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Foley CM, McKenna D, Gallagher K, McLellan K, Alkhdher H, Lacassagne S, Moraitis E, Papadopoulou C, Pilkington C, Al Obaidi M, Eleftheriou D, Brogan P. Systemic juvenile idiopathic arthritis: The Great Ormond Street Hospital experience (2005-2021). Front Pediatr 2023; 11:1218312. [PMID: 37780048 PMCID: PMC10536248 DOI: 10.3389/fped.2023.1218312] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a complex, systemic inflammatory disorder driven by both innate and adaptive immunity. Improved understanding of sJIA pathophysiology has led to recent therapeutic advances including a growing evidence base for the earlier use of IL-1 or IL-6 blockade as first-line treatment. We conducted a retrospective case notes review of patients diagnosed with sJIA over a 16-year period (October 2005-October 2021) at Great Ormond Street Hospital for Children. We describe the clinical presentation, therapeutic interventions, complications, and remission rates at different timepoints over the disease course. We examined our data, which spanned a period of changing therapeutic landscape, to try and identify potential therapeutic signals in patients who received biologic treatment early in the disease course compared to those who did not. A total of 76-children (female n = 40, 53%) were diagnosed with sJIA, median age 4.5 years (range 0.6-14.1); 36% (27/76) presented with suspected or confirmed macrophage activation syndrome. A biologic disease-modifying anti-rheumatic drug (bDMARD) alone was commenced as first-line treatment in 28% (n = 21/76) of the cohort; however, at last review, 84% (n = 64/76) had received treatment with a bDMARD. Clinically inactive disease (CID) was achieved by 88% (n = 67/76) of the cohort at last review; however, only 32% (24/76) achieved treatment-free CID. At 1-year follow-up, CID was achieved in a significantly greater proportion of children who received treatment with a bDMARD within 3 months of diagnosis compared to those who did not (90% vs. 53%, p = 0.002). Based on an ever-increasing evidence base for the earlier use of bDMARD in sJIA and our experience of the largest UK single-centre case series described to date, we now propose a new therapeutic pathway for children diagnosed with sJIA in the UK based on early use of bDMARDs. Reappraisal of the current National Health Service commissioning pathway for sJIA is now urgently required.
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Affiliation(s)
- C. M. Foley
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. McKenna
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. Gallagher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. McLellan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - H. Alkhdher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - S. Lacassagne
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - E. Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - M. Al Obaidi
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. Eleftheriou
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - P. Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Gallagher K, Aruma JFC, Oji-Mmuo CN, Pauli JM, Curtin WM, Goldstein JA, Stuckey HL, Gernand AD. Placental pathology reports: A qualitative study in a US university hospital setting on perceived clinical utility and areas for improvement. PLoS One 2023; 18:e0286294. [PMID: 37289756 PMCID: PMC10249791 DOI: 10.1371/journal.pone.0286294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To explore how placental pathology is currently used by clinicians and what placental information would be most useful in the immediate hours after delivery. STUDY DESIGN We used a qualitative study design to conduct in-depth, semi-structured interviews with obstetric and neonatal clinicians who provide delivery or postpartum care at an academic medical center in the US (n = 19). Interviews were transcribed and analyzed using descriptive content analysis. RESULTS Clinicians valued placental pathology information yet cited multiple barriers that prevent the consistent use of pathology. Four main themes were identified. First, the placenta is sent to pathology for consistent reasons, however, the pathology report is accessed by clinicians inconsistently due to key barriers: difficult to find in the electronic medical record, understand, and get quickly. Second, clinicians value placental pathology for explanatory capability as well as for contributions to current and future care, particularly when there is fetal growth restriction, stillbirth, or antibiotic use. Third, a rapid placental exam (specifically including placental weight, infection, infarction, and overall assessment) would be helpful in providing clinical care. Fourth, placental pathology reports that connect clinically relevant findings (similar to radiology) and that are written with plain, standardized language and that non-pathologists can more readily understand are preferred. CONCLUSION Placental pathology is important to clinicians that care for mothers and newborns (particularly those that are critically ill) after birth, yet many problems stand in the way of its usefulness. Hospital administrators, perinatal pathologists, and clinicians should work together to improve access to and contents of reports. Support for new methods to provide quick placenta information is warranted.
