low. In primary tumors, these clusters were significantly associated with OS (log-rank p<0.0001) and DFS (p<0.001). Conclusion We identified three immunologically distinct clusters of UPS Associated with OS and DFS. Our data support further investigations of combination anti-PD-1/PD-L1 and adenosine pathway inhibitors in UPS.
Collapse
Affiliation(s)
- Rossana Lazcano
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carmelia M. Barreto
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ruth Salazar
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Fernando Carapeto
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Raymond S. Traweek
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cheuk H. Leung
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Swati Gite
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Mehta
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Davis R. Ingram
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Khalida M. Wani
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kim-Anh T. Vu
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Edwin R. Parra
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei Lu
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jianling Zhou
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Russell G. Witt
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Brandon Cope
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prapassorn Thirasastr
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Y. Lin
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christopher P. Scally
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anthony P. Conley
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ravin Ratan
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Andrew Livingston
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexandra M. Zarzour
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joseph Ludwig
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dejka Araujo
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinod Ravi
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shreyaskumar Patel
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert Benjamin
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer Wargo
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ignacio I. Wistuba
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Neeta Somaiah
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christina L. Roland
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Emily Z. Keung
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luisa Solis
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei-Lien Wang
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Alexander J. Lazar
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
- Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elise F. Nassif
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Elise F. Nassif,
| |
Collapse
|
12
|
Mehta J, Grunberg C, Provad E, Pan L, Gerguis M, Mohamed J, Parsons J, Wu K. 266 Airway clearance therapy: experiences and perceptions of adults with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00956-0] [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: 11/06/2022]
|
13
|
Santhosh A, Mehta J, Barwad A, Shamim SA, Rastogi S. Metastatic sclerosing epithelioid fibrosarcoma in an adult male from a tertiary care centre in India: a case report. Ecancermedicalscience 2022; 16:1446. [PMID: 36405948 PMCID: PMC9666284 DOI: 10.3332/ecancer.2022.1446] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare subtype of soft tissue sarcoma and the data from India is sparse. It is an unusual variant of fibrosarcoma that commonly arises in the soft tissues of the limb, head and neck, trunk and occasionally in the visceral organs and bones. This entity is commonly reported in the middle age group, men and women alike. Pathological clinchers include MUC 4 (Mucin 4, cell surface associated) positivity by immunohistochemistry, FUS-CREB3L1 fusion and EWSR1 rearrangement. This disease is notoriously known for its local recurrence and metastatic spread. Response to systemic therapy is poor and relapses are frequent. The role of targeted and immunotherapy is not well defined. CASE PRESENTATION Here we report a 46-year-old gentleman who presented to the Sarcoma Medical Oncology Clinic in our centre. He had primary involvement of right pubic bone with metastasis to liver, lung and diffuse lytic bony lesions. His diagnosis was reviewed multiple times before coming to final diagnosis of SEF. His molecular test for EWSR1 rearrangement was positive by fluorescence in-situ hybridisation. He did not respond to palliative doxorubicin, pazopanib and gemcitabine and docetaxel. CONCLUSION Through this case report, we would like to highlight the rarity of this sarcoma, its classical pathological features, its close relationship to low-grade fibromyxoid sarcoma and the limited therapeutic options available. Hence, there is a need for further research in this entity.
Collapse
Affiliation(s)
- Akhil Santhosh
- Department of Medical Oncology, BRA IRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jay Mehta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shamim A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sameer Rastogi
- Department of Medical Oncology, BRA IRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
14
|
Hilton G, Luijten M, Corvi R, Mehta J, Wolf D. P18-04 A new paradigm of science-based carcinogenicity assessment for agrochemicals. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.644] [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: 11/15/2022]
|
15
|
Esterik JV, Heusinkveld H, Corvaro M, Laan JVD, Lewis D, Madia F, Manou I, Marx-Stoelting P, Melching-Kollmuss S, Pasquier E, Schorsch F, Steiblen G, Strupp C, Wolterink G, Woutersen R, Corvi R, Mehta J, Luijten M. P08-18 Predicting non-genotoxic carcinogenic potential of agrochemicals: a mechanistic approach. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.417] [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: 11/15/2022]
|
16
|
Hernandez S, Lazcano R, Serrano A, Powell S, Kostousov L, Mehta J, Khan K, Lu W, Solis LM. Challenges and Opportunities for Immunoprofiling Using a Spatial High-Plex Technology: The NanoString GeoMx ® Digital Spatial Profiler. Front Oncol 2022; 12:890410. [PMID: 35847846 PMCID: PMC9277770 DOI: 10.3389/fonc.2022.890410] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Characterization of the tumor microenvironment through immunoprofiling has become an essential resource for the understanding of the complex immune cell interactions and the assessment of biomarkers for prognosis and prediction of immunotherapy response; however, these studies are often limited by tissue heterogeneity and sample size. The nanoString GeoMx® Digital Spatial Profiler (DSP) is a platform that allows high-plex profiling at the protein and RNA level, providing spatial and temporal assessment of tumors in frozen or formalin-fixed paraffin-embedded limited tissue sample. Recently, high-impact studies have shown the feasibility of using this technology to identify biomarkers in different settings, including predictive biomarkers for immunotherapy in different tumor types. These studies showed that compared to other multiplex and high-plex platforms, the DSP can interrogate a higher number of biomarkers with higher throughput; however, it does not provide single-cell resolution, including co-expression of biomarker or spatial information at the single-cell level. In this review, we will describe the technical overview of the platform, present current evidence of the advantages and limitations of the applications of this technology, and provide important considerations for the experimental design for translational immune-oncology research using this tissue-based high-plex profiling approach.
