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Lee MC, Jeyalingam T, Parker CH, Liu LW. A125 TANDEM STUDY DESIGN IS LESS LIKELY TO DEMONSTRATE IMPROVED ADENOMA DETECTION RATE THAN PARALLEL STUDY DESIGN IN THE ASSESSMENT OF ARTIFICIAL INTELLIGENCE-ASSISTED COLONOSCOPY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991295 DOI: 10.1093/jcag/gwac036.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Randomized controlled trials have reported that artificial intelligence (AI) improves adenoma detection rate (ADR). Different methodologies, namely parallel and tandem study designs, have been employed to evaluate the efficacy of AI-assisted colonoscopy in randomized controlled trials. In systematic reviews and meta-analyses, a pooled effect that includes both study designs have been reported. However, it is unclear whether there are inconsistencies in the reported results of these two designs. Purpose To determine if there are differences in ADR using AI-aided technologies during colonoscopy between parallel and tandem study designs Method A systematic search of Ovid MEDLINE (1946 to October 2022) and EMBASE (1947 to October 2022) for randomized controlled trials comparing AI-assisted colonoscopy with routine high-definition colonoscopy in polyp detection was conducted. Reference lists of systematic reviews were searched for additional studies. The publications were divided based on trial design: parallel vs. tandem. Analysis was conducted using Review Manager 5.4.1 using a random effects model. Result(s) The search identified 540 articles. After screening the title and abstract for relevance, 19 randomized controlled trials involving a total of 14 657 patients were included for full-text review. Fourteen were parallel studies (14 136 patients) and 5 were tandem studies (521 patients). ADR was reported in 17 studies, and there was overall improvement in ADR with AI-assisted colonoscopy (risk ratio [RR] 1.33, 95% CI 1.22-1.44; p<.0001). Based on a separate pooled analyses of 13 parallel studies and 4 tandem studies, ADR significantly improved with AI assistance compared to routine colonoscopy, regardless of study design (RR 1.35, 95% CI 1.24-1.47 and p<.0001; RR 1.15, 95% CI 1.03-1.28; p=0.02, respectively). A significant increase in ADR with AI assistance were found in 84.6% (11/13) of parallel design studies, but in only 25% (1/4) of tandem studies. Image ![]()
Conclusion(s) AI assistance during colonoscopy significantly increased ADR in both parallel and tandem studies; however, improvement in ADR was less likely to be seen in tandem compared to parallel studies. It remains unclear why this difference exists, but some hypotheses include smaller sample sizes in the tandem studies, significant heterogeneity in the tandem design, and differences in operator bias depending on study design. Better understanding the differences in these study designs will inform future studies of new endoscopic technologies. Disclosure of Interest None Declared
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Affiliation(s)
- M C Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - T Jeyalingam
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - C H Parker
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - L W Liu
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
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Block AM, Tamburini LM, Zeng F, Mancini MR, Jackson CA, Antonacci CL, Karsmarski OP, Stelzer JW, Wellington IJ, Lee MC. Surgical Treatment of Pediatric Scoliosis: Historical Origins and Review of Current Techniques. Bioengineering (Basel) 2022; 9:bioengineering9100600. [PMID: 36290568 PMCID: PMC9598649 DOI: 10.3390/bioengineering9100600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment of scoliosis has been explored and debated in medicine since the first recorded texts. Scoliosis treatment has shifted over time from external modalities, such as traction and bracing, to internal stabilization techniques that leverage surgical advances. Surgical fixation constructs can generally be separated into two different modalities: dynamic vs. static constructs. For skeletally immature individuals with progressive deformities, surgical options range from traditional or magnetically controlled growing rods to vertebral body staples or tethering. For individuals who have reached skeletal maturity, many devices have been developed that provide static length constructs. Understanding the surgical options available is critical for the appropriate management of this varied patient population. With this article, we sought to provide a summary of past and present techniques and devices used in the treatment of scoliosis.