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Affiliation(s)
- Kelly Gallagher
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Jane-Frances C. Aruma
- College of Medicine, Pennsylvania State University College of Medicine University Park Campus, Hershey, Pennsylvania, United States of America
| | - Christiana N. Oji-Mmuo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jaimey M. Pauli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - William M. Curtin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
- Division of Maternal-Fetal Medicine, Department of Pathology and Laboratory Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jeffery A. Goldstein
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Heather L. Stuckey
- Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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3
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Gernand AD, Gallagher K, Bhandari N, Kolsteren P, Lee AC, Shafiq Y, Taneja S, Tielsch JM, Abate FW, Baye E, Berhane Y, Chowdhury R, Dailey-Chwalibóg T, de Kok B, Dhabhai N, Jehan F, Kang Y, Katz J, Khatry S, Lachat C, Mazumder S, Muhammad A, Nisar MI, Sharma S, Martin LA, Upadhyay RP, Christian P. Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection. BMC Pregnancy Childbirth 2023; 23:107. [PMID: 36774497 PMCID: PMC9919738 DOI: 10.1186/s12884-023-05366-2] [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: 07/21/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
| | - Kelly Gallagher
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - James M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, D.C, USA
| | - Firehiwot Workneh Abate
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sitanshi Sharma
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Leigh A Martin
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Khadhouri S, Orecchia L, Banthia R, Piazza P, Mak D, Pyrgidis N, Narayan P, Abad Lopez P, Nawaz F, Thanh T, Claps F, Hogan D, Gomez Rivas J, Alonso S, Chibuzo I, Meghana K, Anbarasan T, Gallagher K, Kasivisvanathan V. External validation of the IDENTIFY risk calculator. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00654-1] [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: 02/12/2023]
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5
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Flatt A, Sheikh S, Peleckis A, Gallagher K, Alvarado P, Hadjiliadis D, Stefanovski D, Gallop R, Rubenstein R, Rickels M, Kelly A. 580 Preservation of beta-cell function in pancreatic insufficient cystic fibrosis with highly effective cystic fibrosis transmembrane conductance regulator modulator therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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6
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McNeill A, Hassan M, Taylor L, Rawlinson A, Good D, Gallagher K. Patient reported outcomes using EPIC-26 one year Post-RP: The impact of surgical approach and training. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00783-2] [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: 10/16/2022] Open
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7
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Senapedis W, Gallagher K, Figueroa E, Farelli J, O'Donnell C, Newman J, McCauley T. P-307 Modulation of the MYC oncogene using programmable epigenetic mRNA therapeutics as a novel therapy for hepatocellular carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Haddad P, Hammoud D, Gallagher K. PO-09: Risk of intracranial hemorrhage of direct oral anticoagulants (DOACs) versus low molecular weight heparin (LMWH) in brain cancers: a meta-analysis of comparative studies. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Greisch JF, den Boer MA, Lai SH, Gallagher K, Bondt A, Commandeur J, Heck AJR. Extending Native Top-Down Electron Capture Dissociation to MDa Immunoglobulin Complexes Provides Useful Sequence Tags Covering Their Critical Variable Complementarity-Determining Regions. Anal Chem 2021; 93:16068-16075. [PMID: 34813704 PMCID: PMC8655740 DOI: 10.1021/acs.analchem.1c03740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
![]()
Native top-down mass
spectrometry (MS) is gaining traction for
the analysis and sequencing of intact proteins and protein assemblies,
giving access to their mass and composition, as well as sequence information
useful for identification. Herein, we extend and apply native top-down
MS, using electron capture dissociation, to two submillion Da IgM-
and IgG-based oligomeric immunoglobulins. Despite structural similarities,
these two systems are quite different. The ∼895 kDa noncovalent
IgG hexamer consists of six IgG subunits hexamerizing in solution
due to three specifically engineered mutations in the Fc region, whereas
the ∼935 kDa IgM oligomer results from the covalent assembly
of one joining (J) chain and 5 IgM subunits into an asymmetric “pentamer”
stabilized by interchain disulfide bridges. Notwithstanding their
size, structural differences, and complexity, we observe that their
top-down electron capture dissociation spectra are quite similar and
straightforward to interpret, specifically providing informative sequence
tags covering the highly variable CDR3s and FR4s of the Ig subunits
they contain. Moreover, we show that the electron capture dissociation
fragmentation spectra of immunoglobulin oligomers are essentially
identical to those obtained for their respective monomers. Demonstrated
for recombinantly produced systems, the approach described here opens
up new prospects for the characterization and identification of IgMs
circulating in plasma, which is important since IgMs play a critical
role in the early immune response to pathogens such as viruses and
bacteria.
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Affiliation(s)
- Jean-Francois Greisch
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Maurits A den Boer
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Szu-Hsueh Lai
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Kelly Gallagher
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Albert Bondt
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Jan Commandeur
- MSVision, Televisieweg 40, 1322 AM Almere, The Netherlands
| | - Albert J R Heck
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands.,Netherlands Proteomics Center, Padualaan 8, 3584 CH Utrecht, The Netherlands
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10
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Hall J, Fried D, Marks L, Gupta G, Jones E, Elmore S, Downs-Canner S, Gallagher K, Carr J, Ogunleye Y, Casey D. Dosimetric and Clinical Factors Associated With Increased Risk of Reconstruction Complications in Patients With Breast Cancer Receiving Post-Mastectomy Radiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.770] [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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11
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Bottomley C, Otiende M, Uyoga S, Gallagher K, Kagucia EW, Etyang AO, Mugo D, Gitonga J, Karanja H, Nyagwange J, Adetifa IMO, Agweyu A, Nokes DJ, Warimwe GM, Scott JAG. Quantifying previous SARS-CoV-2 infection through mixture modelling of antibody levels. Nat Commun 2021; 12:6196. [PMID: 34702829 PMCID: PMC8548402 DOI: 10.1038/s41467-021-26452-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022] Open
Abstract
As countries decide on vaccination strategies and how to ease movement restrictions, estimating the proportion of the population previously infected with SARS-CoV-2 is important for predicting the future burden of COVID-19. This proportion is usually estimated from serosurvey data in two steps: first the proportion above a threshold antibody level is calculated, then the crude estimate is adjusted using external estimates of sensitivity and specificity. A drawback of this approach is that the PCR-confirmed cases used to estimate the sensitivity of the threshold may not be representative of cases in the wider population-e.g., they may be more recently infected and more severely symptomatic. Mixture modelling offers an alternative approach that does not require external data from PCR-confirmed cases. Here we illustrate the bias in the standard threshold-based approach by comparing both approaches using data from several Kenyan serosurveys. We show that the mixture model analysis produces estimates of previous infection that are often substantially higher than the standard threshold analysis.
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Affiliation(s)
- C Bottomley
- International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - M Otiende
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - S Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Gallagher
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - E W Kagucia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - A O Etyang
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D Mugo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Gitonga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - H Karanja
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Nyagwange
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - I M O Adetifa
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - A Agweyu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - D J Nokes
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences, University of Warwick, Coventry, UK
| | - G M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - J A G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
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12
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Boyle C, Gallagher K, Leung S, Good D, McNeill SA, Laird A. 218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic. Br J Surg 2021. [PMCID: PMC8524596 DOI: 10.1093/bjs/znab259.1072] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aim Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff. Method From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases. Results 87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening. Conclusions Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.