Collapse
Affiliation(s)
- Sharia Hernandez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rossana Lazcano
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alejandra Serrano
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven Powell
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Larissa Kostousov
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jay Mehta
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Khaja Khan
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wei Lu
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luisa M Solis
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
17
|
Khetrapal P, Skarbek S, Tapper L, Mason C, Davis S, Henderson D, Riley B, Price L, Cumby C, Kennedy C, Woodcock H, Jain N, Ziser S, Yates T, Mehta J, Amphlett A, Dinneen D, Aziz U, Parekh V, Fernando B, Dilworth P, Jehangir A, Connolly J, Negus R, Murch N, Molloy A, Hui C, Burns A. Setting up an emergency medical task force to manage the demands of COVID-19: experiences of a London teaching hospital. leader 2021; 6:222-227. [DOI: 10.1136/leader-2021-000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/07/2021] [Indexed: 11/04/2022]
|
18
|
Hedman G, Mehta J, Lavender S, Reichelt P, Conrad K, Park S. Consumer opinion of stair descent devices used during emergency evacuation from high-rise buildings. Assist Technol 2021; 33:278-287. [PMID: 31306079 DOI: 10.1080/10400435.2019.1634656] [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] [Indexed: 10/26/2022] Open
Abstract
The use of stair descent devices is an important part of a comprehensive emergency evacuation plan. To date, there is little research on consumer opinion of these devices. A pilot study was performed at a local center for independent living, enabling 14 consumers with mobility impairments to state their initial impressions of 14 devices, representing three general designs: carry-type, track-type, and sled-type. Consumers were able to view the devices, ask questions, and view short videos of the devices in use. Afterwards, consumers were given the opportunity to try out one or more of the devices, and provide their opinion after each trial run. Consumers provided feedback on specific design features, how they anticipated they would feel about using each, and whether they considered each device acceptable for use. Trial use enabled more in-depth opinions, and in some cases, a change in opinion on acceptability.
Collapse
Affiliation(s)
- Glenn Hedman
- Disability & Human Development, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jay Mehta
- Integrated Systems Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Steven Lavender
- Integrated Systems Engineering, The Ohio State University, Columbus, Ohio, USA.,Department of Orthopedics, The Ohio State University, Columbus, Ohio, USA
| | - Paul Reichelt
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Karen Conrad
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sanghyun Park
- Integrated Systems Engineering, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
19
|
Heusinkveld H, Braakhuis H, Corvaro M, Vinken J, Lewis D, Madia F, Manou I, Marx-Stölting P, Melching-Kollmuss S, Nygren J, Pasquier E, Schorsch F, Steiblen G, Wolterink G, Woutersen R, Corvi R, Mehta J, Luijten M. Predicting non-genotoxic carcinogenic potential of agrochemicals: a mechanistic approach. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Haddish-Berhane N, Cho B, Ahn M, Han J, Kim S, Lee K, Cho E, Mehta J, Xie J, Shreeve S, Knoblauch R, Freeman J, Roshak A, Jang S, Lee H, Kang S, Kim K, Oh S. P86.12 Cardiac Safety Assessment of Lazertinib in Patients with EGFR Mutation-Positive Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
Sethia R, Patel J, Pothuri NA, Shah S, Mehta J, Vora J. Tear Film Changes in Type II Diabetes Mellitus with and without Diabetic Retinopathy. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/47967.14490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: With the substantial progress in understanding of the ocular surface system in the past decade, Dry Eye Disease (DED) is the more commonly encountered condition in diabetes. Diabetes and DED have a common association. Aim: To estimate the prevalence of dry eye in diabetic patient and tear film changes with Diabetic Retinopathy (DR). Materials and Methods: It was an observational cross-sectional study, in which 103 type II diabetic patients attending the Department of Ophthalmology in a Tertiary Care Hospital were enrolled, out of which 43 patients had DR and 60 patients had no DR. Dry eye evaluation was done using Ocular Surface Disease Indexing (OSDI) questionnaire and was confirmed objectively using Schirmer’s I and II test and Tear film Break Up Time (TBUT). Statistical Package for the Social Sciences (SPSS) version 20 was used for statistical analysis of this study data. All quantitative data were analysed by using parametric test whereas all qualitative data were analysed by using non-parametric test to find significance level and the p-value <0.05 was considered significant. Results: In present study, 68 among 103 diabetics patients had DED with the prevalence of 66% based on OSDI scoring. Out of the 43 patients with DR and 60 without DR, DED was encountered in 38 and 30 patients, respectively. DED status was not influenced by gender, age and duration of diabetes. An increase in DED was seen with higher HbA1c (Glycated Haemoglobin) values but was not significant. DED in DR group yielded a significant association with OSDI (p=0.002), Schirmer’s I and II (p=0.001) and TBUT (p=0.046). Conclusion: On the basis of present study, it can be stated that the prevalence of dry eye was more in DR patients in comparison to those without retinopathy. Therefore, all diabetic patients should be screened for dry eye, in order to diagnose and treat it at the earliest.
Collapse
|
22
|
Sethia R, Modi S, Shah A, Mehta J. Prevalence of Dry Eye Disease in Medical Students in a Tertiary Care Hospital: A Cross-sectional Study. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/47647.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Dry eyes is a chronic disorder affecting the ocular surface causing tear film instability, visual problems, redness and a feeling of irritation in the eye. It is an emerging preventable health hazard among the young individuals. Aim: To find the prevalence and risk factors of Dry Eye Disease (DED) in the medical field amongst the postgraduates in a tertiary care hospital. Materials and Methods: The present study was a cross-sectional observational study. All participants were assessed on a number of variables, which included duration of residency, smoking, use of cosmetics, screen time and distance of screen from eyes. The present study enrolled 132 students (264 eyes), out of which 66 students were (132 eyes) from surgical field and 66 students were (132 eyes) were from non-surgical field. They were examined for a panel of tests for DED, i.e., Schirmer Test, Tear Break Up Time (TBUT) Test, Meibomian Gland Dysfunction (MGD) grading and Conjunctival Staining. Statistical Package for the Social Sciences (SPSS) v20 was used for statistical analysis. All the qualitative data were analysed by using Chi-square test. Results: Overall prevalence of DED was 56.81% in the medical field amongst residents. Based on the results of all the conventional test performed, most of the residents belonged to the mild category followed by moderate and least in the severe category. Based on TBUT, prevalence of DED was more in surgical (62.67%) compared to non-surgical (37.33%) residents with an Odds Ratio (OR) of 3.35, p-value <0.0001 and risk ratio of 1.67. Residents who spend more screen time (>4 hours/day) and use screen at a distance more than arm-forearm length have more prevalence of DED (p-value of 0.001 and 0.002, respectively). Conclusion: Overall prevalence of DED was 56.81% in the medical field amongst residents. It is concluded that surgeons have a 3.35 chance greater than non-surgical residents for development of DED. Early diagnosis and curbing the modifiable risk factors can reduce the burden of DED and improve the quality of life.
