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Han JK, Perkins J, Lerner D, Yim MT, Ishii LE. Comparison of nasal valve dysfunction treatment outcomes for temperature-controlled radiofrequency and functional rhinoplasty surgery: a systematic review and meta-analyses. Rhinology 2024:3151. [PMID: 38217624 DOI: 10.4193/rhinrhin23.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted. METHODOLOGY Databases: Medline (PubMed), Embase, Cochrane Library. POPULATION adults with preprocedural nasal obstruction symptom evaluation (NOSE) score ≥45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure. RESULTS Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses. CONCLUSIONS TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.
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Affiliation(s)
- J K Han
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Perkins
- Independent Clinical Researcher, Sunnyvale, CA, USA
| | - D Lerner
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Yim
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
| | - L E Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Han JK, Perkins J, Lerner D, Yim MT, Ishii LE. Comparison of nasal valve dysfunction treatment outcomes for temperature-controlled radiofrequency and functional rhinoplasty surgery: a systematic review and meta-analyses. Rhinology 2024; 0:3151. [PMID: 38217624 DOI: 10.4193/rhin23.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted. METHODOLOGY Databases: Medline (PubMed), Embase, Cochrane Library. POPULATION adults with preprocedural nasal obstruction symptom evaluation (NOSE) score ≥45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure. RESULTS Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses. CONCLUSIONS TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.
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Affiliation(s)
- J K Han
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Perkins
- Independent Clinical Researcher, Sunnyvale, CA, USA
| | - D Lerner
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M T Yim
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
| | - L E Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Munro APS, Feng S, Janani L, Cornelius V, Aley PK, Babbage G, Baxter D, Bula M, Cathie K, Chatterjee K, Dodd K, Enever Y, Qureshi E, Goodman AL, Green CA, Harndahl L, Haughney J, Hicks A, van der Klaauw AA, Kanji N, Libri V, Llewelyn MJ, McGregor AC, Maallah M, Minassian AM, Moore P, Mughal M, Mujadidi YF, Holliday K, Osanlou O, Osanlou R, Owens DR, Pacurar M, Palfreeman A, Pan D, Rampling T, Regan K, Saich S, Bawa T, Saralaya D, Sharma S, Sheridan R, Thomson EC, Todd S, Twelves C, Read RC, Charlton S, Hallis B, Ramsay M, Andrews N, Lambe T, Nguyen-Van-Tam JS, Snape MD, Liu X, Faust SN, Feng S, Janani L, Cornelius V, Aley PK, Babbage G, Baxter D, Bula M, Cathie K, Chatterjee K, Dodd K, Enever Y, Qureshi E, Goodman AL, Green CA, Harndahl L, Haughney J, Hicks A, van der Klaauw AA, Kanji N, Libri V, Llewelyn MJ, McGregor AC, Minassian AM, Moore P, Mughal M, Mujadidi YF, Holliday K, Osanlou O, Osanlou R, Owens DR, Pacurar M, Palfreeman A, Pan D, Rampling T, Regan K, Saich S, Bawa T, Saralaya D, Sharma S, Sheridan R, Maallah M, Thomson EC, Todd S, Twelves C, Read RC, Charlton S, Hallis B, Ramsay M, Andrews N, Lambe T, Nguyen-Van-Tam JS, Snape MD, Liu X, Faust SN, Riordan A, Ustianowski A, Rogers C, Katechia K, Cooper A, Freedman A, Hughes R, Grundy L, Tudor Jones L, Harrison E, Snashall E, Mallon L, Burton K, Storton K, Munusamy M, Tandy B, Egbo A, Cox S, Ahmed NN, Shenoy A, Bousfield R, Wixted D, Gutteridge H, Mansfield B, Herbert C, Murira J, Calderwood J, Barker D, Brandon J, Tulloch H, Colquhoun S, Thorp H, Radford H, Evans J, Baker H, Thorpe J, Batham S, Hailstone J, Phillips R, Kumar D, Westwell F, Sturdy A, Barcella L, Soussi N, Mpelembue M, Raj S, Sharma R, Corrah T, John L, Whittington A, Roche S, Wagstaff L, Farrier A, Bisnauthsing K, Abeywickrama M, Spence N, Packham A, Serafimova T, Aslam S, McGreevy C, Borca A, DeLosSantosDominguez P, Palmer E, Broadhead S, Farooqi S, Piper J, Weighell R, Pickup L, Shamtally D, Domingo J, Kourampa E, Hale C, Gibney J, Stackpoole M, Rashid-Gardner Z, Lyon R, McDonnell C, Cole C, Stewart A, McMillan G, Savage M, Beckett H, Moorbey C, Desai A, Brown C, Naker K, Gokani K, Trinham C, Sabine C, Moore S, Hurdover S, Justice E, Stone M, Plested E, Ferreira Da Silva C, White R, Robinson H, Turnbull I, Morshead G, Drake-Brockman R, Smith C, Li G, Kasanyinga M, Clutterbuck EA, Bibi S, Singh M, Champaneri T, Irwin M, Khan M, Kownacka A, Nabunjo M, Osuji C, Hladkiwskyj J, Galvin D, Patel G, Grierson J, Males S, Askoolam K, Barry J, Mouland J, Longhurst B, Moon M, Giddins B, Pereira Dias Alves C, Richmond L, Minnis C, Baryschpolec S, Elliott S, Fox L, Graham V, Baker N, Godwin K, Buttigieg K, Knight C, Brown P, Lall P, Shaik I, Chiplin E, Brunt E, Leung S, Allen L, Thomas S, Fraser S, Choi B, Gouriet J, Perkins J, Gowland A, Macdonald J, Seenan JP, Starinskij I, Seaton A, Peters E, Singh S, Gardside B, Bonnaud A, Davies C, Gordon E, Keenan S, Hall J, Wilkins S, Tasker S, James R, Seath I, Littlewood K, Newman J, Boubriak I, Suggitt D, Haydock H, Bennett S, Woodyatt W, Hughes K, Bell J, Coughlan T, van Welsenes D, Kamal M, Cooper C, Tunstall S, Ronan N, Cutts R, Dare T, Yim YTN, Whittley S, Hamal S, Ricamara M, Adams K, Baker H, Driver K, Turner N, Rawlins T, Roy S, Merida-Morillas M, Sakagami Y, Andrews A, Goncalvescordeiro L, Stokes M, Ambihapathy W, Spencer J, Parungao N, Berry L, Cullinane J, Presland L, Ross Russell A, Warren S, Baker J, Oliver A, Buadi A, Lee K, Haskell L, Romani R, Bentley I, Whitbred T, Fowler S, Gavin J, Magee A, Watson T, Nightingale K, Marius P, Summerton E, Locke E, Honey T, Lingwood A, de la Haye A, Elliott RS, Underwood K, King M, Davies-Dear S, Horsfall E, Chalwin O, Burton H, Edwards CJ, Welham B, Appleby K, Dineen E, Garrahy S, Hall F, Ladikou E, Mullan D, Hansen D, Campbell M, Dos Santos F, Lakeman N, Branney D, Vamplew L, Hogan A, Frankham J, Wiselka M, Vail D, Wenn V, Renals V, Ellis K, Lewis-Taylor J, Habash-Bailey H, Magan J, Hardy A. Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial. Lancet Infect Dis 2022; 22:1131-1141. [PMID: 35550261 PMCID: PMC9084623 DOI: 10.1016/s1473-3099(22)00271-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19. METHODS The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 μg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 μg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (anti-spike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing. FINDINGS Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6-77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3-214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030-27 162), which increased to 37 460 ELU/mL (31 996-43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41-1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996-30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826-64 452), with a geometric mean fold change of 2·19 (1·90-2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37-14·32) and 15·90 (12·92-19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24-16·54] in the BNT162b2 group and 6·22 [3·90-9·92] in the mRNA-1273 group). INTERPRETATION Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose. FUNDING UK Vaccine Task Force and National Institute for Health Research.
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Affiliation(s)
- Alasdair P S Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Leila Janani
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Gavin Babbage
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Marcin Bula
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool, UK
| | - Katrina Cathie
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Krishna Chatterjee
- NIHR Cambridge Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kate Dodd
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool, UK
| | | | - Ehsaan Qureshi
- NIHR/Wellcome Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Christopher A Green
- NIHR/Wellcome Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Linda Harndahl
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - John Haughney
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alexander Hicks
- Wellcome-MRC Institute of Metabolic Science, Department of Clinical Biochemistry, University of Cambridge, Cambridge, UK
| | - Agatha A van der Klaauw
- Wellcome-MRC Institute of Metabolic Science, Department of Clinical Biochemistry, University of Cambridge, Cambridge, UK
| | - Nasir Kanji
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alastair C McGregor
- Department of Infectious Diseases and Tropical Medicine, London Northwest University Healthcare, London, UK
| | - Mina Maallah
- Department of Infectious Diseases and Tropical Medicine, London Northwest University Healthcare, London, UK
| | - Angela M Minassian
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Kyra Holliday
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Orod Osanlou
- Public Health Wales, Betsi Cadwaladr University Health Board, Bangor University, Bangor, UK
| | | | - Daniel R Owens
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Mihaela Pacurar
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Adrian Palfreeman
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
| | - Daniel Pan
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
| | - Tommy Rampling
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karen Regan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Stephen Saich
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tanveer Bawa
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dinesh Saralaya
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sunil Sharma
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ray Sheridan
- Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Emma C Thomson
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Shirley Todd
- Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Chris Twelves
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Sue Charlton
- UK Health Security Agency, Porton Down, Porton, UK
| | | | - Mary Ramsay
- UK Health Security Agency, Colindale, London, UK
| | - Nick Andrews
- UK Health Security Agency, Colindale, London, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
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Wiley Z, Kulshreshtha A, Li D, Kubes J, Kandiah S, Leung S, Kobaidze K, Shin SR, Moanna A, Perkins J, Hogan M, Sims KM, Amzat T, Cantos VD, Elutilo-Ayoola T, Hanna J, Harris NM, Henry TL, Iheaku O, Japaridze M, Lanka V, Johnson TA, Mbaezue N, Rebolledo PA, Sexton ME, Surapaneni PK, Franks N. Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19. J Investig Med 2022; 70:1406-1415. [PMID: 35649686 PMCID: PMC9195155 DOI: 10.1136/jim-2022-002344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.