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Affiliation(s)
- C Boyle
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - K Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - S Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - D Good
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - S A McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - A Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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13
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Khadhouri S, Gallagher K, MacKenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambiar A, Mannas M, Lee T, Marra G, Gomez Rivas J, Marcq G, Assmus M, Ucar T, Claps F, Boltri M, Montagna GL, Burnhope T, Nkwam N, Austin T, Boxall N, Downey A, Sukhu T, Anton-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green J, Nielsen M, Takwoingi Y, McGrath J, Kasivisvanathan V. 92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study. Br J Surg 2021. [PMCID: PMC8135806 DOI: 10.1093/bjs/znab135.029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.
Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.
Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.
Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
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Affiliation(s)
- S Khadhouri
- University of Aberdeen, Aberdeen, United Kingdom
- BURST, London, United Kingdom
| | - K Gallagher
- Western General Hospital, Edinburgh, United Kingdom
- BURST, London, United Kingdom
| | - K MacKenzie
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - T Shah
- Charing Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - C Gao
- Addenbrookes Hospital, Cambridge, United Kingdom
- BURST, London, United Kingdom
| | - S Moore
- Wrexham Maelor Hospital, Wrexham, United Kingdom
- BURST, London, United Kingdom
| | - E Zimmermann
- Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
- BURST, London, United Kingdom
| | - E Edison
- Whipps Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - M Jefferies
- Morriston Hospital, Swansea, United Kingdom
- BURST, London, United Kingdom
| | - A Nambiar
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - M Mannas
- University of British Columbia, Vancouver, Canada
| | - T Lee
- University of British Columbia, Vancouver, Canada
| | - G Marra
- University of Turin, Turin, Italy
| | | | - G Marcq
- University of Lille, Lille, France
| | - M Assmus
- University of Alberta, Edmonton, Canada
| | - T Ucar
- Istanbul Medeniyet University, Istanbul, Turkey
| | - F Claps
- University of Trieste, Trieste, Italy
| | - M Boltri
- University of Trieste, Trieste, Italy
| | | | - T Burnhope
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - N Nkwam
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Austin
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - N Boxall
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - A Downey
- Doncaster Royal Infirmary, Doncaster, United Kingdom
| | - T Sukhu
- University of North Carolina Hospitals, Chapel Hill, USA
| | | | - S Rai
- St James University Hospital, Leeds, United Kingdom
| | - Y F Chin
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - M Moore
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Drake
- The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - J Green
- Whipps Cross Hospital, London, United Kingdom
| | - M Nielsen
- University of North Carolina Hospitals, Chapel Hill, USA
| | - Y Takwoingi
- University of Birmingham, Birmingham, United Kingdom
| | - J McGrath
- University of Exeter Medical School, Exeter, United Kingdom
| | - V Kasivisvanathan
- University College London, London, United Kingdom
- BURST, London, United Kingdom
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14
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Light A, Gallagher K, Bhatt N, Clement K, Kulkarni MA, Khadhouri S, Zimmermann E, Gao C, Lam C, Anbarasan T, Chan V, Rossi S, Jayaraajan K, Asif A, Shah T, Kasivisvanathan V. 377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.030] [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: 11/14/2022]
Abstract
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.
Method
RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.
Results
As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusions
RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.
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Affiliation(s)
- A Light
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Gallagher
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Western General Hospital, Edinburgh, United Kingdom
| | - N Bhatt
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Queen Elizabeth Hospital, King's Lynn, United Kingdom
| | - K Clement
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Royal Alexandra Hospital, Paisley, United Kingdom
| | - M a Kulkarni
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Guy's Hospital, London, United Kingdom
| | - S Khadhouri
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - E Zimmermann
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Torbay Hospital, Torbay, United Kingdom
| | - C Gao
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- William Harvey Hospital, Ashford, United Kingdom
| | - C Lam
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Bronglais Hospital, Aberystwyth, United Kingdom
| | - T Anbarasan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - V Chan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leeds School of Medicine, Leeds, United Kingdom
| | - S Rossi
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Jayaraajan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Imperial College School of Medicine, London, United Kingdom
| | - A Asif
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leicester Medical School, Leicester, United Kingdom
| | - T Shah
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Charing Cross Hospital, London, United Kingdom
| | - V Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- University College London, London, United Kingdom
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Sarkar M, Uppala R, Zeng C, Billi A, Tsoi L, Kidder A, Xing X, Perez White B, Shao S, Plazyo O, Sirobhushanam S, Xing E, Jiang Y, Gallagher K, Voorhees J, Kahlenberg J, Gudjonsson J. 168 STING-IFN-κ-APOBEC3G pathway mediates resistance to CRISPR transfection in keratinocytes. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.188] [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: 10/21/2022]
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16
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Wolf S, Audu C, Joshi A, denDekker A, Melvin W, Xing X, Wasikowski R, Tsoi L, Kunkel S, Gudjonsson J, O'Riordan M, Kahlenberg J, Gallagher K. 633 Regulation of IFN kappa in keratinocytes of diabetic wounds. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Lam CM, Gallagher K, Bhatt N, Clement K, Zimmermann E, Shah T, Khadhouri S, Kulkarni M, Gao C, Light A, Jayaraajan K, Asif A, Anbarasan T, Chan V, Kasivisvanathan V. P57 Global recruitment for the RESECT study (transurethral REsection and Single-instillation intravesical chemotherapy Evaluation in bladder Cancer Treatment) - an international observational cohort study aiming to improve the quality of surgery for non-muscle invasive bladder cancer. BJS Open 2021. [PMCID: PMC8153804 DOI: 10.1093/bjsopen/zrab032.056] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.
Methods
RESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.
Results
As of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusion
RESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.