Collapse
|
23
|
Mehta J, Yates T, Smith P, Henderson D, Winteringham G, Burns A. Rapid implementation of Microsoft Teams in response to COVID-19: one acute healthcare organisation's experience. BMJ Health Care Inform 2020; 27:bmjhci-2020-100209. [PMID: 33177050 PMCID: PMC7661347 DOI: 10.1136/bmjhci-2020-100209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background COVID-19 presented significant challenges to healthcare organisations, which needed to rapidly remodel their services but were unable to allow staff to meet face to face to minimise infection risk. During this communication predicament, National Health Service (NHS) Digital announced the provision of Microsoft Teams, a digital communication and collaboration tool, which was implemented at Royal Free London NHS Foundation Trust within 2 weeks.Method Given the need to deploy at scale, rapidly and with minimal resource, an agile decentralised innovation management approach was used, empowering staff to be local implementors.Results Resulting use cases were highly original and varied, ranging from a COVID-19 Education Programme to coordination of oxygen demand. Analytics showed rapid and persistent adoption, surpassing 500 daily active users within 11 days. Usage continues to increase, consistent with a direct network effect.Conclusion These findings suggest a high demand for this format of communication and high willingness to adopt it. Further qualitative research into staff perceptions would be valuable to confirm this, and to assess the user experience.Overall, this has been a radical approach to digital implementation in healthcare, and has so far proved effective in delivering a cost minimal, rapid communication tool at scale in the midst of a global pandemic.
Collapse
Affiliation(s)
- Jay Mehta
- Faculty of Medicine, Imperial College London, London, UK .,Department of Clinical Informatics, Royal Free London NHS Foundation Trust, London, UK
| | - Timothy Yates
- Department of Clinical Informatics, Royal Free London NHS Foundation Trust, London, UK.,Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | - Penelope Smith
- Department of Clinical Informatics, Royal Free London NHS Foundation Trust, London, UK.,Department of Acute Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Daisy Henderson
- Department of Medical Education, Royal Free London NHS Foundation Trust, London, UK
| | - Glenn Winteringham
- Information Management and Technology Directorate, Royal Free London NHS Foundation Trust, London, UK
| | - Aine Burns
- Department of Medical Education, Royal Free London NHS Foundation Trust, London, UK.,Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Trifilio S, Gordon L, Rubin H, Grosshans N, Mehta J. The non-steroidal anti-inflammatory drug salsalate provides safe and effective control of mucositis-unrelated pain during autologous and allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2020; 29:3643-3648. [PMID: 33179136 DOI: 10.1007/s00520-020-05664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pain is a serious adverse event which frequently accompanies hematopoietic stem cell transplantation (HSCT). The safety and efficacy of NSAIDS during HSCT is currently unknown. Salsalate is a platelet-sparing NSAID with a favorable toxicity profile compared with other NSAIDS. We report the safety and efficacy of salsalate for different types of pain during SCT. METHODS We conducted a retrospective study of SCT recipients empirically treated with salsalate for > 48 h. Pain scores were assessed using the verbal rating scale for pain. A subset analysis of patients who received > 7 days of salsalate during periods of pancytopenia, mucositis, and other end-organ toxicities is included. RESULTS Sixty-four patients, 42 auto- and 22 allografts, were identified. Reason for use: vertebral-related pain (30%), musculoskeletal (30%), and cytokine inflammatory pain syndromes (24%). Median dose 1500 mg/day, number of treatment days = 5, started on day+5 post-HSCT. Pain resolved/improved to pain score < 4 in 76% and stable in 15%. Forty-four patients (28-auto and 16 allografts) received > 7-day salsalate. Median WBC and platelet nadir were < 0.1 and 10,000 cells/ml respectively. EFFICACY pain was improved or eradicated in 64% and stable in 32%. TOXICITY LFT elevation (n = 2), elevated serum creatinine (n = 2), and minor bleed (n = 5-nose, gums, and urine). Salsalate discontinuation (n = 6): ineffective (n = 1), the liver (n = 1), the kidney (n = 1), > 5 platelet transfusions (n = 1), and vomiting (n = 2). There was no treatment related mortality. Salsalate was well tolerated, safe, and beneficial for several different types of pain during HSCT.
Collapse
Affiliation(s)
- S Trifilio
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA.
| | - L Gordon
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - H Rubin
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - N Grosshans
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - J Mehta
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| |
Collapse
|
25
|
Correll CK, Ditmyer MM, Mehta J, Imundo LF, Klein-Gitelman MS, Monrad SU, Battafarano DF. 2015 American College of Rheumatology Workforce Study and Demand Projections of Pediatric Rheumatology Workforce, 2015-2030. Arthritis Care Res (Hoboken) 2020; 74:340-348. [PMID: 33107674 DOI: 10.1002/acr.24497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Describe the character and composition of the 2015 pediatric rheumatology workforce in the United States (US), evaluate current workforce trends, and project future supply and demand of pediatric rheumatology workforce through 2030. METHODS The American College of Rheumatology (ACR) created the Workforce Study Group (WSG) to study the rheumatology workforce. The WSG used primary and secondary data to create a representative workforce model. Pediatric rheumatology supply and demand was projected through 2030 using an integrated data-driven framework to capture a more realistic clinical full-time equivalent (FTE) and produce a better picture of access to care issues in pediatric rheumatology. RESULTS The 2015 pediatric workforce was estimated at 287 FTE (300 providers), while the estimated excess demand was 95 (33%). The projected demand will continue to increase to almost 100% (N=230) by 2030 if no changes occur in succession planning, new graduate entrants into the profession, and other factors associated with the workforce. CONCLUSION This study projects that the pediatric rheumatology workforce gap will continue to worsen significantly from the 2015 baseline, and by 2030 the demand for pediatric rheumatologists will be twice the supply. Innovative strategies are needed to increase the workforce supply and to improve access to care.