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Affiliation(s)
- Zanthia Wiley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dong Li
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julianne Kubes
- Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serena Leung
- Kaiser Permanente of Georgia, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Jonathan Perkins
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Hogan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kanika M Sims
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tolu Amzat
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jasmah Hanna
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine M Harris
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Onyinye Iheaku
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariam Japaridze
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vaishnavi Lanka
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nkechi Mbaezue
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nicole Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Wenger T, Perkins J, Drusin M, Bindschadler M, Bly R, Friedman S, Bonilla-Velez J, Dahl J, Ganti S, Mercan E, Stuhaug E, Bennett J, Nelson Z, Lutsky E, Bull C, Jensen D, Dmyterko V, Palmer E, Dobyns W, Perkins J. eP282: Alpelisib for the treatment of PIK3CA-related head and neck lymphatic malformations and overgrowth. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Myers C, Bennett J, Sternen D, Rogge L, Emery L, Narayanan J, Brooks N, Nelson Z, Jensen D, Dmyterko V, Perkins J, Paschal C. 20. Diagnostic utility and lessons learned from deep sequencing vascular malformations. Cancer Genet 2022. [DOI: 10.1016/j.cancergen.2021.05.034] [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: 11/02/2022]
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Sheppard SE, Sanders VR, Srinivasan A, Finn LS, Adams D, Elton A, Amlie-Lefond C, Nelson Z, Dmyterko V, Jensen D, Zenner K, Perkins J, Bennett JT. Cerebrofacial vascular metameric syndrome is caused by somatic pathogenic variants in PIK3CA. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006147. [PMID: 34887309 PMCID: PMC8751408 DOI: 10.1101/mcs.a006147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022] Open
Abstract
Disorganized morphogenesis of arteries, veins, capillaries, and lymphatic vessels results in vascular malformations. Most individuals with isolated vascular malformations have postzygotic (mosaic), activating pathogenic variants in a handful of oncogenes within the PI3K–RAS–MAPK pathway (Padia et al., Laryngoscope Investig Otolaryngol 4: 170–173 [2019]). Activating pathogenic variants in the gene PIK3CA, which encodes for the catalytic subunit of phosphatidylinositol 3-kinase, are present in both lymphatic and venous malformations as well as arteriovenous malformations in other complex disorders such as CLOVES syndrome (congenital, lipomatous, overgrowth, vascular malformations, epidermal anevi, scoliosis) (Luks et al., Pediatr Dev Pathol 16: 51 [2013]; Luks et al., J Pediatr 166: 1048–1054.e1–5 [2015]; Al-Olabi et al., J Clin Invest 128: 1496–1508 [2018]). These vascular malformations are part of the PIK3CA-related overgrowth spectrum, a spectrum of entities that have regionalized disordered growth due to the presence of tissue-restricted postzygotic PIK3CA pathogenic variants (Keppler-Noreuil et al., Am J Med Genet A 167A: 287–295 [2015]). Cerebrofacial vascular metameric syndrome (CVMS; also described as cerebrofacial arteriovenous metameric syndrome, Bonnet–Dechaume–Blanc syndrome, and Wyburn–Mason syndrome) is the association of retinal, facial, and cerebral vascular malformations (Bhattacharya et al., Interv Neuroradiol 7: 5–17 [2001]; Krings et al., Neuroimaging Clin N Am 17: 245–258 [2007]). The segmental distribution, the presence of tissue overgrowth, and the absence of familial recurrence are all consistent with CVMS being caused by a postzygotic mutation, which has been hypothesized by previous authors (Brinjiki et al., Am J Neuroradiol 39: 2103–2107 [2018]). However, the genetic cause of CVMS has not yet been described. Here, we present three individuals with CVMS and mosaic activating pathogenic variants within the gene PIK3CA. We propose that CVMS be recognized as part of the PIK3CA-related overgrowth spectrum, providing justification for future trials using pharmacologic PIK3CA inhibitors (e.g., alpelisib) for these difficult-to-treat patients.
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Affiliation(s)
- Sarah E Sheppard
- Division of Human Genetics, Department of Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Comprehensive Vascular Anomaly Program, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Victoria R Sanders
- Division of Human Genetics, Department of Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Comprehensive Vascular Anomaly Program, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Abhay Srinivasan
- Comprehensive Vascular Anomaly Program, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Division of Interventional Radiology, Department of Radiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Laura S Finn
- Department of Pathology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Denise Adams
- Comprehensive Vascular Anomaly Program, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.,Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Andrew Elton
- University of Minnesota School of Medicine, Minneapolis, Minnesota 55455, USA
| | | | - Zoe Nelson
- Seattle Children's Hospital, Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington 98105, USA
| | - Victoria Dmyterko
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington 98101, USA
| | - Dana Jensen
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington 98101, USA
| | - Kaitlyn Zenner
- Seattle Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle, Washington 98105, USA.,Vascular Anomalies Program, Seattle Children's Hospital, Seattle, Washington 98105, USA
| | - Jonathan Perkins
- Seattle Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle, Washington 98105, USA.,Vascular Anomalies Program, Seattle Children's Hospital, Seattle, Washington 98105, USA
| | - James T Bennett
- Seattle Children's Hospital, Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington 98105, USA.,Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington 98101, USA.,Vascular Anomalies Program, Seattle Children's Hospital, Seattle, Washington 98105, USA
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8
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Napieralski R, Schricker G, Auer G, Aubele M, Perkins J, Magdolen V, Ulm K, Hamann M, Walch A, Weichert W, Kiechle M, Wilhelm OG. PITX2 DNA-Methylation: Predictive versus Prognostic Value for Anthracycline-Based Chemotherapy in Triple-Negative Breast Cancer Patients. Breast Care (Basel) 2021; 16:523-531. [PMID: 34720812 DOI: 10.1159/000510468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background PITX2 DNA methylation has been shown to predict outcomes in high-risk breast cancer patients after anthracycline-based chemotherapy. To determine its prognostic versus predictive value, the impact of PITX2 DNA methylation on outcomes was studied in an untreated cohort vs. an anthracycline-treated triple-negative breast cancer (TNBC) cohort. Material and Methods The percent DNA methylation ratio (PMR) of paired-like homeodomain transcription factor 2 (PITX2) was determined by a validated methylation-specific real-time PCR test. Patient samples of routinely collected archived formalin-fixed paraffin-embedded (FFPE) tissue and clinical data from 144 TNBC patients of 2 independent cohorts (i.e., 66 untreated patients and 78 patients treated with anthracycline-based chemotherapy) were analyzed. Results The risk of 5- and 10-year overall survival (OS) increased continuously with rising PITX2 DNA methylation in the anthracycline-treated population, but it increased only slightly during 10-year follow-up time in the untreated patient population. PITX2 DNA methylation with a PMR cutoff of 2 did not show significance for poor vs. good outcomes (OS) in the untreated patient cohort (HR = 1.55; p = 0.259). In contrast, the PITX2 PMR cutoff of 2 identified patients with poor (PMR >2) vs. good (PMR ≤2) outcomes (OS) with statistical significance in the anthracycline-treated cohort (HR = 3.96; p = 0.011). The results in the subgroup of patients who did receive anthracyclines only (no taxanes) confirmed this finding (HR = 5.71; p = 0.014). Conclusion In this hypothesis-generating study PITX2 DNA methylation demonstrated predominantly predictive value in anthracycline treatment in TNBC patients. The risk of poor outcome (OS) correlates with increasing PITX2 DNA methylation.
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Affiliation(s)
| | | | - Gert Auer
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | | | | | - Viktor Magdolen
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center (CCCTUM), Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Moritz Hamann
- Department of Gynecology Rotkreuzklinikum München, Munich, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center (CCCTUM), Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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9
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Perkins J, Grogan C. M221 FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME MASQUERADING AS INTUSSUSCEPTION. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Richardson C, Friedman SD, Park JS, Bonilla-Velez J, Dahl JP, Parikh SR, Perkins J, Johnson K. Comparison of Slide Tracheoplasty Technique on Postoperative Anatomic Outcomes in Three-Dimensional Printed Models. Laryngoscope 2021; 132:1306-1312. [PMID: 34606107 DOI: 10.1002/lary.29874] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS We hypothesized that the use of three-dimensional (3D) printed tracheal models to reproducibly simulate surgical technique variations in slide tracheoplasty would demonstrate the quantitative impact of surgical variables on postoperative tracheal dimensions. STUDY DESIGN Prospective analysis of three-dimensional printed surgical simulation models. METHODS Slide tracheoplasty was performed on 3D printed long segment tracheal stenosis models with combinations of tracheal transection incision angle (90°, 45° beveled superior to inferior, 45° beveled inferior to superior) and tracheal transection location relative to the stenosis (at midpoint, 2 mm each superior and inferior to midpoint). Postoperative computed tomography (CT) scans measured changes in tracheal length, volume, and cross-sectional area compared to controls. Statistical analysis was performed using one-way analysis of variance and unpaired two-tailed t-tests. RESULTS Slide tracheoplasty yielded 27 reconstructed tracheas. On average, slide tracheoplasty reduced total tracheal length by 36%. Beveled tracheal incisions yielded 9.5% longer final tracheas than straight transection incisions (P < .0001). Cross-sectional area at the stenosis midpoint increased from 9.0 mm2 to 45 mm2 but did not vary with technique (P > .05). Total tracheal luminal volume increased from 900 mm3 to 1378 mm3 overall and was largest with beveled incisions (P = .03). More material was discarded with straight incisions compared to beveled (89 mg vs. 19 mg, P < .0001). CONCLUSIONS Beveled tracheal transection incisions resulted in increased tracheal length, longer anastomotic segments, increased volume, and reduced tissue waste as compared to straight incisions. Offsetting the incision from the midpoint of stenosis did not significantly affect reconstructed tracheal morphology. Using 3D printed models for surgical simulation can be helpful for the quantitative study of the effect isolated surgical variables on technical outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Clare Richardson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Seth D Friedman
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jason S Park
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Juliana Bonilla-Velez
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A.,Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Sanjay R Parikh
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Jonathan Perkins
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
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11
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Wenger TL, Perkins J, Parish-Morris J, Hing AV, Chen ML, Cielo CM, Li D, Bhoj EJ, Hakonarson H, Zackai E, McDonald-McGinn DM, Taylor JA, Jackson O, Sie K, Bly R, Dahl J, Evans KN. Cleft palate morphology, genetic etiology, and risk of mortality in infants with Robin sequence. Am J Med Genet A 2021; 185:3694-3700. [PMID: 34291880 DOI: 10.1002/ajmg.a.62430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/26/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022]
Abstract
Robin sequence (RS) has many genetic and nongenetic causes, including isolated Robin sequence (iRS), Stickler syndrome (SS), and other syndromes (SyndRS). The purpose of this study was to determine if the presence and type of cleft palate varies between etiologic groups. A secondary endpoint was to determine the relationship of etiologic group, cleft type, and mortality. Retrospective chart review of patients with RS at two high-volume craniofacial centers. 295 patients with RS identified. CP was identified in 97% with iRS, 95% with SS, and 70% of those with SyndRS (p < .0001). U-shaped CP was seen in 86% of iRS, 82% with SS, but only 27% with SyndRS (p < .0001). At one institution, 12 children (6%) with RS died, all from the SyndRS group (p < .0001). All died due to medical comorbidities related to their syndrome. Only 25% of children who died had a U-shaped CP. The most common palatal morphology among those who died was an intact palate. U-shaped CP was most strongly associated with iRS and SS, and with a lower risk of mortality. RS with submucous CP, cleft lip and palate or intact palate was strongly suggestive of an underlying genetic syndrome and higher risk of mortality.