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Affiliation(s)
- C M Lam
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Gallagher
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - N Bhatt
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Clement
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - E Zimmermann
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Shah
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - S Khadhouri
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - M Kulkarni
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - C Gao
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Light
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Jayaraajan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Asif
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Anbarasan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Chan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Kasivisvanathan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
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Haddad P, Gallagher K, Hammoud D. PO-07 Comparison of primary thromboprophylaxis agents (PTA) efficacy in multiple myeloma (MM) treated with immunomodulators (IMID): a network meta-analysis. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00166-3] [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: 10/21/2022]
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19
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Taylor LA, Gallagher K, Ott KA, Gernand AD. How often is the placenta included in human pregnancy research? A rapid systematic review of the literature. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13215.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The placenta is a complex organ that plays a vital role not only in nutrient transfer but also in directing maternal and fetal physiological processes across pregnancy. Due to its multi-functionality, assessing the placenta can provide critical information about maternal and child health and risks of adverse outcomes. Objective: We aimed to quantify the percentage of human pregnancy studies that include placenta data. Methods: We conducted a rapid review of pregnancy studies conducted in the US that were published as original research in PubMed in 2018. Human studies conducted during the second trimester, third trimester, or labor and/or delivery were eligible. The systematic search produced 1,448 publications. After screening and full article review, 290 studies met all eligibility criteria. We then extracted data on study design, reporting of placenta data, time and type of data collection, and study objective categorization. Results: In total, 32% of studies were randomized controlled trials; the remaining were observational studies. Only 14% included placenta data of any kind. A total of 10% included placenta data during pregnancy and 7% included data after delivery; only 2% included both. Most data during pregnancy were collected by ultrasound and most data on the delivered placenta were from pathology exams. Study objectives were focused on maternal and/or infant outcomes (99.7%), while only one study had a placenta outcome. Conclusion: Based on this rapid review, a small proportion of pregnancy studies use placenta data in research. The placenta, an essential component of understanding healthy or adverse outcomes, deserves much more attention in pregnancy research.
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20
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Haddad P, Hammoud D, Gallagher K. P26.01 Survival Impact of Adjuvant Postoperative Radiation Therapy (PORT) in Locally Advanced Thymic Carcinoma (TC): An Up-To-Date Meta-Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.630] [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: 10/21/2022]
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21
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Haddad P, Hammoud D, Gallagher K. P26.02 The Impact of Clinicopathologic Factors on the Overall Survival of Thymic Neuroendocrine Tumors (TNET): A Pooled Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.631] [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: 10/21/2022]
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22
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Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKM. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop 2021. [PMID: 32862265 DOI: 10.1007/s00264-020-04739-y/figures/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. METHODS A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. RESULTS Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. CONCLUSION COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
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Affiliation(s)
- A Narang
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - G Chan
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - A Aframian
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Z Ali
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - A Carr
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - H Goodier
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - C Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Park
- St Mary's Hospital, London, London, UK
| | - K Sugand
- St Mary's Hospital, London, London, UK
| | - T Walton
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Wilson
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - A Belgaumkar
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - K Gallagher
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - K Ghosh
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - C Gibbons
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Keightley
- Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Z Nawaz
- Frimley Park Hospital, Camberley, UK
| | - C Wakeling
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - K Sarraf
- St Mary's Hospital, London, London, UK
| | - B A Rogers
- Brighton and Sussex University Hospitals, Brighton, UK
| | - W K M Kieffer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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23
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Goldstein JA, Gallagher K, Beck C, Kumar R, Gernand AD. Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease. Front Immunol 2020; 11:531543. [PMID: 33281808 PMCID: PMC7691234 DOI: 10.3389/fimmu.2020.531543] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Events in fetal life impact long-term health outcomes. The placenta is the first organ to form and is the site of juxtaposition between the maternal and fetal circulations. Most diseases of pregnancy are caused by, impact, or are reflected in the placenta. The purpose of this review is to describe the main inflammatory processes in the placenta, discuss their immunology, and relate their short- and long-term disease associations. Acute placental inflammation (API), including maternal and fetal inflammatory responses corresponds to the clinical diagnosis of chorioamnionitis and is associated with respiratory and neurodevelopmental diseases. The chronic placental inflammatory pathologies (CPI), include chronic villitis of unknown etiology, chronic deciduitis, chronic chorionitis, eosinophilic T-cell vasculitis, and chronic histiocytic intervillositis. These diseases are less-well studied, but have complex immunology and show mechanistic impacts on the fetal immune system. Overall, much work remains to be done in describing the long-term impacts of placental inflammation on offspring health.