Collapse
Affiliation(s)
- Colleen K Correll
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, United States
| | - Marcia M Ditmyer
- University of Nevada, School of Dental Medicine, Las Vegas, Las Vegas, NV
| | - Jay Mehta
- Children's Hospital of Philadelphia, Division of Rheumatology, Philadelphia, PA
| | - Lisa F Imundo
- Columbia University, Department of Pediatrics, New York, NY
| | | | - Seetha U Monrad
- University of Michigan, Departments of Internal Medicine and Learning Health Sciences, Ann Arbor, Michigan, United States
| | | |
Collapse
|
26
|
Kaur R, Mehta J, Borges AM. Role of SMARCA4 (BRG1) and SMARCB1 (INI1) in Dedifferentiated Endometrial Carcinoma With Paradoxical Aberrant Expression of MMR in the Well-Differentiated Component: A Case Report and Review of the Literature. Int J Surg Pathol 2020; 29:571-577. [PMID: 32940101 DOI: 10.1177/1066896920959453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dedifferentiated endometrial carcinoma is an uncommon highly aggressive uterine tumor. It comprises 2 components: a well-differentiated, low-grade epithelial carcinoma and an undifferentiated carcinoma. The undifferentiated carcinoma frequently exhibits rhabdoid cytologic features. Many of these tumors are characterized by an aberrant switch/sucrose non-fermenting (SWI/SNF) complex. They may also exhibit aberrant expression of mismatch repair (MMR) proteins. Together, these play an important role in the pathogenesis and aggressive nature of the tumor. MATERIAL AND METHODS We present a case of dedifferentiated endometrial carcinoma in a 63-year-old female showing loss of expression of SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4/BRG1), and aberrant expression of MMR proteins. We also review the literature starting from the earliest recognition of this entity and the various studies done to explain its molecular pathogenesis and prognostic importance. RESULTS AND CONCLUSIONS Recognition of SWI/SNF complex-deficient dedifferentiated endometrial carcinoma is important as these tumors do not respond to platinum-based chemotherapy, and consideration of alternative therapies is often necessary. We also want to emphasize that though most of the studies have found MMR deficiency in the undifferentiated carcinoma component, it may be seen only in the low-grade, well-differentiated component, as observed in this case.
Collapse
Affiliation(s)
| | - Jay Mehta
- Centre for Oncopathology, Mumbai, India
| | | |
Collapse
|
27
|
Mehta J, Borges A. ALK positive histiocytosis in an adult female with an EML4-ALK RNA fusion. Human Pathology: Case Reports 2020. [DOI: 10.1016/j.ehpc.2020.200404] [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: 10/23/2022] Open
|
28
|
Villar MV, Spreafico A, Moreno V, Braña I, Hernandez T, Razak AA, Wang J, Haddish-Berhane N, Mehta J, Johnson A, Maes A, Haslam J, Mistry P, Kalota A, Lenox L, Infante J, Lorenzi M, Xie H, Lauring J, Patel M. 537MO First-in-human study of JNJ-64619178, a protein arginine methyltransferase 5 (PRMT5) inhibitor, in patients with advanced cancers. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
29
|
Henderson D, Woodcock H, Mehta J, Khan N, Shivji V, Richardson C, Aya H, Ziser S, Pollara G, Burns A. Keep calm and carry on learning: using Microsoft Teams to deliver a medical education programme during the COVID-19 pandemic. Future Healthc J 2020; 7:e67-e70. [PMID: 33094260 DOI: 10.7861/fhj.2020-0071] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The outbreak of COVID-19 in the UK in March 2020 required a radical remodelling of the medical workforce at Royal Free London NHS Foundation Trust to prepare for the anticipated surge of hospital admissions. The provision of relevant teaching and training was immediately identified as a priority, particularly for staff due to work outside their regular medical specialty. Rather than deliver face-to-face teaching, doctors at the Trust utilised Microsoft Teams, an online communications and collaboration platform, to deliver a multi-disciplinary Trust-wide education programme responsive to the needs of surveyed medical staff. To date members of 18 departments across the Trust have delivered 51 virtual teaching sessions which have been viewed 3,814 times. During this pandemic the virtual education programme has facilitated rapid dissemination of new information and provided a platform for discussion and unity amongst colleagues with overwhelmingly positive feedback from both learners and teachers.
Collapse
Affiliation(s)
- Daisy Henderson
- Sheila Sherlock Postgraduate Medical Education Centre, London, UK
| | | | - Jay Mehta
- Royal Free London NHS Foundation Trust, London, UK
| | - Nuzhath Khan
- Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Haleema Aya
- Sheila Sherlock Postgraduate Medical Education Centre, London, UK
| | - Shier Ziser
- Sheila Sherlock Postgraduate Medical Education Centre, London, UK
| | - Gabriele Pollara
- Royal Free London NHS Foundation Trust, London, UK and University College London, London, UK
| | - Aine Burns
- Sheila Sherlock Postgraduate Medical Education Centre, London, UK and Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
30
|
Halyabar O, Mehta J, Ringold S, Rumsey DG, Horton DB. Treatment Withdrawal Following Remission in Juvenile Idiopathic Arthritis: A Systematic Review of the Literature. Paediatr Drugs 2019; 21:469-492. [PMID: 31673960 PMCID: PMC7301222 DOI: 10.1007/s40272-019-00362-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Early diagnosis and treatment of juvenile idiopathic arthritis (JIA) with conventional and biologic disease-modifying anti-rheumatic drugs have vastly improved outcomes for children with these diseases. Currently, a large proportion of children with JIA are able to achieve clinical inactive disease and remission. With this success, important questions have arisen about when medications can be stopped and how to balance the risks and benefits of continuing medications versus the potential for flare after stopping. AIM The aim was to conduct a systematic review of the available literature to summarize current evidence about medication withdrawal for JIA in remission. METHODS We conducted a systematic literature search in PubMed and Embase from 1990 to 2019. References were first screened by title and then independently screened by title and abstract by two authors. A total of 77 original papers were selected for full-text review. Data were extracted from 30 papers on JIA and JIA-associated uveitis, and the quality of the evidence was evaluated using National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) tools. Studies on biochemical and radiologic biomarkers were also reviewed and summarized. RESULTS Most studies investigating treatment withdrawal in JIA have been observational and of poor or fair quality; interpretations of these studies have been limited by differences in study populations, disease and remission durations, the medications withdrawn, approaches to withdrawal, and definitions of disease outcomes. Overall the data suggest that flares are common after stopping JIA medications, particularly biologic medications. Clinical characteristics associated with increased risks of flare have not been consistently identified. Biochemical biomarkers and ultrasound findings have been shown to predict outcomes after stopping medications, but to date, no such predictor has been consistently validated across JIA populations. Studies have also not identified optimal strategies for withdrawing medication for well-controlled JIA. Promising withdrawal strategies include discontinuing methotrexate before biologic medications in children receiving combination therapy, dose reduction for children on biologics, and treat-to-target approaches to withdrawal. These and other strategies require further investigation in larger, high-quality studies. CONCLUSIONS The published literature on treatment withdrawal in JIA has varied in design and quality, yielding little conclusive evidence thus far on the management of JIA in remission. Given the importance of this question, international collaborative efforts are underway to study clinical and biologic predictors of successful medication withdrawal in JIA. These efforts may ultimately support the development of personalized approaches to withdrawing medication in children with JIA in remission.