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Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan Perkins
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Julia Parish-Morris
- Division of Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne V Hing
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Maida L Chen
- Division of Pulmonary Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Christopher M Cielo
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hakon Hakonarson
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaine Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Donna M McDonald-McGinn
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse A Taylor
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Oksana Jackson
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Sie
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Randall Bly
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - John Dahl
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kelly N Evans
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, WA, USA
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12
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Boonyaratanakornkit J, Singh S, Weidle C, Rodarte J, Bakthavatsalam R, Perkins J, Stewart-Jones GBE, Kwong PD, McGuire AT, Pancera M, Taylor JJ. Protective antibodies against human parainfluenza virus type 3 infection. MAbs 2021; 13:1912884. [PMID: 33876699 PMCID: PMC8078717 DOI: 10.1080/19420862.2021.1912884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Human parainfluenza virus type III (HPIV3) is a common respiratory pathogen that afflicts children and can be fatal in vulnerable populations, including the immunocompromised. There are currently no effective vaccines or therapeutics available, resulting in tens of thousands of hospitalizations per year. In an effort to discover a protective antibody against HPIV3, we screened the B cell repertoires from peripheral blood, tonsils, and spleen from healthy children and adults. These analyses yielded five monoclonal antibodies that potently neutralized HPIV3 in vitro. These HPIV3-neutralizing antibodies targeted two non-overlapping epitopes of the HPIV3 F protein, with most targeting the apex. Prophylactic administration of one of these antibodies, PI3-E12, resulted in potent protection against HPIV3 infection in cotton rats. Additionally, PI3-E12 could also be used therapeutically to suppress HPIV3 in immunocompromised animals. These results demonstrate the potential clinical utility of PI3-E12 for the prevention or treatment of HPIV3 in both immunocompetent and immunocompromised individuals.
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Affiliation(s)
- Jim Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Suruchi Singh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Connor Weidle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Justas Rodarte
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Jonathan Perkins
- Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Guillaume B E Stewart-Jones
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Washington, USA
| | - Peter D Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Washington, USA
| | - Andrew T McGuire
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Marie Pancera
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Washington, USA
| | - Justin J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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13
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Nwachuku EL, Puccio A, Okonkwo DO, Chang YF, Perkins J, Mancinelli M. p-Tau as a Prognostic Biomarker Following Severe Traumatic Brain Injury. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_443] [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: 11/14/2022] Open
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14
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Rudsenske N, Perkins J. M225 INCIDENTAL FINDING OF LOW SERUM IGA IN TYPE 1 DIABETES MELLITUS REVEALS DIAGNOSIS OF CVID. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.253] [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]
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15
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Kiechle M, Schricker G, Napieralski R, Aubele M, Auer G, Ulm K, Perkins J, Paepke S, Hamann M, Wilhelm OG. Abstract P3-08-65: PITX2 DNA methylation: A prognostic/predictive biomarker for anthracycline-based chemotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Published data on the basis of a research-use-only PITX2 methylation assay using fresh-frozen tissue showed that the PITX2 DNA methylation may be a predictive marker for response to (neo) adjuvant anthracycline-based chemotherapy in breast cancer patients, including high-risk lymph node positive, estrogen receptor-positive, HER2-negative breast cancer and triple-negative breast cancer (TNBC). A retrospective study showed that high-risk ER-positive patients with a high PITX2 methylation ratio (PMR>12) had a poor outcome after anthracycline-based chemotherapy [HR 2,28; 95%-Cl 1,49 - 3,49; p<0.001, median DFS 71 months] compared to patients with low PITX2 methylation ratios [PMR≤12, median DFS 105 months]. Nevertheless, the question regarding the prognostic versus predictive value of PITX2 methylation for anthracycline therapy remained unanswered so far. Within an exploratory study using archived tissue specimen, this question was addressed by comparing the impact of PITX2 methylation on outcome in an untreated versus treated TNBC population. Methods: Patient samples and clinical data from 144 TNBC patients of 2 cohorts were analyzed: 1) 66 untreated patients from the Karolinska Institute in Sweden (primary diagnosis 1971-1976) and 2) 78 patients treated with anthracycline-based chemotherapy from the Comprehensive Cancer Center TUM in Germany (primary diagnosis 1996 to 2014). The main eligibility criteria were as follows: ER-negative, PR-negative, HER2-negative breast cancer (TNBC); no endocrine therapy; untreated collective: no further therapy besides surgery and radiation therapy; treated collective: surgery followed by anthracycline based chemotherapy. Samples were assessed for PITX2 methylation using a CE marked PITX2 RGQ PCR Test. The study was designed to determine the PITX2 PMR cut-off value in the untreated population (n=66, prognostic value) and to subsequently determine if this cut-off provides statistical significance in the treated population (n=78, prognostic & predictive value) as well. If no statistically significant cut-off value can be determined in the untreated population, cut-off determination was performed in the treated population and the cut-off was applied in the untreated population. The primary clinical endpoint for all cut-offs was 10-years DFS, secondary clinical endpoints were DFS censored at 5-years and OS censored at 5- and 10-years. Results: The untreated TNBC study population demonstrated a higher event rate at 10-years DFS/OS compared to the anthracycline-treated population [36 DFS/28 OS events vs 28 DFS/14 OS events]. Anthracycline treatment improved significantly overall survival [HR=0.42; p=0.008]. Risk recurrence increased continuously over 5 year and 10 years DFS/OS with increasing PITX2 DNA methylation in the anthracycline-treated population but not in the untreated patients over 5 years DFS/OS and only marginally over 10 years DFS/OS. PITX2 methylation identifies at the cut-off of PMR 2 a patient population with poor vs good overall survival with statistical significance [HR=3.96, p=0.011] in the treated patient cohort but did not identify patients with poor vs good outcome in the untreated patient cohort [HR=1.55, p=0.259].
Summary: In this hypothesis generating study DNA-methylation of PITX2 identifies with high statistical significance anthracycline-treated patients with poor vs good survival. Recurrence risk increases with increasing PITX2 DNA-methylation. PITX2 DNA-methylation shows no prognostic, but significant predictive value for anthracycline treatment in TNBC patients in this study. To confirm conclusively the predictive value of PITX2 DNA-methylation, the results warrant a confirmatory study with tumor specimens from a prospective trial of anthracycline-treated patients vs. anthracycline-free treated patients.
Citation Format: Marion Kiechle, Gabriele Schricker, Rudolf Napieralski, Michaela Aubele, Gert Auer, Kurt Ulm, Jonathan Perkins, Stefan Paepke, Moritz Hamann, Olaf G. Wilhelm. PITX2 DNA methylation: A prognostic/predictive biomarker for anthracycline-based chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-65.
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Affiliation(s)
- Marion Kiechle
- 1Klinik Gynäkologie und Geburtshilfe, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center, Munich, Germany
| | | | | | | | - Gert Auer
- 4Karolinska University Hospital, Stockholm, Sweden
| | - Kurt Ulm
- 5Technische Universität München, Munich, Germany
| | | | - Stefan Paepke
- 1Klinik Gynäkologie und Geburtshilfe, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center, Munich, Germany
| | - Moritz Hamann
- 7Klinik Gynäkologie und Geburtshilfe, Rotkreuzklinikum München, Munich, Germany
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Kamran S, Akhtar N, George P, Singh R, Imam Y, Salam A, Babu B, Burke P, Own A, Vattoth S, Perkins J, Parray A, Qadri S, Hamid T. Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category. J Stroke Cerebrovasc Dis 2020; 29:104509. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/29/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
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17
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Zenner K, Cheng CV, Jensen DM, Timms AE, Shivaram G, Bly R, Ganti S, Whitlock KB, Dobyns WB, Perkins J, Bennett JT. Genotype correlates with clinical severity in PIK3CA-associated lymphatic malformations. JCI Insight 2019; 4:129884. [PMID: 31536475 DOI: 10.1172/jci.insight.129884] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022] Open
Abstract
Lymphatic malformations (LMs) are congenital, nonneoplastic vascular malformations associated with postzygotic activating PIK3CA mutations. The mutation spectrum within LMs is narrow, with the majority having 1 of 3 hotspot mutations. Despite this relative genetic homogeneity, clinical presentations differ dramatically. We used molecular inversion probes and droplet digital polymerase chain reaction to perform deep, targeted sequencing of PIK3CA in 271 affected and unaffected tissue samples from 81 individuals with isolated LMs and retrospectively collected clinical data. Pathogenic PIK3CA mutations were identified in affected LM tissue in 64 individuals (79%) with isolated LMs, with variant allele fractions (VAFs) ranging from 0.1% to 13%. Initial analyses revealed no correlation between VAF and phenotype variables. Recognizing that different mutations activate PI3K to varying degrees, we developed a metric, the genotype-adjusted VAF (GVAF), to account for differences in mutation strength, and found significantly higher GVAFs in LMs with more severe clinical characteristics including orofacial location or microcystic structure. In addition to providing insight into LM pathogenesis, we believe GVAF may have broad applicability for genotype-phenotype analyses in mosaic disorders.