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Affiliation(s)
- Jeffery A. Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kelly Gallagher
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Celeste Beck
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Rajesh Kumar
- Section of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University, Chicago, IL, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
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24
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Haddad P, Hammoud D, Gallagher K. Comparison of Treatment Modalities in Frontline Therapy of Stages I&IIE NK/T-Cell Lymphoma (ENKTL): An Updated Network Meta-analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Haddad P, Akhtar F, Gallagher K. The Impact of Postoperative Radiation Therapy (PORT) on Clinical Outcomes of Resected Atypical Meningioma: A Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Haddad P, Hammoud D, Gallagher K. The Survival Impact of Adding Postoperative Radiation Therapy (PORT) to Adjuvant Therapies in Locally Advanced Resected Thymic Carcinoma (TC): A Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Haddad P, Hammoud D, Gallagher K. The Impact of Postoperative Radiation Therapy (PORT) on the Overall Survival (OS) of Completely Resected Masaoka/Masaoka-Koga Stage II Thymoma: An Updated Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1176] [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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28
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Marcq G, Olivier J, Xylinas E, Ouzaid I, Lebacle C, Uzan A, Schneider A, Bardet F, Pradère B, Khadhouri S, Gallagher K, Mackenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambia A, Kasivisvanathan V. Étude de la détection des néoplasies urologiques chez les patients consultant pour suspicion de cancer du tractus urinaire : résultat d’IDENTIFY étude multicentrique prospective. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.163] [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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29
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Bazan J, Stephens J, Agnese D, Skoracki R, Reiland J, Arneson K, Gupta G, Gallagher K, McElroy S, Park K, Grignol V, Lee C, Sisk G, Schulz S, Chetta M, Jhawar S, Grecula J, Martin D, Carson W, Farrar W, Carlson M, Gupta N, White J. PO-0933: Prospective Evaulation Of Iort Boost In Women Undergoing Lumpectomy With Oncoplastic Reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Haddad P, Hammoud D, Gallagher K. The Impact of Adjuvant Chemoradiotherapy on the Overall Survival of Completely Resected Ampullary and Periampullary Carcinoma: An Updated Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1788] [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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31
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Gernand A, Berhane Y, Bhandari N, Chowdhury R, Jehan F, Khatry S, Kolsteren P, Lee ACC, Muhammad A, Shafiq Y, Taneja S, Tielsch J, Taylor L, Gallagher K, Christian P, Yan J, Roskosky M. Harmonization of Maternal Nutrition Trials – Finding and Creating Similarities in Protocols and Outcomes. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa065_003] [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: 11/14/2022] Open
Abstract
Abstract
Objectives
Public health and clinical recommendations should be based on results from multiple studies, however trials often have outcomes that are not defined in the same way. This project aims to harmonize selected protocols, outcome definitions, and data analysis across five randomized trials of antenatal balanced energy-protein supplementation being conducted in Burkina Faso, Ethiopia, India, Nepal, and Pakistan.
Methods
Harmonization efforts include a range of activities from reviewing detailed protocols, biospecimen collection plans, data dictionaries, and data analysis plans to proposing best practices and acceptable practices based on field limitations. Most studies have not begun or are early in enrollment, an ideal time frame to make changes. A two-day workshop of lead investigators, content experts and advisors will be held in late February, and harmonization activities will continue thereafter.
Results
All studies are examining anthropometry at birth as a primary outcome, however the timing of birth measurements (hours since birth) and types of measurements taken differ across trials. All studies are estimating gestational age by ultrasound measurements, but the gestational age at ultrasound differs (in part due to differences in timing of antenatal care by country) as well as the number of fetal biometry measures. Finally, stillbirth is a key outcome across trials, but initial definitions had slight differences that will now be harmonized. We are also able to add new, important maternal and child health outcomes to each trial that will have the same protocols from inception (e.g., microbiome).
Conclusions
Efforts thus far have resulted in communication between study investigators, consideration of improved protocols, and addition of new outcomes to collect across all sites. Further results are forthcoming after the February workshop, which will include documentation of how much definitions vary across studies and the challenges of standardization. We expect the harmonization process to improve overall reporting within each study and provide opportunities for better meta-analyses.
Funding Sources
The Bill and Melinda Gates Foundation.
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Affiliation(s)
| | | | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies
| | | | | | | | - Anne C C Lee
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies
| | - James Tielsch
- Milken Institute School of Public Health, The George Washington University
| | | | | | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Jian Yan
- Bill and Melinda Gates Foundation
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Murphy SC, Negron ME, Pieracci EG, Deressa A, Bekele W, Regassa F, Wassie BA, Afera B, Hajito KW, Walelign E, Abebe G, Newman S, Rwego IB, Mutonga D, Gulima D, Kebede N, Smith WA, Kramer LM, Kibria A, Bonnenfant YT, Mortenson JA, Vieira AR, Kadzik M, Sugerman D, Amare B, Kanter T, Walke H, Belay E, Gallagher K. One Health collaborations for zoonotic disease control in Ethiopia. REV SCI TECH OIE 2019; 38:51-60. [PMID: 31564741 DOI: 10.20506/rst.38.1.2940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.
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Presley C, Janse S, Anderson E, Gallagher K, Ferris A, Janssen E, Basu Roy U, Bridges J. P1.16-21 Does Age Affect What Patients Value When Considering Lung Cancer Treatments? Evidence from a National Survey. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1247] [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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Gallagher K, Ralph J, Petros T, Qualls C, Leeman L, Rogers RG. Postpartum Weight Retention in Primiparous Women and Weight Outcomes in Their Offspring. J Midwifery Womens Health 2019; 64:427-434. [PMID: 31298482 DOI: 10.1111/jmwh.12986] [Citation(s) in RCA: 6] [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] [Received: 09/05/2018] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To explore the effect of prepregnancy body mass index (BMI) and gestational weight gain on postpartum weight retention in nulliparous women and weight-for-length percentiles of offspring to 2 years following birth. METHODS A retrospective secondary analysis of a large, prospective longitudinal study of women conducted during pregnancy and after their first birth was completed to examine outcomes associated with postpartum weight retention. A chart review of the offspring of these women was completed to explore the relationship between maternal prepregnancy BMI and gestational weight gain on offspring weight-for-length percentiles. RESULTS Data from 652 woman-infant dyads were available for analysis. Average postpartum weight retention was 4.0 kg at one year for all groups. At 6 weeks postpartum, women who were obese prior to pregnancy retained significantly less weight than did women who were normal weight prior to pregnancy (P < .05). Women who were normal weight or overweight at the onset of pregnancy and had gestational weight gain within Institute of Medicine recommendations retained significantly less weight at 6 weeks, 6 months, and 1 year postpartum (P < .01) when compared with women in those same weight groups who had a gestational weight gain in excess of the recommended guideline. Women who entered pregnancy obese and who had a gestational weight gain within the recommended weight range during pregnancy retained significantly less weight compared with women who were obese and who gained in excess of the guideline at 6 weeks postpartum only (P < .05). No statistically significant differences were seen in offspring weight-for-length percentiles at any time point based on maternal prepregnancy BMI or weight gain within guidelines. DISCUSSION Many women retained weight up to one year postpartum. In this study, we saw no statistically significant differences between the prepregnant BMI groups or between gestational weight gain within guidelines or in excess of guidelines on offspring weight-for-length percentiles.