Collapse
Affiliation(s)
- Olha Halyabar
- Department of Pediatrics, Boston Children’s
Hospital, Boston, Massachusetts, USA
| | - Jay Mehta
- Department of Pediatrics, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah Ringold
- Department of Pediatrics, Seattle Children’s
Hospital, Seattle, Washington, USA
| | - Dax G. Rumsey
- Department of Pediatrics, University of Alberta, Edmonton,
Alberta, Canada
| | - Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson
Medical School, New Brunswick, NJ, USA,Rutgers Center for Pharmacoepidemiology and Treatment
Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick,
NJ, USA,Department of Biostatistics and Epidemiology, Rutgers
School of Public Health, Piscataway, NJ, USA
| |
Collapse
|
31
|
Abstract
"E-learning" refers to instruction occurring via digital media and ideally uses an engaging and learner-centered approach. Advantages of e-learning methods include (1) they can enable consistent messages, (2) they may use novel instructional methods, and (3) they enable documentation of usage and assessment. This article discusses principles for and challenges to developing e-learning materials. The authors provide a collection of available e-learning materials used to teach adult and pediatric rheumatology developed by individuals, professional societies, and private companies. Finally, they discuss challenges to using e-learning materials.
Collapse
Affiliation(s)
- Megan L Curran
- Section of Rheumatology, Children's Hospital of Colorado, University of Colorado School of Medicine, 13123 East 16th Street, Box 311, Aurora, CO 80045, USA.
| | - Kristen Hayward
- Division of Rheumatology, Seattle Children's Hospital, University of Washington, School of Medicine, 4800 Sand Point Way Northeast, M/S MA.7.110, Seattle, WA 98105, USA
| | - Jay Mehta
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10109, Philadelphia, PA 19104, USA
| |
Collapse
|
32
|
Mehta P, Mehta J. Reframing Clinician Distress: Moral Injury Not Burnout. Fed Pract 2019; 36:504-506. [PMID: 31892771 PMCID: PMC6913604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Paulette Mehta
- Central Arkansas Veterans Health Care System; University of Arkansas for Medical Sciences
| | - Jay Mehta
- Central Arkansas Veterans Health Care System; University of Arkansas for Medical Sciences
| |
Collapse
|
33
|
Kushner CJ, Tarazi M, Gaffney RG, Feng R, Ardalan K, Brandling-Bennett HA, Castelo-Soccio L, Chang JC, Chiu YE, Gmuca S, Hunt RD, Kahn PJ, Knight AM, Mehta J, Pearson DR, Treat JR, Wan J, Yeguez AC, Concha JSS, Patel B, Okawa J, Arkin LM, Werth VP. AB002. Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in pediatric cutaneous lupus among pediatric dermatologists and rheumatologists. Ann Transl Med 2019. [DOI: 10.21037/atm.2019.ab002] [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: 11/06/2022]
|
34
|
Buckley L, Ware E, Kreher G, Wiater L, Mehta J, Burnham JM. Outcome Monitoring and Clinical Decision Support in Polyarticular Juvenile Idiopathic Arthritis. J Rheumatol 2019; 47:273-281. [PMID: 31308202 DOI: 10.3899/jrheum.190268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Inconsistent assessment and treatment may impair juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular JIA (rheumatoid factor-positive and -negative) outcomes by standardizing point-of-care disease activity monitoring and implementing clinical decision support (CDS) to reduce treatment variation. METHODS We performed a quality improvement initiative in an outpatient pediatric rheumatology practice. The interventions, implemented from April to November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of polyarticular JIA CDS to guide medication selection, dosing, treatment duration, and tapering. Process measures included visit-level target attestation (goal: 50%) and CDS use (goal: 15%). Our goal was to reduce the polyarticular JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least 2 visits from April 2016 through July 2017, and were classified as having early (≤ 6 mos) or established disease (> 6 mos). RESULTS Patients with polyarticular JIA (n = 97; 81% established disease) were observed for 10.3 months (interquartile range: 6.4-12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of polyarticular JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p < 0.001) and established polyarticular JIA (2.1 to 1.0, p = 0.01). A high proportion of patients with early disease received biologic therapy (73.7%). In established disease, although prescription of nonbiologic and biologic disease-modifying antirheumatic drugs remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p = 0.008). CONCLUSION Implementation of structured disease activity monitoring and CDS in polyarticular JIA was associated with significant reductions in disease activity scores in both early and established disease.
Collapse
Affiliation(s)
- Lisa Buckley
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Eileen Ware
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Genna Kreher
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Lisa Wiater
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Jay Mehta
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Jon M Burnham
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. .,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia.
| |
Collapse
|
35
|
Hinze CH, Foell D, Johnson AL, Spalding SJ, Gottlieb BS, Morris PW, Kimura Y, Onel K, Li SC, Grom AA, Taylor J, Brunner HI, Huggins JL, Nocton JJ, Haines KA, Edelheit BS, Shishov M, Jung LK, Williams CB, Tesher MS, Costanzo DM, Zemel LS, Dare JA, Passo MH, Ede KC, Olson JC, Cassidy EA, Griffin TA, Wagner-Weiner L, Weiss JE, Vogler LB, Rouster-Stevens KA, Beukelman T, Cron RQ, Kietz D, Schikler K, Mehta J, Ting TV, Verbsky JW, Eberhard AB, Huang B, Giannini EH, Lovell DJ. Serum S100A8/A9 and S100A12 Levels in Children With Polyarticular Forms of Juvenile Idiopathic Arthritis: Relationship to Maintenance of Clinically Inactive Disease During Anti-Tumor Necrosis Factor Therapy and Occurrence of Disease Flare After Discontinuation of Therapy. Arthritis Rheumatol 2019; 71:451-459. [PMID: 30225949 DOI: 10.1002/art.40727] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/11/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the relationship between serum levels of S100A8/A9 and S100A12 and the maintenance of clinically inactive disease during anti-tumor necrosis factor (anti-TNF) therapy and the occurrence of disease flare following withdrawal of anti-TNF therapy in patients with polyarticular forms of juvenile idiopathic arthritis (JIA). METHODS In this prospective, multicenter study, 137 patients with polyarticular-course JIA whose disease was clinically inactive while receiving anti-TNF therapy were enrolled. Patients were observed for an initial 6-month phase during which anti-TNF treatment was continued. For those patients who maintained clinically inactive disease over the 6 months, anti-TNF was withdrawn and they were followed up for 8 months to assess for the occurrence of flare. Serum S100 levels were measured at baseline and at the time of anti-TNF withdrawal. Spearman's rank correlation test, Mann-Whitney U test, Kruskal-Wallis test, receiver operating characteristic (ROC) curve, and Kaplan-Meier survival analyses were used to assess the relationship between serum S100 levels and maintenance of clinically inactive disease and occurrence of disease flare after anti-TNF withdrawal. RESULTS Over the 6-month initial phase with anti-TNF therapy, the disease state reverted from clinically inactive to clinically active in 24 (18%) of the 130 evaluable patients with polyarticular-course JIA; following anti-TNF withdrawal, 39 (37%) of the 106 evaluable patients experienced a flare. Serum levels of S100A8/A9 and S100A12 were elevated in up to 45% of patients. Results of the ROC analysis revealed that serum S100 levels did not predict maintenance of clinically inactive disease during anti-TNF therapy nor did they predict disease flare after treatment withdrawal. Elevated levels of S100A8/A9 were not predictive of the occurrence of a disease flare within 30 days, 60 days, 90 days, or 8 months following anti-TNF withdrawal, and elevated S100A12 levels had a modest predictive ability for determining the risk of flare within 30, 60, and 90 days after treatment withdrawal. Serum S100A12 levels at the time of anti-TNF withdrawal were inversely correlated with the time to disease flare (r = -0.36). CONCLUSION Serum S100 levels did not predict maintenance of clinically inactive disease or occurrence of disease flare in patients with polyarticular-course JIA, and S100A12 levels were only moderately, and inversely, correlated with the time to disease flare.