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Affiliation(s)
- Kaitlyn Zenner
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Chi Vicky Cheng
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Dana M Jensen
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Andrew E Timms
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | | | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kathryn B Whitlock
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - James T Bennett
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division Genetic Medicine, University of Washington, Seattle, Washington, USA
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18
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Cuffolo G, Hardy E, Perkins J, Hands LJ. The effects of foam sclerotherapy on ulcer healing: a single-centre prospective study. Ann R Coll Surg Engl 2019; 101:285-289. [PMID: 30602297 PMCID: PMC6432956 DOI: 10.1308/rcsann.2018.0218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This prospective study of foam sclerotherapy for varicose veins aimed to determine the outcomes of treatment including ulcer healing and complication rates in our unit. Data were collected prospectively over a 10-year period and maintained on a database by our vascular sciences unit, which performed the planning and post-treatment venous duplex scans. Patients undergoing treatment due to venous ulceration were identified from this database. An initial cohort of patients underwent a follow-up scan and assessment at one year. MATERIALS AND METHODS Patients were treated with foam sclerotherapy, in multiple sessions if required, to occlude all incompetent superficial veins greater than 3 mm in size. We used 3% sodium tetradecyl sulphate as our sclerosing agent, according to our departmental protocol, followed by a period of compression therapy. Patients underwent pre- and post-treatment scans to assess venous competence, the effects of treatment and any complications that arose. RESULTS We identified 336 patients treated for clinical, aetiological, anatomical and pathophysiological stage 5/6 venous ulceration. At six weeks post-treatment, 21% had fully healed ulcers and a further 46.1% were clinically improving with no further venous incompetence. The remainder continued treatment. An initial cohort of 162 patients was assessed at one year and 77.1% ulcers remained healed. The remainder demonstrated some venous incompetence and ultimately 12.5% required further treatment. Our complication rates were similar to those quoted in published meta-analyses including a deep vein thrombosis rate of 1.16%. CONCLUSIONS Foam sclerotherapy remains a useful treatment option for venous ulceration with a low morbidity rate.
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Affiliation(s)
- G Cuffolo
- Department of Vascular Surgery, Oxford University Hospitals, Oxford, UK
- Department of General Surgery, Wexham Park Hospital, Wexham, Slough, UK
| | - E Hardy
- Department of Vascular Surgery, Oxford University Hospitals, Oxford, UK
| | - J Perkins
- Department of Vascular Surgery, Oxford University Hospitals, Oxford, UK
| | - LJ Hands
- Department of Vascular Surgery, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
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19
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Padia R, Zenner K, Bly R, Bennett J, Bull C, Perkins J. Clinical application of molecular genetics in lymphatic malformations. Laryngoscope Investig Otolaryngol 2019; 4:170-173. [PMID: 30847392 PMCID: PMC6383318 DOI: 10.1002/lio2.241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/12/2018] [Accepted: 11/08/2018] [Indexed: 01/19/2023] Open
Abstract
Objectives To describe the clinical presentation of lymphatic malformations (LM) and genotypically associated disorders and to summarize the recent literature regarding the genetic etiology of LM and provide a biologic correlation to medical and surgical management. Results LM are congenital lesions derived from a developmental abnormality of the lymphatic vessels. The severity of disease varies widely and complications can occur with higher staged disease and those associated with a known constellation of symptoms. Somatic mutations of the PIK3CA gene have been found to be an etiologic factor in the development of LM and associated overgrowth syndromes. Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor that inhibits the pathway downstream of PIK3CA. Preliminary studies in select groups of patients suggest that sirolimus has a role in the medical management of certain aspects of this disease. Conclusions Discovery of LM molecular genetics has led to the possibility of targeted therapies and highlights the importance of precision medicine in rare diseases. Identifying genetic mutations in larger cohorts of patients with LM will lead to additional insights. Knowledge of the genetic basis for disease can then lead to discovery of directed medical therapy. A specific molecular diagnosis can also help families understand better why their child is different and provide accurate counseling for subsequent pregnancies. Level of Evidence 6.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology Seattle Children's Hospital Seattle Washington
| | - Kaitlyn Zenner
- Department of Otolaryngology-Head and Neck Surgery, Division of Genetic Medicine University of Washington School of Medicine Seattle Washington
| | - Randall Bly
- Division of Pediatric Otolaryngology Seattle Children's Hospital Seattle Washington.,Department of Otolaryngology-Head and Neck Surgery, Division of Genetic Medicine University of Washington School of Medicine Seattle Washington
| | - James Bennett
- Department of Surgery, and the Center for Developmental Biology and Regenerative Medicine Seattle Children's Hospital Seattle Washington.,Department of Pediatrics Division of Genetic Medicine, University of Washington School of Medicine Seattle Washington
| | - Catherine Bull
- Division of Pediatric Otolaryngology Seattle Children's Hospital Seattle Washington
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology Seattle Children's Hospital Seattle Washington.,Department of Otolaryngology-Head and Neck Surgery, Division of Genetic Medicine University of Washington School of Medicine Seattle Washington
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20
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Schricker G, Napieralski R, Noske A, Piednoir E, Manner O, Schüren E, Lauber J, Perkins J, Magdolen V, Schmitt M, Ulm K, Weichert W, Kiechle M, Martens JWM, Wilhelm OG. Clinical performance of an analytically validated assay in comparison to microarray technology to assess PITX2 DNA-methylation in breast cancer. Sci Rep 2018; 8:16861. [PMID: 30442983 PMCID: PMC6237923 DOI: 10.1038/s41598-018-34919-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/26/2018] [Indexed: 12/25/2022] Open
Abstract
Significant evidence has accumulated that DNA-methylation of the paired-like homeodomain transcription factor 2 (PITX2) gene can serve as a prognostic and predictive biomarker in breast cancer. PITX2 DNA-methylation data have been obtained so far from microarray and polymerase chain reaction (PCR)-based research tests. The availability of an analytically validated in vitro methylation-specific real-time PCR assay format (therascreen PITX2 RGQ PCR assay) intended for the determination of the percent methylation ratio (PMR) in the (PITX2) promoter 2 prompted us to investigate whether the clinical performance of these different assay systems generate comparable clinical outcome data. Mathematically converted microarray data of a previous breast cancer study (n = 204) into PMR values leads to a PITX2 cut-off value at PMR 14.73. Recalculation of the data to experimentally equivalent PMRs with the PCR PITX2 assay leads to a cut-off value at PMR 12 with the highest statistical significance. This cut-off predicts outcome of high-risk breast cancer patients to adjuvant anthracycline-based chemotherapy (n = 204; Hazard Ratio 2.48; p < 0.001) comparable to microarray generated results (n = 204; Hazard ratio 2.32; p < 0.0001). The therascreen PITX2 RGQ PCR assay is an analytically validated test with high reliability and robustness and predicts outcome of high-risk breast cancer patients to anthracycline-based chemotherapy.
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Affiliation(s)
- Gabriele Schricker
- Therawis Diagnostics GmbH, Grillparzerstrasse 14, 81675, Munich, Germany.
| | - Rudolf Napieralski
- Therawis Diagnostics GmbH, Grillparzerstrasse 14, 81675, Munich, Germany
| | - Aurelia Noske
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Elodie Piednoir
- HalioDx Luminy Biotech Entreprises, 163 Avenue de Luminy, 13009, Marseille, France
| | - Olivia Manner
- HalioDx Luminy Biotech Entreprises, 163 Avenue de Luminy, 13009, Marseille, France
| | - Elisabeth Schüren
- Therawis Diagnostics GmbH, Grillparzerstrasse 14, 81675, Munich, Germany
| | - Jürgen Lauber
- QIAGEN GmbH, Qiagen Strasse 1, 40724, Hilden, Germany
| | - Jonathan Perkins
- QIAGEN Manchester Ltd., Lloyd Street North, Manchester, M15 6SH, United Kingdom
| | - Viktor Magdolen
- Department of Obstetrics and Gynecology, Clinical Research Unit, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Manfred Schmitt
- Therawis Diagnostics GmbH, Grillparzerstrasse 14, 81675, Munich, Germany
- Department of Obstetrics and Gynecology, Clinical Research Unit, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Grillparzerstrasse 18, 81675, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Clinical Research Unit, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Olaf G Wilhelm
- Therawis Diagnostics GmbH, Grillparzerstrasse 14, 81675, Munich, Germany
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21
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Perkins J, Yates A, Schmidt L. SELECTIVE IGA DEFICIENCY IN A WILLIAMS SYNDROME PATIENT, AN UNCOMMON PRESENTATION OF A COMMON DIAGNOSIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.313] [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: 10/27/2022]
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22
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Calimlim A, Zemple R, Perkins J, Saccocci M, Dane F, Bernier C, Rose-Inman H, Glick R. 254 Timing Impact of Out-of-Hospital Intravenous Fluids in Sepsis. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.259] [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]
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23
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Schmitt M, Wilhelm OG, Noske A, Schricker G, Napieralski R, Vetter M, Aubele M, Perkins J, Lauber J, Ulm K, Thomssen C, Martens JWM, Weichert W, Kiechle M. Clinical Validation of PITX2 DNA Methylation to Predict Outcome in High-Risk Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy. Breast Care (Basel) 2018; 13:425-433. [PMID: 30800037 DOI: 10.1159/000493016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/16/2022] Open
Abstract
Background: Breast cancer patients at high risk for recurrence are treated with anthracycline-based chemotherapy, but not all patients do equally benefit from such a regimen. To further improve therapy decision-making, biomarkers predicting outcome are of high unmet medical need. Methods: The percent DNA methylation ratio (PMR) of the promoter gene coding for the Paired-like homeodomain transcription factor 2 (PITX2) was determined by a validated methylation-specific real-time polymerase chain reaction (PCR) test. The multicenter study was conducted in routinely collected archived formalin-fixed paraffin-embedded (FFPE) tissue from 205 lymph node-positive breast cancer patients treated with adjuvant anthracycline-based chemotherapy. Results: The cut-off for the PITX2 methylation status (PMR = 12) was confirmed in a randomly selected cohort (n = 60) and validated (n = 145) prospectively with disease-free survival (DFS) at the 10-year follow-up. DFS was significantly different between the PMR ≤ 12 versus the PMR > 12 group with a hazard ratio (HR) of 2.74 (p < 0.001) in the validation cohort and also for the patient subgroup treated additionally with endocrine therapy (HR 2.47; p = 0.001). Conclusions: Early-stage lymph node-positive breast cancer patients with low PITX2 methylation do benefit from adjuvant anthracycline-based chemotherapy. Patients with a high PITX2 DNA methylation ratio, approximately 30%, show poor outcome and should thus be considered for alternative chemotherapy regimens.