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Affiliation(s)
- Kelly Gallagher
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| | - Jody Ralph
- Faculty of Nursing, University of Windsor, Windsor, Ontario, Canada
| | - Thomas Petros
- Department of Psychology, University of North Dakota, Grand Forks, North Dakota
| | - Clifford Qualls
- Clinical and Translation Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Leeman
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Rebecca G Rogers
- Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, Texas
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Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Abstract OT2-04-04: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-04] [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: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials demonstrate that addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. The advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: To determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Sites: Ohio State University, Avera Medical Group, University of North Carolina-Chapel Hill
Patient Accrual: Current accrual is 5/176.
Contact Information: Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-04.
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Affiliation(s)
- JG Bazan
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Stephens
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - D Agnese
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - R Skoracki
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Arneson
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Reiland
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - G Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Gallagher
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - S McElroy
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - N Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - JR White
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
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Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Abstract PD8-07: Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings.
METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing partial mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard partial mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention.
RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of partial mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors.
FactorShave (n=197)No Shave (n=201)p-valueAge (years); median (range)67 (36-94)64 (29-89)0.585Race 0.062-- White173 (87.8%)164 (81.6%) -- Black20 (10.2%)33 (16.4%) -- Asian2 (1.0%)2 (1.0%) -- Native American0 (0%)2 (1.0%) -- Unknown/Declined2 (1.0%)0 (0%) Hispanic ethnicity28 (14.2%)32 (15.9%)0.806Invasive tumor size (cm); median (range)1.30 (0.09-8.00)1.20 (0.05-7.50)0.282DCIS extent (cm); median (range)0.80 (0.10-6.40)1.00 (0.05-5.50)0.906Invasive histology 0.556-- Ductal177 (89.8%)186 (92.5%) -- Lobular16 (8.1%)13 (6.5%) -- Mucinous3 (1.5%)2 (1.0%) -- Other1 (0.5%)0 (0%) Neoadjuvant therapy15 (7.6%)19 (9.5%)0.592Palpable tumor57 (28.9%)56 (27.9%)0.825Node positive*24 (16.3%)16 (10.6%)0.175*Of the 298 patients who had lymph nodes evaluated
Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p<0.001). They were also less likely to require re-excision or mastectomy for margin clearance (8.6% vs. 23.9%, p<0.001). There were no significant differences between the two groups in terms of adverse events (p=0.280). Rates of seroma (1.5% vs. 0.5%, p=0.368), hematoma (0.5% vs. 0.5%, p=1.000) and abscess (0.3% vs. 0%, p=0.495) were similar between the “shave” and “no shave” groups, respectively.
CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing partial mastectomy.
Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.
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Affiliation(s)
- AB Chagpar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - T Tsangaris
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - C Garcia-Cantu
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Howard-McNatt
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Chiba
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AC Berger
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Levine
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JS Gass
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - K Gallagher
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SS Lum
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - RD Martinez
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AI Willis
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SV Pandya
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - EA Brown
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Fenton
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Mendiola
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Murray
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - V Haddad
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NL Solomon
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Senthil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - H Bansil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Ollila
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SK Snyder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Edmonson
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Lazar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JP Namm
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - F Li
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Butler
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NE McGowan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - ME Herrera
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - YP Avitan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - B Yoder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Dupont
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
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Peppers J, Paller AS, Maeda-Chubachi T, Wu S, Robbins K, Gallagher K, Kraus JE. A phase 2, randomized dose-finding study of tapinarof (GSK2894512 cream) for the treatment of atopic dermatitis. J Am Acad Dermatol 2018; 80:89-98.e3. [PMID: 30554600 DOI: 10.1016/j.jaad.2018.06.047] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Safe and efficacious topical treatments are needed for atopic dermatitis (AD). OBJECTIVE We assessed the safety and efficacy of tapinarof cream (2 concentrations and 2 application frequencies) in patients with AD. METHODS A double-blind, vehicle-controlled, randomized, 6-arm trial (1:1:1:1:1:1) in patients age 12 to 65 years, with body surface area involvement of at least 5% to 35% and an Investigator's Global Assessment score of 3 or higher (moderate to severe) at baseline. Primary end points included an Investigator's Global Assessment score of clear or almost clear (0 or 1) and a minimum 2-grade improvement (treatment success) at week 12. Secondary analyses included a 75% or greater improvement in Eczema Area and Severity Index score, reduction of numeric rating scale (NRS) score for itch from baseline, and other prespecified end points. RESULTS The rates of treatment success with tapinarof cream at week 12 were 53% (a concentration of 1% twice daily), 46% (a concentration of 1% once daily), 37% (a concentration of 0.5% twice daily), 34% (0.5% once daily), 24% (vehicle twice daily), and 28% (vehicle once daily). The rate with a concentration of 1% twice daily (53%) was statistically significantly higher than the rate with vehicle twice daily (24%). Treatment success was maintained for 4 weeks after the end of tapinarof treatment. The rate of treatment-emergent adverse events was higher with tapinarof (93 of 165 [56%]) than with vehicle (34 of 82 [41%]), and the events were mild to moderate in intensity. LIMITATIONS Large confirmation trials are needed. CONCLUSIONS Tapinarof cream is efficacious and well tolerated in adolescent and adult patients with AD.