Collapse
Affiliation(s)
| | - Dirk Foell
- University Hospital Münster, Münster, Germany
| | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Beth S Gottlieb
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Karen Onel
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | - Suzanne C Li
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Kathleen A Haines
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | - Calvin B Williams
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Melissa S Tesher
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | | | | | - Jason A Dare
- University of Arkansas for Medical Science, Little Rock
| | | | - Kaleo C Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | | | | | | | | | - Jennifer E Weiss
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Jay Mehta
- Children's Hospital at Montefiore, Bronx, New York
| | - Tracy V Ting
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Anne B Eberhard
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
36
|
Kushner C, Tarazi M, Gaffney R, Feng R, Ardalan K, Brandling‐Bennett H, Castelo‐Soccio L, Chang J, Chiu Y, Gmuca S, Hunt R, Kahn P, Knight A, Mehta J, Pearson D, Treat J, Wan J, Yeguez A, Concha J, Patel B, Okawa J, Arkin L, Werth V. 儿科皮肤病专家和风湿病专家对 CLASI 的评估. Br J Dermatol 2019. [DOI: 10.1111/bjd.17378] [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]
|
37
|
Kushner C, Tarazi M, Gaffney R, Feng R, Ardalan K, Brandling‐Bennett H, Castelo‐Soccio L, Chang J, Chiu Y, Gmuca S, Hunt R, Kahn P, Knight A, Mehta J, Pearson D, Treat J, Wan J, Yeguez A, Concha J, Patel B, Okawa J, Arkin L, Werth V. Evaluation of CLASI by paediatric dermatologists and rheumatologists. Br J Dermatol 2019. [DOI: 10.1111/bjd.17364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Sevenoaks H, Ajwani S, Hujazi I, Sergeant J, Woodruff M, Barrie J, Mehta J. Shift working reduces operative experience for trauma and orthopaedic higher surgical trainees: a UK multicentre study. Ann R Coll Surg Engl 2018; 101:197-202. [PMID: 30525912 DOI: 10.1308/rcsann.2018.0203] [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: 11/22/2022] Open
Abstract
INTRODUCTION In recent years there has been a rise in the number of trauma and orthopaedics trainees working on full shift patterns. Historically, most trauma and orthopaedics trainees worked 24 hours non-resident on-call shifts. The effect of this change in shift patterns has not previously been measured. As two trusts (one trauma unit, one major trauma centre) in our region underwent a change to full shift working, we assessed the impact on the trainees' operating experience. METHODS Fifty-five logbooks were analysed across the two trusts over a two-year period, with comparisons made between pre- and post-shift working. RESULTS Overall operating fell by 13% for trainees working full shift patterns, which was statistically significant. There was a loss of elective operating of 15% at the trauma unit and 32% at the major trauma centre for trainees doing shift work. The effect on trauma operating opportunities was mixed. Index operating was largely preserved. CONCLUSIONS Shift working significantly impacts on surgical training opportunities. We explore approaches to minimising this effect.
Collapse
Affiliation(s)
- H Sevenoaks
- School of Surgery, North West Deanery , Manchester , UK
| | - S Ajwani
- School of Surgery, North West Deanery , Manchester , UK
| | - I Hujazi
- School of Surgery, North West Deanery , Manchester , UK
| | - J Sergeant
- Centre for Biostatistics and Arthritis Research, UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester , Manchester , UK
| | - M Woodruff
- School of Surgery, North West Deanery , Manchester , UK
| | - J Barrie
- School of Surgery, North West Deanery , Manchester , UK
| | - J Mehta
- School of Surgery, North West Deanery , Manchester , UK
| |
Collapse
|
39
|
Mehta J. Endometriotic Spot- What are we Missing out on…? J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Mehta J. Radical Hysterectomy with Laparoscopic Shearer. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.719] [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: 11/25/2022]
|
41
|
Cooper JC, Rouster-Stevens K, Wright TB, Hsu JJ, Klein-Gitelman MS, Ardoin SP, Schanberg LE, Brunner HI, Eberhard BA, Wagner-Weiner L, Mehta J, Haines K, McCurdy DK, Phillips TA, Huang Z, von Scheven E. Pilot study comparing the childhood arthritis and rheumatology research alliance consensus treatment plans for induction therapy of juvenile proliferative lupus nephritis. Pediatr Rheumatol Online J 2018; 16:65. [PMID: 30348175 PMCID: PMC6196456 DOI: 10.1186/s12969-018-0279-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To reduce treatment variability and facilitate comparative effectiveness studies, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) published consensus treatment plans (CTPs) including one for juvenile proliferative lupus nephritis (LN). Induction immunosuppression CTPs outline treatment with either monthly intravenous (IV) cyclophosphamide (CYC) or mycophenolate mofetil (MMF) in conjunction with one of three corticosteroid (steroid) CTPs: primarily oral, primarily IV or mixed oral/IV. The acceptability and in-practice use of these CTPs are unknown. Therefore, the primary aims of the pilot study were to demonstrate feasibility of adhering to the LN CTPs and delineate barriers to implementation in clinical care in the US. Further, we aimed to explore the safety and effectiveness of the treatments for induction therapy. METHODS Forty-one patients were enrolled from 10 CARRA sites. Patients had new-onset biopsy proven ISN/RPS class III or IV proliferative LN, were starting induction therapy with MMF or IV CYC and high-dose steroids and were followed for up to 24 months. Routine clinical data were collected at each visit. Provider reasons for CTP selection were assessed at baseline. Adherence to the CTPs was evaluated by provider survey and medication logs. Complete and partial renal responses were reported at 6 months. RESULTS The majority of patients were female (83%) with a mean age of 14.7 years, SD 2.8. CYC was used more commonly than MMF for patients with ISN/RPS class IV LN (vs. class III), those who had hematuria, and those with adherence concerns. Overall adherence to the immunosuppression induction CTPs was acceptable with a majority of patients receiving the target MMF (86%) or CYC (63%) dose. However, adherence to the steroid CTPs was poor (37%) with large variability in dosing. Renal response endpoints were exploratory and did not show a significant difference between CYC and MMF. CONCLUSIONS Overall, the immunosuppression CTPs were followed as intended in the majority of patients however, adherence to the steroid CTPs was poor indicating revision is necessary. In addition, our pilot study revealed several sources of treatment selection bias that will need to be addressed in for future comparative effectiveness research.