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Affiliation(s)
- Manfred Schmitt
- Therawis Diagnostics GmbH, Munich, Germany.,Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Aurelia Noske
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | | | | | - Martina Vetter
- Department of Gynecology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | | | | | | | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC, Rotterdam, The Netherlands
| | - Wilko Weichert
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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24
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Piacitelli AM, Jensen DM, Brandling-Bennett H, Gray MM, Batra M, Gust J, Thaker A, Paschal C, Tsuchiya K, Pritchard CC, Perkins J, Mirzaa GM, Bennett JT. Characterization of a severe case of PIK3CA-related overgrowth at autopsy by droplet digital polymerase chain reaction and report of PIK3CA sequencing in 22 patients. Am J Med Genet A 2018; 176:2301-2308. [PMID: 30063105 DOI: 10.1002/ajmg.a.40487] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/06/2018] [Accepted: 07/08/2018] [Indexed: 12/12/2022]
Abstract
PIK3CA-related overgrowth spectrum (PROS) refers to a group of disorders of segmental overgrowth of a wide variety of tissues as well as venous and lymphatic malformations. Clinical and molecular diagnosis can be challenging due to phenotypic heterogeneity and difficulties detecting low-level mosaicism using standard methods. Here, we report a patient with a severe presentation of PIK3CA-related overgrowth with analysis of 27 posthumously collected tissues by droplet digital polymerase chain reaction (PCR) at autopsy. This patient had a complicated medical course, with coagulopathy, ischemic brain injury, and sepsis resulting in multi-organ failure and death at age 2 months despite sirolimus therapy. Five of the 27 tissues analyzed possessed a mosaic PIK3CA mutation (p.E545K), with mutation levels ranging from 3 to 20% across affected tissues. We found no correlation between tissue-specific disease severity and mutation levels, likely reflecting sampling limitations. We also tested a series of 22 individuals with somatic overgrowth and/or vascular-lymphatic malformations using a targeted next generation sequencing panel and found PIK3CA mutations in nine individuals, identifying three novel PIK3CA variants. This report expands the clinical and molecular spectrum of PROS, emphasizes that different molecular methods can be complimentary in the diagnosis of these disorders, and highlights the risk of coagulopathy in a subset of patients with PIK3CA-related overgrowth.
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Affiliation(s)
- Andrew M Piacitelli
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Dana M Jensen
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington
| | | | - Megan Mariner Gray
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington
| | - Maneesh Batra
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington
| | - Juliane Gust
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.,Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle, Washington
| | - Ameet Thaker
- Department of Pathology, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Catherine Paschal
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Karen Tsuchiya
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington
| | - James T Bennett
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington
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25
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Abstract
PURPOSE OF REVIEW This chapter will summarize the most recent literature regarding the current state of medical treatment for vascular anomalies. RECENT FINDINGS Research into the biology of these anomalies has strengthened our understanding of each anomaly and has helped to pave the way for more tailored treatment options involving molecular and/or genetic targets. SUMMARY While there is still a role for surgical intervention, medical therapies that target the etiology of vascular anomalies may represent an alternative or adjunctive approach in the management of these lesions.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Catherine Bull
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Amy E. Geddis
- Cancer and Blood Disorders Clinic, Seattle Children's Hospital, Seattle, Washington, United States
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
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26
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Paepke S, Wilhelm OG, Schmitt M, Noske A, Schricker G, Napieralski R, Vetter M, Thomssen C, Perkins J, Lauber J, Ulm K, Martens JWM, Weichert W, Kiechle M. PITX2 DNA-Methylierung: Erster klinisch validierter prädiktiver Marker zur Vorhersage des Ansprechens auf anthrazyklin-basierte Chemotherapie bei Brustkrebspatientinnen mit hohem Rezidivrisiko. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Paepke
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - OG Wilhelm
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - M Schmitt
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - A Noske
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - G Schricker
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - R Napieralski
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - M Vetter
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - C Thomssen
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - J Perkins
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - J Lauber
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - K Ulm
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - JWM Martens
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - W Weichert
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
| | - M Kiechle
- Klinik und Poliklinik für Frauenheilkunde/Institut für Pathologie, Klinikum rechts der Isar, Technische Universität München, Comprehensive Cancer Center; Qiagen GmbH, Hilden und Therawis Diagnostics GmbH München, Deutschland
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27
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Tripathy D, Bardia A, Blum JL, Rocque G, Wilks S, Lakhanpal S, Migas J, Cappelleri J, Perkins J, Comstock G, Wang Y. Abstract OT3-05-03: POLARIS: Palbociclib (P) in hormone receptor-positive (HR+) advanced breast cancer: A prospective multicenter noninterventional study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-03] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: P is a novel cyclin-dependent kinase 4/6 inhibitor approved in the United States and Canada in combination with endocrine therapy for HR+/human epidermal growth factor receptor 2–negative (HER2-) advanced breast cancer (ABC). Despite promising trial results, not all patients respond to P. Moreover, despite a median age at diagnosis of 62 years, elderly patients are underrepresented in targeted therapy trials, including the PALOMA studies assessing P. It is important to understand P use in real-world practice settings, including tolerability and outcomes in the vulnerable older population. In addition, understanding the mechanisms of P response or resistance is critical to identify clinical factors and biomarkers that can predict which patients will benefit from P. This multicenter observational and biomarker study will seek to address these and other data gaps.
Trial Design: This is a prospective, noninterventional study of 1500 patients treated with P from 100 US and 10 Canadian sites. Study duration will span 2 years of recruitment and 3 years of follow-up after P treatment, until patient withdrawal from the study or death. Study participation is not intended to alter routine treatment; all treatment decisions, including type and timing of disease monitoring, are at the discretion of the treating physician and patient.
Eligibility: Eligible patients are aged ≥18 years with a diagnosis of adenocarcinoma of the breast with (1) evidence of advanced or metastatic disease not amenable to treatment with curative intent, (2) documented HR+/HER2- status, and (3) planned treatment with P. Patients with a life expectancy <3 months at initial diagnosis, those participating in interventional trials, and those receiving active treatment for malignancies other than ABC at enrollment are ineligible.
Aims: In a large real-world cohort of HR+/HER2- ABC patients treated with P in routine clinical practice, this study aims to assess the following: prescribing and treatment patterns for ABC before, during, and after P therapy; overall clinical response to P; biomarker assessment investigating potential mechanisms of response and resistance to P based on genomic analyses of blood samples; patient quality of life, as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30; geriatric assessments in patients aged ≥70 years at enrollment based on the G8 Geriatric Screening Tool and the Activities of Daily Living questionnaire; and sequencing of treatment for metastatic disease. Other outcomes to be assessed include survival and toxicity.
Methods: Data will be collected from routine clinical assessments. Patients will have the option to provide blood samples drawn at standard-of-care intervals at baseline, during P treatment, and at the end of treatment for potential biomarker identification. Analyses will be primarily descriptive, with point estimates and confidence intervals as well as Kaplan-Meier methods used to assess time-to-event outcomes.
Accrual: Presently, 46 patients from 20 sites are enrolled.
Funding: Pfizer Inc.
Citation Format: Tripathy D, Bardia A, Blum JL, Rocque G, Wilks S, Lakhanpal S, Migas J, Cappelleri J, Perkins J, Comstock G, Wang Y. POLARIS: Palbociclib (P) in hormone receptor-positive (HR+) advanced breast cancer: A prospective multicenter noninterventional study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-03.
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Affiliation(s)
- D Tripathy
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - A Bardia
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - JL Blum
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - G Rocque
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - S Wilks
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - S Lakhanpal
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - J Migas
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - J Cappelleri
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - J Perkins
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - G Comstock
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
| | - Y Wang
- Univeristy of Texas, MD Anderson Cancer Center, Houston, TX; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX; University of Alabama Birmingham, Birmingham, AL; Texas Oncology, San Antonio, TX; St. Vincent's Birmingham, Birmingham, AL; OSF St Joseph Medical Center, Bloomington, IL; Pfizer Inc, Groton, CT; Pfizer Inc, New York, NY; Pfizer Inc, Santa Rosa, CA
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Heike CL, Avellino AM, Mirza SK, Kifle Y, Perkins J, Sze R, Egbert M, Hing AV. Sleep Disturbances in 22q11.2 Deletion Syndrome: A Case with Obstructive and Central Sleep Apnea. Cleft Palate Craniofac J 2017; 44:340-6. [PMID: 17477750 DOI: 10.1597/05-196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The 22q11.2 deletion syndrome is characterized by wide phenotypic variability, frequently involving characteristic craniofacial features, cardiac malformations, and learning difficulties. Skeletal anomalies are also common and include an obtuse angle of the cranial base, retrognathia, and cervical spine abnormalities. Despite these anomalies, sleep-disturbed breathing is not reported frequently in patients with 22q11.2 deletion syndrome. We describe a patient with an obstructive sleep disturbance that was successfully treated with a tonsillectomy followed by mandibular distraction osteogenesis. She also had central sleep apnea, initially attributed to spinal cord impingement from cervical instability. Posterior cervical fusion was associated with a decrease in the number of central apneic events.