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Affiliation(s)
| | - Amy S Paller
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | | | - John E Kraus
- ICON plc, Research Triangle Park, North Carolina
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Chew E, Gallagher K. CKD rates after radical and partial nephrectomy in patients with normal pre-operative renal function after 8 years of follow-up. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gallagher K, Youssef B, Georges R, Mahajan A, Feghali J, Tannous J, Nabha R, Ayoub Z, Jalbout W, Taddei P. EP-1861: Predicted reduction in fatal second cancers by proton therapy of childhood intracranial tumors. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32170-4] [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: 10/14/2022]
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Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Abstract P4-02-06: Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-06] [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: Applying the PAM50 classifier to targeted RNA-Sequencing data allows HER2+ tumors to be sub-categorized into intrinsic breast cancer subtypes. HER2+ breast cancers belonging to the HER2-enriched [HER2-E] subtype exhibit the highest rate of response to neoadjuvant therapy with combination of HER2-blockade and chemotherapy, as well as dual-HER2 blockade alone. A non-invasive predictor of PAM50 subtype from clinical dynamic contrast-enhanced MRI [DCE-MRI] could provide valuable clinical guidance in the treatment of HER2+ breast cancer. In this work, we identify a set of computer-extracted heterogeneity features computed within the lesion and its surrounding peritumoral region capable of distinguishing HER2-E from other HER2+ breast cancers [Non-HER2-E]. We then demonstrate that this imaging signature of HER2-E is also predictive of pathological complete response [pCR] in an independent HER2+ testing set, consistent with the HER2-E subtype's elevated response to HER2-targeted therapy.
Methods: The training set consisted of 42 HER2+ patients with both 1.5 or 3 T DCE-MRI and targeted RNA sequencing collected prior to neoadjuvant treatment from a multicenter trial [BrUOG 211B, n=35] and The Cancer Genome Atlas-Breast Cancer project [TCGA-BRCA, n=7]. Intrinsic subtypes were assigned by unsupervised hierarchical clustering of the PAM50 gene set. 19 patients were determined to belong to the HER2-E subtype, while the remaining 23 represented non-HER2-E subtypes [19 HER2-Luminal, 4 HER2-basal]. Lesion boundaries were annotated by an expertly trained radiologist and expanded to 5 annular peritumoral regions in 3 mm increments out to a maximum radius of 15 mm. Computer-extracted heterogeneity features were computed voxelwise within intratumoral and peritumoral regions by first order statistics. A top HER2-E-associated feature from each region was identified by Wilcoxon feature selection and used to train a diagonal linear discriminant analysis [DLDA] classifier to predict HER2-E in a 3-fold cross-validation setting. This classifier was then applied to pCR prediction from DCE-MRI in a testing set of 28 HER2+ patients with available post neoadjuvant chemotherapy surgical specimens at one institution. 16 patients achieved pCR (ypT0/is), while the remainder had partial or no response (non-pCR).
Results: A combination of heterogeneity features within the intratumoral region and annular peritumoral regions out to 12 mm from the tumor yielded optimal results within the training set, with an average HER2-E prediction AUC of .77 +/- .03. When applied to response prediction in an independent testing set, this HER2-E classifier was predictive of pCR (AUC = .72).
Conclusions: Computer-extracted heterogeneity features calculated within the tumor and the surrounding peritumoral environment on DCE-MRI were able to distinguish the HER2-E PAM50 intrinsic subtype from other HER2+ breast cancers. HER2-E was characterized by elevated expression of intratumoral and peritumoral heterogeneity features, indicating a more disordered imaging phenotype within and around the tumor. Additional independent validation of these findings is needed.
Citation Format: Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers [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 P4-02-06.
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Affiliation(s)
- N Braman
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - P Prasanna
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - S Singh
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - N Beig
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - H Gilmore
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - M Etesami
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Bates
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - K Gallagher
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - BN Bloch
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - G Somlo
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - W Sikov
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - L Harris
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Plecha
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - V Varadan
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - A Madabhushi
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
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Abstract
Oncogenic osteomalacia (OO) is an uncommon but treatable cause of osteomalacia related to tumor production of FGF23, usually caused by benign mesenchymal neoplasms. Paranasal sinus glomangiomas are a rare cause of OO, with only one previously reported case. Here we describe a second case (first reported in English) of paranasal sinus glomangioma-induced osteomalacia in a 42-year-old man. He presented with weakness and multiple spontaneous fractures, and was found to have an ethmoid sinus glomangioma with intracranial extension. The tumor was removed via endoscopic endonasal approach to the anterior skull base, which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively.
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Affiliation(s)
- Malia S Gresham
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Steven Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, United States
| | - Yi J Zhang
- Division of Neurological Surgery, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Kelly Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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Abstract
INTRODUCTION Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. METHODS Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. RESULTS There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). CONCLUSIONS The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.
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Affiliation(s)
- W K M Kieffer
- Brighton and Sussex University Hospitals NHS Trust , UK
| | | | - K Gallagher
- Brighton and Sussex University Hospitals NHS Trust , UK
| | - I McFadyen
- University Hospitals of North Midlands NHS Trust, UK , UK
| | - J Bernard
- St George's University Hospitals NHS Foundation Trust, UK , UK
| | - B A Rogers
- Brighton and Sussex University Hospitals NHS Trust , UK
- Brighton and Sussex Medical School, UK , UK
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Kieffer W, Michalik D, Gallagher K, McFadyen I, Bernard J, Rogers B, Flood C. Temporal variation in major trauma admissions: Is there a trauma season? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giulvezan S, Gallagher K, Davies N. Assessment of interlinked double staircase acuity test. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0562] [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: 10/23/2022]
Affiliation(s)
- S. Giulvezan
- Ophthalmology; Chelsea and Westminster Hospital; London United Kingdom
| | - K. Gallagher
- Education; Moorfields Eye Hospital; London United Kingdom
| | - N. Davies
- Ophthalmology; Chelsea and Westminster Hospital; London United Kingdom
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Wong J, Gallagher K, Zhang J. TU-F-CAMPUS-T-02: Vernier Picket Fence Test: A Non-Imaging Method to Localize the Radiation Isocenter with Submillimeter Accuracy. Med Phys 2015. [DOI: 10.1118/1.4925802] [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: 11/07/2022] Open
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Gallagher K, Tannous J, Nabha R, Feghali J, Ayoub Z, Jalbout W, Youssef B, Taddei P. TU-F-CAMPUS-T-05: Replacement Computational Phantoms to Estimate Dose in Out-Of-Field Organs and Tissues. Med Phys 2015. [DOI: 10.1118/1.4925790] [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: 11/07/2022] Open
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Mehta H, Sim DA, Keane PA, Zarranz-Ventura J, Gallagher K, Egan CA, Westcott M, Lee RWJ, Tufail A, Pavesio CE. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis. Eye (Lond) 2015; 29:1060-8. [PMID: 26021867 DOI: 10.1038/eye.2015.65] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/21/2015] [Indexed: 12/31/2022] Open
Abstract
AIM The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). METHODS Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. RESULTS The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA <0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04). CONCLUSION A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.