Collapse
Affiliation(s)
- Jennifer C Cooper
- University of California, San Francisco, 550 16th Street, 5th Floor, San Francisco, CA, 94158, USA.
| | - Kelly Rouster-Stevens
- 0000 0001 0941 6502grid.189967.8Emory University School of Medicine/Children’s Healthcare of Atlanta, 2015 Uppergate Dr, Atlanta, GA 30322 USA
| | - Tracey B Wright
- Texas Scottish Rite Children’s Hospital, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Joyce J Hsu
- 0000000419368956grid.168010.eStanford University, 725 Welch Rd, Palo Alto, CA 94304 USA
| | - Marisa S Klein-Gitelman
- 0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611 USA
| | - Stacy P Ardoin
- 0000 0001 2285 7943grid.261331.4Ohio State University College of Medicine, 480 Medical Center Dr. S-2056, Columbus, OH 43210 USA
| | - Laura E Schanberg
- 0000000100241216grid.189509.cDuke University Medical Center, 2100 Erwin Rd, Durham, NC 27705 USA
| | - Hermine I Brunner
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - B Anne Eberhard
- Cohen Children’s Hospital Medical Center, 1991 Marcus Ave, Lake Success, NY 11042 USA
| | - Linda Wagner-Weiner
- 0000 0000 8736 9513grid.412578.dUniversity of Chicago Hospitals, 5841 S. Maryland Ave, MC 5044, Chicago, IL 60637 USA
| | - Jay Mehta
- 0000000121791997grid.251993.5Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 USA
| | - Kathleen Haines
- 0000 0004 0407 6328grid.239835.6Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601 USA
| | - Deborah K McCurdy
- 0000 0000 9632 6718grid.19006.3eUniversity of California, 200 UCLA Medical Plaza, Los Angeles, 90095 CA USA
| | - Thomas A Phillips
- 0000000100241216grid.189509.cDuke University Medical Center, 2400 Pratt, St. Durham, NC 27705 USA
| | - Zhen Huang
- 0000000100241216grid.189509.cDuke University Medical Center, 2400 Pratt, St. Durham, NC 27705 USA
| | - Emily von Scheven
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, 550 16th Street, 5th Floor, San Francisco, CA 94158 USA
| | | |
Collapse
|
42
|
Gmuca S, Lieberman SM, Mehta J. Pediatric Neuromyelitis Optica Spectrum Disorder and Sjögren Syndrome: More Common Than Previously Thought? J Rheumatol 2018; 44:959-960. [PMID: 28572479 DOI: 10.3899/jrheum.160978] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
| | - Scott M Lieberman
- Stead Family Department of Pediatrics, Division of Rheumatology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jay Mehta
- Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
43
|
Kushner CJ, Tarazi M, Gaffney RG, Feng R, Ardalan K, Brandling-Bennett HA, Castelo-Soccio L, Chang JC, Chiu YE, Gmuca S, Hunt RD, Kahn PJ, Knight AM, Mehta J, Pearson DR, Treat JR, Wan J, Yeguez AC, Concha JSS, Patel B, Okawa J, Arkin LM, Werth VP. Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists. Br J Dermatol 2018; 180:165-171. [PMID: 30033560 DOI: 10.1111/bjd.17012] [Citation(s) in RCA: 14] [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] [Accepted: 07/15/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. OBJECTIVES This study aimed to validate the CLASI in paediatrics. METHODS Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. RESULTS CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73-0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. CONCLUSIONS CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.