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MESH Headings
- Child, Preschool
- Chromosome Deletion
- Chromosomes, Human, Pair 22/genetics
- Cleft Lip/genetics
- Cleft Lip/surgery
- Cleft Palate/genetics
- Cleft Palate/surgery
- Craniofacial Abnormalities/complications
- Craniofacial Abnormalities/genetics
- Craniofacial Abnormalities/therapy
- Female
- Humans
- Infant
- Mandibular Advancement/methods
- Micrognathism/complications
- Micrognathism/genetics
- Micrognathism/surgery
- Odontoid Process/abnormalities
- Odontoid Process/diagnostic imaging
- Odontoid Process/surgery
- Osteogenesis, Distraction/methods
- Polysomnography
- Radiography
- Sleep Apnea, Central/etiology
- Sleep Apnea, Central/genetics
- Sleep Apnea, Central/therapy
- Sleep Apnea, Obstructive/etiology
- Sleep Apnea, Obstructive/genetics
- Sleep Apnea, Obstructive/therapy
- Spinal Cord Compression/complications
- Spinal Cord Compression/diagnostic imaging
- Spinal Cord Compression/surgery
- Syndrome
- Tonsillectomy
- Treatment Outcome
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Affiliation(s)
- Carrie L Heike
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington, USA
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Pet MA, Dodge R, Siebold B, Kinter S, Perkins J, Tse RW. Speech and Surgical Outcomes in Children With Veau Types III and IV Cleft Palate: A Comparison of Internationally Adopted and Nonadopted Children. Cleft Palate Craniofac J 2017; 55:396-404. [PMID: 29437506 DOI: 10.1177/1055665617735109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] Open
Abstract
OBJECTIVE This study compares speech and surgical outcomes in internationally adopted and nonadopted patients undergoing cleft palate repair, and examines the influence of age at initial palatoplasty. DESIGN Retrospective cohort study setting: Tertiary Care Children's Hospital. PATIENTS 70 international adoptees and 211 nonadoptees with Veau type III and IV clefts (without associated syndrome) repaired at our institution. OUTCOME MEASURES Outcomes included VPI, compensatory misarticulations, intelligibility, nasal air emission, oronasal fistula, and secondary speech surgery. Speech evaluations completed near 5 years of age were gathered from a prospectively collected database. RESULTS Adoptees underwent palatoplasty 5.2 months after arrival, a mean of 10.4 months later than nonadoptees. Adoptees were significantly more likely to develop moderate/severe VPI and trended toward more frequent need for secondary speech surgery. Oronasal fistula occurred at similar rates. Increased age at initial palatoplasty was a significant predictor of moderate to severe VPI, and need for secondary speech surgery. CONCLUSIONS International adoptees undergo palatoplasty 10.4 months later than nonadoptees and are significantly more likely to develop moderate/severe VPI, with a trend toward increased secondary speech surgery. An association between treatment delay and moderate/severe VPI and secondary speech surgery has been demonstrated. While a causal relationship between delayed repair and inferior outcomes in international adoptees has not been proven, this data suggests that surgical intervention upon unrepaired cleft palates soon after adoption may be beneficial. The opportunity for a change in practice exists, as half of the 10.4-month relative delay in palate repair occurs postadoption.
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Affiliation(s)
- Mitchell A Pet
- 1 Division of Plastic and Reconstructive Surgery, Seattle Children's Hospital Seattle, Seattle, WA, USA
| | - Ryan Dodge
- 2 University of Washington School of Medicine Seattle, Seattle, WA, USA
| | - Babette Siebold
- 3 Seattle Children's Hospital Research Institute Seattle, Seattle, WA, USA
| | - Sara Kinter
- 4 Speech and Language Program, Seattle Children's Hospital Seattle, Seattle, WA, USA
| | - Jonathan Perkins
- 5 Department of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Raymond W Tse
- 1 Division of Plastic and Reconstructive Surgery, Seattle Children's Hospital Seattle, Seattle, WA, USA
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30
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Najmabadi F, Raffray AR, Abdel-Khalik SI, Bromberg L, El-Guebaly LA, Goodin D, Haynes D, Latkowski J, Meier W, Moore R, Neff S, Olson CL, Perkins J, Petti D, Petzoldt R, Rose DV, Sharp WM, Sharpe P, Tillack MS, Waganer L, Welch D, Yoda M, Yu SS, Zaghloul M. Operational Windows for Dry-Wall and Wetted-Wall IFE Chambers. Fusion Science and Technology 2017. [DOI: 10.13182/fst04-a580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- F. Najmabadi
- University of California, San Diego, Department of Electrical and Computer Engineering and Center for Energy Research, La Jolla, California 92093
| | - A. R. Raffray
- University of California, San Diego, Mechanical and Aerospace Engineering Department and Center for Energy Research, La Jolla, California 92093
| | - S. I. Abdel-Khalik
- Georgia Institute of Technology, Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332-0405
| | - L. Bromberg
- Georgia Institute of Technology, Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332-0405
| | - L. A. El-Guebaly
- Georgia Institute of Technology, Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332-0405
| | - D. Goodin
- General Atomics, San Diego, California 92186
| | - D. Haynes
- Georgia Institute of Technology, Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332-0405
| | - J. Latkowski
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - W. Meier
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - R. Moore
- Idaho National Engineering and Environmental Laboratory, Fusion Safety Program, EROB E-3 MS 3815, Idaho Falls, Idaho 83415-3815
| | - S. Neff
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - C. L. Olson
- Sandia National Laboratories, Albuquerque, New Mexico 87185
| | - J. Perkins
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - D. Petti
- Idaho National Engineering and Environmental Laboratory, Fusion Safety Program, EROB E-3 MS 3815, Idaho Falls, Idaho 83415-3815
| | - R. Petzoldt
- General Atomics, San Diego, California 92186
| | - D. V. Rose
- Mission Research Corporation, Albuquerque, New Mexico 87110
| | - W. M. Sharp
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - P. Sharpe
- Idaho National Engineering and Environmental Laboratory, Fusion Safety Program, EROB E-3 MS 3815, Idaho Falls, Idaho 83415-3815
| | - M. S. Tillack
- University of California, San Diego, Mechanical and Aerospace Engineering Department and Center for Energy Research, La Jolla, California 92093
| | - L. Waganer
- Boeing High Energy Systems, St. Louis, Missouri 63166
| | - D.R. Welch
- Mission Research Corporation, Albuquerque, New Mexico 87110
| | - M. Yoda
- Georgia Institute of Technology, Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332-0405
| | - S. S. Yu
- Lawrence Berkeley National Laboratory, Berkeley, California 94720
| | - M. Zaghloul
- University of California, San Diego, Mechanical and Aerospace Engineering Department and Center for Energy Research, La Jolla, California 92093
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Kharfan-Dabaja MA, Parody R, Perkins J, Lopez-Godino O, Lopez-Corral L, Vazquez L, Caballero D, Falantes J, Shapiro J, Ortí G, Barba P, Valcárcel D, Esquirol A, Martino R, Piñana JL, Solano C, Tsalatsanis A, Pidala J, Anasetti C, Perez-Simón JA. Tacrolimus plus sirolimus with or without ATG as GVHD prophylaxis in HLA-mismatched unrelated donor allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 52:438-444. [PMID: 27819684 DOI: 10.1038/bmt.2016.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/28/2022]
Abstract
HLA-matched related or unrelated donors are not universally available. Consequently, patients can be offered hematopoietic stem cell transplantation (HSCT) from alternative donors, including mismatched unrelated donors (MMURD), known to cause a higher incidence of acute GVHD (aGVHD) and chronic GVHD. In vivo T-cell-depletion strategies, such as antithymocyte globulin (ATG) therapy, significantly decrease the risk of GVHD. We performed a multicenter, retrospective study comparing tacrolimus (TAC) and sirolimus (SIR) with or without ATG in 104 patients (TAC-SIR=45, TAC-SIR-ATG=59) who underwent MMURD HSCT. Use of ATG was associated with a lower incidence, albeit not statistically significant, of grades 2-4 aGVHD (46% vs 64%, P=0.09), no difference in grades 3-4 aGVHD (10% vs 15%, P=0.43), a trend for a lower incidence of moderate/severe chronic GVHD (16% vs 37%, P=0.09) and more frequent Epstein-Barr virus reactivation (54% vs 18%, P=0.0002). There were no statistically significant differences in 3-year overall survival (OS) (TAC-SIR-ATG=40% (95% confidence interval (CI)=24-56%) vs TAC-SIR=54% (95% CI=37-70%), P=0.43) or 3-year cumulative incidence of relapse/progression (TAC-SIR-ATG=40% (95% CI=28-58%) vs TAC-SIR=22% (95% CI=13-39%), P=0.92). An intermediate Center for International Blood & Marrow Transplant Research disease risk resulted in a significantly lower non-relapse mortality and better OS at 3 years. Our study suggests that addition of ATG to TAC-SIR in MMURD HSCT does not affect OS when compared with TAC-SIR alone.