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Affiliation(s)
- H Mehta
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D A Sim
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - P A Keane
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - J Zarranz-Ventura
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] Vitreo-Retinal Service, Bristol Eye Hospital, Bristol, UK
| | - K Gallagher
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M Westcott
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R W J Lee
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK [4] School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A Tufail
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK
| | - C E Pavesio
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK
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Gallagher K, Migliaccio L, Rogers RG, Leeman L, Hervey E, Qualls C. Impact of nulliparous women's body mass index or excessive weight gain in pregnancy on genital tract trauma at birth. J Midwifery Womens Health 2015; 59:54-9. [PMID: 24588877 DOI: 10.1111/jmwh.12114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to explore the impact of body mass index (BMI) or pregnancy weight gain on the presence, site, and severity of genital tract trauma at childbirth in nulliparous women. METHODS The present study is a subanalysis of a prospective cohort of healthy nulliparous women recruited during pregnancy and followed through birth. Weight gain during pregnancy and prepregnancy BMI were recorded. At birth, women underwent detailed mapping of genital tract trauma. For analyses, women were dichotomized into obese (BMI ≥ 30) versus nonobese (BMI < 30) at baseline as well as into those who gained weight as recommended by the Institute of Medicine (IOM) and those who gained more than the recommended amount to determine the impact of obesity or excessive weight gain on rates of genital tract trauma. RESULTS Data from 445 women were available for analysis. Presence and severity of genital tract trauma did not vary between obese and nonobese women (51% vs 53%, P = .64). Likewise, women who had more than the IOM-recommended weight gain did not have a higher incidence of perineal lacerations (52% versus 53% with perineal lacerations, P = .69). Obese women were more likely to gain in excess of the IOM guidelines during pregnancy (75% vs 50% excessive weight gain in obese vs nonobese women, respectively; P < .001). DISCUSSION A woman's BMI or excessive weight gain in pregnancy did not influence her risk of genital tract trauma at birth.
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Affiliation(s)
| | | | - BA Rogers
- Consultant Trauma and Orthopaedic Surgeon
| | - L Leonard
- Consultant Trauma and Orthopaedic Surgeon, Department of Orthopaedics, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE
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Sauk J, Coron E, Kava L, Suter M, Gora M, Gallagher K, Rosenberg M, Ananthakrishnan A, Nishioka N, Lauwers G, Woods K, Brugge W, Forcione D, Bouma BE, Tearney G. Interobserver agreement for the detection of Barrett's esophagus with optical frequency domain imaging. Dig Dis Sci 2013; 58:2261-5. [PMID: 23508980 PMCID: PMC3732518 DOI: 10.1007/s10620-013-2625-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optical frequency domain imaging (OFDI) is a second-generation form of optical coherence tomography (OCT) providing comprehensive cross-sectional views of the distal esophagus at a resolution of ~7 μm. AIM Using validated OCT criteria for squamous mucosa, gastric cardia mucosa, and Barrett's esophagus (BE), the objective of this study was to determine the inter- and intra-observer agreements by a large number of OFDI readers for differentiating these tissues. METHODS OFDI images were obtained from nine subjects undergoing screening and surveillance for BE. Sixty-four OFDI image regions of interest were randomly selected for review. A training set of 19 images was compiled distinguishing squamous mucosa from gastric cardia and BE using previously validated OCT criteria. The ten readers then interpreted images in a test set of 45 different images of squamous mucosa (n = 15), gastric cardia (n = 15), or BE (n = 15). Interobserver agreement differentiating the three tissue types and BE versus non-BE mucosa was determined using multi-rater Fleiss's κ value. The images were later randomized again and four readers repeated the test 3 weeks later to assess intraobserver reliability. RESULTS All ten readers showed excellent agreement for the differentiation of BE versus non-BE mucosa (κ = 0.811 p < 0.0001) and for differentiating BE versus gastric cardia versus squamous mucosa (κ = 0.866, p < 0.0001). For the four readers who repeated the test, the median intraobserver agreement (BE vs. non-BE) was high (κ = 0.975, IQR: 0.94, 1.0). CONCLUSIONS Trained readers have a high interobserver agreement for differentiating BE, squamous, and gastric cardia mucosa using OFDI.
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Affiliation(s)
- J Sauk
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - E Coron
- Department of Gastroenterology and Hepatology; University Hospital; Nantes, France
| | - L Kava
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Suter
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Gora
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - K Gallagher
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Rosenberg
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - A Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - N Nishioka
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - G Lauwers
- Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
| | - K Woods
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts,Digestive Diseases, Interventional Endoscopy, Emory University School of Medicine; Atlanta, Georgia
| | - W Brugge
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - D Forcione
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - BE Bouma
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - G Tearney
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
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