Collapse
Affiliation(s)
- C J Kushner
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - M Tarazi
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - R G Gaffney
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - R Feng
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - K Ardalan
- Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - H A Brandling-Bennett
- Department of Pediatrics and Dermatology, University of Washington School of Medicine, Seattle, WA, U.S.A
| | - L Castelo-Soccio
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J C Chang
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - Y E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - S Gmuca
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - R D Hunt
- Departments of Dermatology and Pediatrics, Baylor College of Medicine, Houston, TX, U.S.A
| | - P J Kahn
- Department of Pediatrics, Division of Rheumatology, NYU Langone Medical Center, New York, NY, U.S.A
| | - A M Knight
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J Mehta
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - D R Pearson
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - J R Treat
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - J Wan
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A
| | - A C Yeguez
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A
| | - J S S Concha
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - B Patel
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - J Okawa
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| | - L M Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin School of Medicine, Madison, WI, U.S.A
| | - V P Werth
- Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, U.S.A.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A
| |
Collapse
|
44
|
Lovell DJ, Johnson AL, Huang B, Gottlieb BS, Morris PW, Kimura Y, Onel K, Li SC, Grom AA, Taylor J, Brunner HI, Huggins JL, Nocton JJ, Haines KA, Edelheit BS, Shishov M, Jung LK, Williams CB, Tesher MS, Costanzo DM, Zemel LS, Dare JA, Passo MH, Ede KC, Olson JC, Cassidy EA, Griffin TA, Wagner-Weiner L, Weiss JE, Vogler LB, Rouster-Stevens KA, Beukelman T, Cron RQ, Kietz D, Schikler K, Schmidt KM, Mehta J, Wahezi DM, Ting TV, Verbsky JW, Eberhard BA, Spalding S, Chen C, Giannini EH. Risk, Timing, and Predictors of Disease Flare After Discontinuation of Anti-Tumor Necrosis Factor Therapy in Children With Polyarticular Forms of Juvenile Idiopathic Arthritis With Clinically Inactive Disease. Arthritis Rheumatol 2018; 70:1508-1518. [PMID: 29604189 DOI: 10.1002/art.40509] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the frequency, time to flare, and predictors of disease flare upon withdrawal of anti-tumor necrosis factor (anti-TNF) therapy in children with polyarticular forms of juvenile idiopathic arthritis (JIA) who demonstrated ≥6 months of continuous clinically inactive disease. METHODS In 16 centers 137 patients with clinically inactive JIA who were receiving anti-TNF therapy (42% of whom were also receiving methotrexate [MTX]) were prospectively followed up. If the disease remained clinically inactive for the initial 6 months of the study, anti-TNF was stopped and patients were assessed for flare at 1, 2, 3, 4, 6, and 8 months. Life-table analysis, t-tests, chi-square test, and Cox regression analysis were used to identify independent variables that could significantly predict flare by 8 months or time to flare. RESULTS Of 137 patients, 106 (77%) maintained clinically inactive disease while receiving anti-TNF therapy for the initial 6 months and were included in the phase of the study in which anti-TNF therapy was stopped. Stopping anti-TNF resulted in disease flare in 39 (37%) of 106 patients by 8 months. The mean/median ± SEM time to flare was 212/250 ± 9.77 days. Patients with shorter disease duration at enrollment, older age at onset and diagnosis, shorter disease duration prior to experiencing clinically inactive disease, and shorter time from onset of clinically inactive disease to enrollment were found to have significantly lower hazard ratios for likelihood of flare by 8 months (P < 0.05). CONCLUSION Over one-third of patients with polyarticular JIA with sustained clinically inactive disease will experience a flare by 8 months after discontinuation of anti-TNF therapy. Several predictors of lower likelihood of flare were identified.
Collapse
Affiliation(s)
- Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beth S Gottlieb
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Suzanne C Li
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Kathleen A Haines
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Melissa S Tesher
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | - Denise M Costanzo
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Jason A Dare
- University of Arkansas for Medical Science, Little Rock
| | | | - Kaleo C Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | | | | | | | | | - Jennifer E Weiss
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jay Mehta
- Children's Hospital at Montefiore, Bronx, New York
| | | | - Tracy V Ting
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - B Anne Eberhard
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | - Chen Chen
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | |
Collapse
|
45
|
Budhdeo R, Mehta J, Man C. Eye examinations audit of zygomatic complex & orbital floor fractures. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.314] [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: 10/28/2022]
|
46
|
Mehta J, Budhdeo R. Audit on locating ectopic canines. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.315] [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: 11/27/2022]
|
47
|
Mehta J, Shah P, Mirza T. To extract or not to extract? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.308] [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: 10/28/2022]
|
48
|
Mor‐Vaknin N, Rivas M, Legendre M, Mohan S, Yuanfan Y, Mau T, Johnson A, Huang B, Zhao L, Kimura Y, Spalding SJ, Morris PW, Gottlieb BS, Onel K, Olson JC, Edelheit BS, Shishov M, Jung LK, Cassidy EA, Prahalad S, Passo MH, Beukelman T, Mehta J, Giannini EH, Adams BS, Lovell DJ, Markovitz DM. High Levels of DEK Autoantibodies in Sera of Patients With Polyarticular Juvenile Idiopathic Arthritis and With Early Disease Flares Following Cessation of Anti-Tumor Necrosis Factor Therapy. Arthritis Rheumatol 2018; 70:594-605. [PMID: 29287303 PMCID: PMC5876119 DOI: 10.1002/art.40404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/18/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The nuclear oncoprotein DEK is an autoantigen associated with juvenile idiopathic arthritis (JIA), especially the oligoarticular subtype. DEK is a secreted chemotactic factor. Abundant levels of DEK and DEK autoantibodies are found in inflamed synovium in JIA. We undertook this study to further characterize the nature of DEK autoantibodies in screening serum samples from 2 different cohorts that consisted mostly of patients with JIA. METHODS DEK autoantibody levels were analyzed in sera from 33 JIA patients, 13 patients with other inflammatory conditions, and 11 healthy controls, as well as in 89 serum samples from JIA patients receiving anti-tumor necrosis factor (anti-TNF) therapy. Recombinant His-tagged full-length DEK protein (1-375 amino acids [aa]) and the 187-375-aa and 1-350-aa His-tagged DEK fragments made in a baculovirus system were used for enzyme-linked immunosorbent assay (ELISA) and immunoblotting. The C-terminal 25-aa fragment of DEK was expressed in a glutathione S-transferase-tagged vector. ELISA results were calculated as area under the curve by the trapezoidal rule. RESULTS DEK autoantibody levels were significantly higher in patients with polyarticular JIA than in those with oligoarticular JIA, and were higher in patients with polyarticular JIA who had more active disease after cessation of anti-TNF therapy. Immunoblotting against the C-terminal 25-aa fragment of DEK confirmed that this section of the DEK molecule is the most immunogenic domain. CONCLUSION DEK autoantibody levels are higher in patients with polyarticular JIA than in those with oligoarticular JIA, and higher in patients who have disease flares after cessation of anti-TNF therapy. The C-terminal 25-aa fragment is the most immunogenic portion of DEK. These findings are significant with respect to the nature of DEK autoantibodies, their contribution to JIA pathogenesis, and their implications for JIA management.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anne Johnson
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center and University of Cincinnati School of MedicineCincinnatiOhio
| | | | - Yukiko Kimura
- Joseph M. Sanzari Children's HospitalHackensack University Medical CenterHackensackNew Jersey
| | | | | | - Beth S. Gottlieb
- Cohen Children's Medical Center, Northwell HealthHofstra Norwell School of MedicineHempsteadNew York
| | - Karen Onel
- Joseph M. Sanzari Children's HospitalHackensack University Medical CenterHackensackNew Jersey
| | | | | | | | | | | | | | | | | | - Jay Mehta
- Children's Hospital at Montefiore/Albert Einstein College of MedicineBronxNew York
| | | | | | | | | |
Collapse
|
49
|
Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Malhotra H, Agarwal M, Chakarborti P, Varma N, Mathews V, Bhattacharyya J, Seth T, Gyathri K, Menon H, Subramanian PG, Sharma A, Bhattacharyya M, Mehta J, Shah S, Gogoi PK, Nair R, Agarwal U, Varma S, Prasad SVVS, Mishra D. Revised myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_88_17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|