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Affiliation(s)
- M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Parody
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
| | - J Perkins
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,College of Pharmacy, University of South Florida, Tampa, FL, USA
| | | | | | - L Vazquez
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - D Caballero
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - J Falantes
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
| | - J Shapiro
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Ortí
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Barba
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - D Valcárcel
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Esquirol
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - R Martino
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - J L Piñana
- Hospital Clínico de Valenci, Valencia, Spain
| | - C Solano
- Hospital Clínico de Valenci, Valencia, Spain
| | - A Tsalatsanis
- Center for Evidence-Based Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - J Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - C Anasetti
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J A Perez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
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Bly RA, Perkins J, Parikh SR. Can topical beta-blockers reduce the size of superficial infantile hemangiomas of the head and neck? Laryngoscope 2016; 127:4-5. [PMID: 27808405 DOI: 10.1002/lary.26350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, U.S.A
| | - Jonathan Perkins
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, U.S.A
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Weigle H, Trigonis R, Bunn D, Krakauer D, Long L, Perkins J. 345 Severe Sepsis: What Gets it Right? A Comparison of the Quick Sequential Organ Failure Assessment Versus Systemic Inflammatory Response Syndrome Criteria. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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Chun R, Jabbour N, Balakrishnan K, Bauman N, Darrow DH, Elluru R, Grimmer JF, Perkins J, Richter G, Shin J. Education on, Exposure to, and Management of Vascular Anomalies During Otolaryngology Residency and Pediatric Otolaryngology Fellowship. JAMA Otolaryngol Head Neck Surg 2016; 142:648-51. [PMID: 27124736 DOI: 10.1001/jamaoto.2016.0605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The field of vascular anomalies presents diverse challenges in diagnosis and management. Although many lesions involve the head and neck, training in vascular anomalies is not universally included in otolaryngology residencies and pediatric otolaryngology (POTO) fellowships. OBJECTIVE To explore the education in, exposure to, and comfort level of otolaryngology trainees with vascular anomalies. DESIGN, SETTING, AND PARTICIPANTS A survey was distributed to 39 POTO fellows and 44 residents in postgraduate year 5 who matched into POTO fellowships from April 22 through June 16, 2014. MAIN OUTCOMES AND MEASURES Survey responses from trainees on exposure to, education on, and comfort with vascular anomalies. RESULTS Forty-four residents in postgraduate year 5 who applied to POTO fellowships and 39 POTO fellows were emailed the survey. Fourteen respondents were unable to be contacted owing to lack of a current email address. Thirty-six of 69 residents and fellows (18 fellows and 18 residents [52%]) responded to the survey. Twenty-seven trainees (75%) reported no participation in a vascular anomalies clinic during residency; 6 of these 27 individuals (22%) trained at institutions with a vascular anomalies clinic but did not participate in the clinic, and 28 of the 36 respondents (78%) reported that they had less than adequate or no exposure to vascular anomalies in residency. Among POTO fellows, 11 of 17 (65%) did not participate in a vascular anomalies clinic during fellowship, even though 8 of the 11 had a vascular anomalies clinic at their fellowship program. During fellowship training, 12 of 18 fellows (67%) reported that they had adequate exposure to vascular anomalies. Only 20 respondents (56%) felt comfortable distinguishing among diagnoses of vascular anomalies, and only 4 residents (22%) and 9 fellows (50%) felt comfortable treating patients with vascular anomalies. All fellows believed that training in vascular anomalies was important in fellowship, and 100% of respondents indicated that increased exposure to diagnosis and management of vascular anomalies would have been beneficial to their ability to care for patients. CONCLUSIONS AND RELEVANCE These data indicate that most otolaryngology trainees do not receive formal training in vascular anomalies in residency and that such training is valued among graduating trainees. Conversely, most POTO fellows felt their exposure was adequate and 50% of fellows felt comfortable treating vascular anomalies. However, 65% of POTO fellows had no participation in a vascular anomalies clinic, where many patients are managed by a multidisciplinary team. This finding may indicate that POTO fellows may have a false sense of confidence in managing patients with vascular anomalies and that residency and fellowship programs may consider changes in didactic and clinical programs.
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Affiliation(s)
- Robert Chun
- Medical College of Wisconsin, Department of Otolaryngology, Children's Hospital of Wisconsin, Milwaukee
| | - Noel Jabbour
- Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Nancy Bauman
- Department of Otolaryngology, George Washington University, Washington, DC
| | - David H Darrow
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk
| | - Ravindhra Elluru
- Department of Otolaryngology, Dayton Children's Hospital, Dayton, Ohio
| | - J Fredrik Grimmer
- Division of Otolaryngology-Head and Neck Surgery, Primary Children's Hospital, University of Utah Health Sciences, Salt Lake City
| | - Jonathan Perkins
- Department of Otolaryngology, Washington University, St Louis, Missouri
| | - Gresham Richter
- Department of Otolaryngology, University of Arkansas, Fayetteville
| | - Jennifer Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Perkins J, Voore N, Sanna S, Patel J, Mann E, Gozu A. 363 Assessment of an Emergency Department Chest Pain Patient Cohort at Low Risk for Significant Adverse Events During Admission for Acute Coronary Syndrome. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.399] [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]
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36
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Halldorson JB, Rayhill S, Bakthavatsalam R, Montenovo M, Dick A, Perkins J, Reyes J. Serum alkaline phosphatase and bilirubin are early surrogate markers for ischemic cholangiopathy and graft failure in liver transplantation from donation after circulatory death. Transplant Proc 2015; 47:465-8. [PMID: 25769592 DOI: 10.1016/j.transproceed.2014.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/15/2014] [Accepted: 10/28/2014] [Indexed: 01/08/2023]
Abstract
Liver transplantation with the use of donation after circulatory death (DCD) is associated with ischemic cholangiopathy (IC) often leading to graft loss. We hypothesized that serial postoperative analysis of alkaline phosphatase and bilirubin might identify patients who would later on develop ischemic cholangiopathy and/or graft loss, allowing early recognition and potentially retransplantation. The University of Washington DCD experience totals 89 DCD liver transplantations performed from 2003 to 2011 with Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively; 84/89 patients transplanted with DCD livers lived ≥ 60 days after transplantation and were analyzed. Serum bilirubin and alkaline phosphatase levels at 1 week, 2 week, 1 month, and 2 months after transplantation were analyzed. Two-month serum bilirubin and alkaline phosphatase proved to have the strongest associations with development of IC and graft failure. Two-month alkaline phosphatase of <100 U/L had a negative predictive value of 97% for development of IC. Two-month alkaline phosphatase demonstrated an inflection starting at >300 U/L strongly associated with development of IC (P < .0001). Serum bilirubin at 2 months was most strongly associated with graft failure within the 1st year with a strong inflection point at 2.5 mg/dL (P = .0001). All jaundiced recipients at 60 days after transplantation (bilirubin >2.5 mg/dL) developed graft failure within the 1st year (P < .0001). Use of these early surrogate markers could facilitate prioritization and early retransplantation for DCD liver recipients with allografts destined for failure.
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Affiliation(s)
- J B Halldorson
- Division of Transplantation, University of California, San Diego, California.
| | - S Rayhill
- Division of Transplantation, University of Washington, Seattle, Washington
| | - R Bakthavatsalam
- Division of Transplantation, University of Washington, Seattle, Washington
| | - M Montenovo
- Division of Transplantation, University of Washington, Seattle, Washington
| | - A Dick
- Division of Transplantation, University of Washington, Seattle, Washington
| | - J Perkins
- Division of Transplantation, University of Washington, Seattle, Washington
| | - J Reyes
- Division of Transplantation, University of Washington, Seattle, Washington
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Blanca-Lopez N, Perez-Alzate D, Ruano F, Garcimartin M, de la Torre V, Mayorga C, Somoza ML, Perkins J, Blanca M, Canto MG, Torres MJ. Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis. Allergy 2015; 70:1013-9. [PMID: 25913298 DOI: 10.1111/all.12636] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 04/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. OBJECTIVE To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX. METHODS Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure. RESULTS Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX-selective cases developed positive responses after re-provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX. DISCUSSION The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely.
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Affiliation(s)
| | | | - F. Ruano
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | | | | | - C. Mayorga
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. L. Somoza
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - J. Perkins
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
| | - M. G. Canto
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. J. Torres
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
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Chai J, Biasiolli L, Li L, Handa A, Perkins J, Hands L, Sideso E, Jezzard P, Robson M, Choudhury R. In-vivo carotid plaque characterisation using quantitative T2 map: Histological validation and lipid quantification. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.068] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Côté V, Ruiz AG, Perkins J, Sillau S, Friedman NR. Characteristics of children under 2 years of age undergoing tonsillectomy for upper airway obstruction. Int J Pediatr Otorhinolaryngol 2015; 79:903-908. [PMID: 25912628 DOI: 10.1016/j.ijporl.2015.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 01/14/2015] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To study characteristics of children less than 2 years who underwent a tonsillectomy for sleep disordered breathing (SDB) or obstructive sleep apnea (OSA) to assess for factors associated with requesting a preoperative polysomnogram (PSG) and to identify predictors of upper airway obstruction in this group. MATERIALS AND METHODS A retrospective chart review of children under 2 years who underwent a tonsillectomy over a 7-year period at a tertiary care pediatric hospital was undertaken. Patient demographics, characteristics and polysomnography results, when applicable, were collected. In order to determine if the gathered demographics of our cohort differed from the non-surgical population, we compared our data with available Colorado data for each variable. Children were stratified by OSA severity using their obstructive apnea-hypopnea index (OAHI). RESULTS 197 (2.2%) of 9038 patients who underwent tonsillectomy for SDB or OSA were ≤ 24 months. The proportions of male, African-American, Hispanic, obese, underweight, premature, syndromic and daycare patients in our cohort were significantly different than in the general population. In a multivariate model, the odds of African-Americans having severe OSA were 12.5 times greater than the odds of Caucasians. The odds of patients with syndromes or craniofacial anomalies were 11 times greater (p < 0.0001), and the odds of patients in daycare were 2.2 times lower (p = 0.04) of undergoing a PSG before tonsillectomy. Weight did not influence polysomnogram requests. CONCLUSIONS In children under 2 years, ethnicity seems to be a predictor of OSA severity. African-American, prematurity, daycare and Down syndrome patients were significantly more represented in our study population. PSG is more likely to be requested for syndromic children.
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Affiliation(s)
- Valérie Côté
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Amanda G Ruiz
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Jonathan Perkins
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Stefan Sillau
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States
| | - Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States.
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Verraich J, Shivaram G, Ghodke B, Vaidya S, Zopf D, Perkins J. Pre-operative n-butyl-2-cyanoacrylate glue embolization of pediatric head and neck venous malformations: technique and clinical outcomes. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Halldorson JB, Bakthavatsalam R, Montenovo M, Dick A, Rayhill S, Perkins J, Reyes J. Differential rates of ischemic cholangiopathy and graft survival associated with induction therapy in DCD liver transplantation. Am J Transplant 2015; 15:251-8. [PMID: 25534449 DOI: 10.1111/ajt.12962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 07/09/2014] [Accepted: 08/04/2014] [Indexed: 01/25/2023]
Abstract
Transplantation utilizing donation after circulatory death (DCD) donors is associated with ischemic cholangiopathy (IC) and graft loss. The University of Washington (UW) DCD experience totals 89 DCD liver transplants performed between 2003 and 2011. Overall outcome after DCD liver transplantation at UW demonstrates Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively, with the great majority of patient and graft losses occurring in the first-year posttransplant from IC. Our program has almost exclusively utilized either anti-thymocyte globulin (ATG) or basiliximab induction (86/89) for DCD liver transplantations. Analysis of the differential effect of induction agent on graft survival demonstrated graft survival of 96.9% at 1 year for ATG versus 75.9% for basiliximab (p = 0.013). The improved survival did not appear to be from a lower rate of rejection (21.9% vs. 22.2%) but rather a differential rate of IC, 35.2% for basiliximab versus 12.5% for ATG (p = 0.011). Multivariable analysis demonstrated induction agent to be independently associated with graft survival and IC free graft survival when analyzed against variables including donor age, fWIT, donor cold ischemia time and transplant era.
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Affiliation(s)
- J B Halldorson
- Division of Transplantation, University of California, San Diego, CA
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Chai J, Biasiolli L, Li L, Handa A, Perkins J, Hands L, Sideso E, Jezzard P, Robson M, Choudhury R. In-vivo carotid plaques characterisation using quantitative T2 map: histological validation and lipid quantification. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.10.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kairis O, Kosmas C, Karavitis C, Ritsema C, Salvati L, Acikalin S, Alcalá M, Alfama P, Atlhopheng J, Barrera J, Belgacem A, Solé-Benet A, Brito J, Chaker M, Chanda R, Coelho C, Darkoh M, Diamantis I, Ermolaeva O, Fassouli V, Fei W, Feng J, Fernandez F, Ferreira A, Gokceoglu C, Gonzalez D, Gungor H, Hessel R, Juying J, Khatteli H, Khitrov N, Kounalaki A, Laouina A, Lollino P, Lopes M, Magole L, Medina L, Mendoza M, Morais P, Mulale K, Ocakoglu F, Ouessar M, Ovalle C, Perez C, Perkins J, Pliakas F, Polemio M, Pozo A, Prat C, Qinke Y, Ramos A, Ramos J, Riquelme J, Romanenkov V, Rui L, Santaloia F, Sebego R, Sghaier M, Silva N, Sizemskaya M, Soares J, Sonmez H, Taamallah H, Tezcan L, Torri D, Ungaro F, Valente S, de Vente J, Zagal E, Zeiliguer A, Zhonging W, Ziogas A. Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management. Environ Manage 2014; 54:971-82. [PMID: 23811772 DOI: 10.1007/s00267-013-0110-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 06/07/2013] [Indexed: 05/25/2023]
Abstract
Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.
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Affiliation(s)
- Or Kairis
- Laboratory of Soils, Agricultural University of Athens, Iera Odos 75, Athens, 11855, Greece
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Kosmas C, Kairis O, Karavitis C, Ritsema C, Salvati L, Acikalin S, Alcala M, Alfama P, Atlhopheng J, Barrera J, Belgacem A, Solé-Benet A, Brito J, Chaker M, Chanda R, Coelho C, Darkoh M, Diamantis I, Ermolaeva O, Fassouli V, Fei W, Feng J, Fernandez F, Ferreira A, Gokceoglu C, Gonzalez D, Gungor H, Hessel R, Juying J, Khatteli H, Khitrov N, Kounalaki A, Laouina A, Lollino P, Lopes M, Magole L, Medina L, Mendoza M, Morais P, Mulale K, Ocakoglu F, Ouessar M, Ovalle C, Perez C, Perkins J, Pliakas F, Polemio M, Pozo A, Prat C, Qinke Y, Ramos A, Ramos J, Riquelme J, Romanenkov V, Rui L, Santaloia F, Sebego R, Sghaier M, Silva N, Sizemskaya M, Soares J, Sonmez H, Taamallah H, Tezcan L, Torri D, Ungaro F, Valente S, de Vente J, Zagal E, Zeiliguer A, Zhonging W, Ziogas A. Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach. Environ Manage 2014; 54:951-970. [PMID: 23797485 DOI: 10.1007/s00267-013-0109-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Abstract
An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.
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Lee J, Sung J, Lee J, Perkins J. Biomarker difference between controlled and uncontrolled hypertension among us adults: National health and nutrition examination survey 2005-2008. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ustinova KI, Perkins J, Leonard WA, Hausbeck CJ. Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: a pilot study. Brain Inj 2014; 28:486-95. [PMID: 24702281 DOI: 10.3109/02699052.2014.888593] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The study objective was to test the efficacy of game-based virtual reality (VR) therapy as a mean of correcting postural and co-ordination abnormalities in individuals with traumatic brain injury (TBI). Therapy was done with interactive customized VR games and scenarios, utilizing an Xbox Kinect sensor. RESEARCH DESIGN The study was a pilot project using the structure of a phase II clinical trial. METHODS AND PROCEDURES Fifteen participants with mild-to-moderate chronic TBI-related balance and motor co-ordination impairments participated in 15 sessions, each lasting ∼50-55 minutes, scheduled 2-3 times a week over 5-6 consecutive weeks. Participants were evaluated at baseline, immediately after the final session and in a 1-month follow-up with a battery of clinical tests (measuring postural stability, gait and co-ordination) and movement performance parameters. Movement parameters included arm-leg co-ordination, dynamic stability and arm precision, calculated from kinematic data recorded with Xbox Kinect sensor. RESULTS Following therapy, most participants improved their static and dynamic postural stability, gait and arm movements. These effects persisted over the retention interval. CONCLUSIONS Results will be used to improve the VR program, with the goal of producing a cost-effective, accessible and easy to individualize therapeutic approach. The pilot data will be used for designing a larger scale clinical trial.
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Affiliation(s)
- K I Ustinova
- The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University , MI , USA and
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Parmar SR, Bookout R, Shapiro JF, Tombleson R, Perkins J, Kim J, Yue B, Tomblyn M, Alsina M, Nishihori T. Comparison of 1-day vs 2-day dosing of high-dose melphalan followed by autologous hematopoietic cell transplantation in patients with multiple myeloma. Bone Marrow Transplant 2014; 49:761-6. [PMID: 24662419 DOI: 10.1038/bmt.2014.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/28/2014] [Accepted: 02/04/2014] [Indexed: 12/22/2022]
Abstract
High-dose melphalan at 200 mg/m(2) can be administered in 1 day or over 2 consecutive days before autologous hematopoietic cell transplantation (HCT) for multiple myeloma (MM). Limited data exist on the comparison of the two dosing schedules. A retrospective study of 278 consecutive MM patients receiving high-dose melphalan from January 2010 to December 2012 was conducted. Objectives were to compare the length of hospitalization, toxicity profile, response rates, PFS and OS. One hundred and eighty five patients received 2-day dosing and 93 received 1-day dosing. The two end points of the 95% confidence interval (CI) for the difference did not exceed the preselected margin, therefore the length of hospitalization was considered equivalent. No significant differences were found for response rates, PFS and OS. The toxicity profile was similar with the exception of more frequent ⩾grade 3 oral mucositis in the 2-day group (13.5% vs 5.4%; odds ratio 3.07 (95% CI:1.11-8.48); P=0.03). High-dose melphalan, given either in 1 day or over 2 days, produced comparable treatment outcomes except for increased grade 3/4 mucositis in the 2-day regimen. One-day dosing could shorten the hospital stay by 1 day and may allow better resource utilization.
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Affiliation(s)
- S R Parmar
- Department of Pharmacy, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Bookout
- Department of Pharmacy, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J F Shapiro
- Department of Pharmacy, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Tombleson
- Department of Pharmacy, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Perkins
- University of South Florida College of Pharmacy, Tampa, FL, USA
| | - J Kim
- Biostatistics Core, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - B Yue
- Biostatistics Core, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - M Tomblyn
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - M Alsina
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - T Nishihori
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Ustinova K, Perkins J. Virtual reality game-based therapy for restoring postural and coordination abnormalities in patients with TBI. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
IMPORTANCE Disk battery ingestion is common in the pediatric population, with over 50,000 ingestions reported annually. In the upper aerodigestive tract, consequences of such ingestions vary widely from superficial mucosal ulcerations to death from erosion through vital structures. This report describes a battery ingestion complication, vocal cord paralysis, to our knowledge not previously described in the otolaryngology literature. OBSERVATIONS We describe a patient who presented with biphasic stridor and drooling after upper esophageal disk battery ingestion. The battery was removed 5 hours after ingestion, but stridor with respiratory distress persisted. To stabilize the airway, a tracheotomy was performed after a several-week period of inpatient observation. Two years after ingestion, the patient is tracheostomy dependent. CONCLUSIONS AND RELEVANCE Disk battery ingestion has the potential for recurrent laryngeal nerve damage and vocal cord paralysis. Expeditious battery removal and long-term care are crucial for successful ingestion management, as ingestion complications can be significant.
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Affiliation(s)
- Sapna A Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA.
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Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, Chun RH, Garzon MC, Holland KE, Liberman L, MacLellan-Tobert S, Mancini AJ, Metry D, Puttgen KB, Seefeldt M, Sidbury R, Ward KM, Blei F, Baselga E, Cassidy L, Darrow DH, Joachim S, Kwon EKM, Martin K, Perkins J, Siegel DH, Boucek RJ, Frieden IJ. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131:128-40. [PMID: 23266923 PMCID: PMC3529954 DOI: 10.1542/peds.2012-1691] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [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] [Indexed: 12/13/2022] Open
Abstract
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
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Affiliation(s)
| | | | - Sarah L. Chamlin
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Anita Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nancy M. Bauman
- Department of Otolaryngology, Children’s National Medical Center, Washington, District of Columbia
| | | | | | | | | | | | | | - Anthony J. Mancini
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | | | - Marcia Seefeldt
- Department of Dermatology, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Robert Sidbury
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Kendra M. Ward
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Francine Blei
- Departments of Hematology & Oncology, Vascular Birthmark Institute of New York, New York, New York
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Cassidy
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David H. Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | | | | | | | | | | | - Robert J. Boucek
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Ilona J. Frieden
- Departments of Dermatology & Pediatrics, University of California San Francisco, San Francisco, California
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