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Affiliation(s)
- Andrew M. Block
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Lisa M. Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Francine Zeng
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Casey A. Jackson
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | | | - Owen P. Karsmarski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - John W. Stelzer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
| | - Ian J. Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT 06032, USA
- Correspondence:
| | - Mark C. Lee
- Department of Orthopaedic Surgery, Connecticut Children’s Medical Center, Hartford, CT 06106, USA
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Lee MC, Wong YK, Lee ACW, Fung HS, Chiang JB, Kwok CH, Chiu LF. Single-centre Initial Experience of Transradial Access for Abdominal Interventional Radiology. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- MC Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - YK Wong
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - ACW Lee
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - HS Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - JB Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - CH Kwok
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - LF Chiu
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
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Kia C, Stelzer JW, Lee MC. Delayed Postoperative Spinal Cord Injury with Complete Paralysis After Adolescent Idiopathic Surgery: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00034. [PMID: 35081063 DOI: 10.2106/jbjs.cc.21.00497] [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
CASE We report a 14-year-old girl with adolescent idiopathic scoliosis who experienced bilateral lower extremity paralysis related to postoperative hypotension 10 hours after posterior spinal fusion. She returned to the operating room for spinal cord decompression and hardware removal. Six weeks later, reinstrumentation was performed, and complete neurologic recovery was achieved. CONCLUSION Delayed presentation of neurologic injury after scoliosis surgery is particularly uncommon. Close postoperative monitoring, with an emphasis on hypotensive etiologies and a low threshold to remove the instrumentation, is essential to rapidly diagnose and treat these catastrophic events.
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Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - John W Stelzer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Mark C Lee
- Department of Orthopaedic Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
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Patel HA, Chaudhry S, Lee MC, Solomito M. Streamlining Postoperative Care After Pediatric Supracondylar Humerus Fractures: Is Follow-up After Pin Removal Routinely Needed? J Pediatr Orthop 2021; 41:e464-e469. [PMID: 34096552 DOI: 10.1097/bpo.0000000000001815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed reduction and percutaneous pinning is the standard of care for displaced supracondylar humerus fractures (SCHFs). Although the operative management of SCHFs has achieved good consensus with low complication rates, there remains a paucity of literature on postoperative management. We hypothesized that routine office visits after pin removal can safely be avoided in uncomplicated SCHFs without compromising patient care. METHOD A retrospective review was conducted to query the electronic medical record for SCHFs, treated with closed reduction and percutaneous pinning. Patients with complicated SCHFs were excluded. Patients were divided into 2 cohorts: follow-up (FU) and nonfollow-up (NFU), depending on the presence or absence of after-pin removal (APR) FU visits. Demographics, surgical variables, number of x-rays, referrals for physical therapy, total FU visits, complications, and clinical events after pin removal up to 3 months were compared. Subgroup analysis was performed according to Gartland fracture types. RESULTS A total of 179 patients were included in the study, 111 in the FU group and 68 in the NFU group. There were no significant differences found in demographics between the 2 groups. There were no significant differences in complications and APR clinical events between 2 groups (P>0.05). An average of 1.98 additional x-rays were taken APR in FU group. None of the NFU group patients required physical therapy. Excluding patients with pin site infections, 15/108 (13.9%) of FU group patients had >1 APR visits. SUMMARY For operatively managed uncomplicated SCHFs, patients who do not have routinely scheduled FU APR have no greater incidence of clinical events APR than patients with a scheduled FU. With a detailed discussion including expectations, timeframe for resuming activities, home exercises, and reassurance of the ease of FU if desired, routine FU APR can be safely eliminated after uncomplicated SCHFs in order to streamline postoperative care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Harshadkumar A Patel
- Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, CT
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Patel HA, Lee MC, Chaudhry S. Extensor Pollicis Longus Tendon Rupture After a Pediatric Distal Radius Fracture: A Case Report and Literature Review. JBJS Case Connect 2020; 10:e2000022. [PMID: 32910621 DOI: 10.2106/jbjs.cc.20.00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 16-year-old boy underwent closed reduction and pinning of a Salter-Harris II distal radius fracture (DRF). Extensor pollicis longus (EPL) rupture occurred 6 weeks after the injury. Extensor indicis proprius transfer was performed using wide-awake local anesthesia no tourniquet (WALANT) technique. Active thumb range of motion was restored, and the patient returned to all activities, including sports, after 2 months. CONCLUSION Although delayed attritional EPL rupture after DRF is a well-known complication in adults, this is the first reported case in a truly skeletally immature patient. Awareness of this complication prompts monitoring for prodromal signs and symptoms. The WALANT technique is feasible in selected children.
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Affiliation(s)
- Harshadkumar A Patel
- 1Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, Connecticut
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Yohe N, Ciminero M, Solomito M, Lee MC. Impact of Pediatric Subspecialty Training on Perioperative Complications in Adolescent Idiopathic Scoliosis Surgery. Orthopedics 2020; 43:e454-e459. [PMID: 32745224 DOI: 10.3928/01477447-20200721-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/25/2019] [Indexed: 02/03/2023]
Abstract
This was a retrospective study of data prospectively collected from 2012 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The objective was to evaluate the effect of pediatric fellowship training on 30-day perioperative morbidity and mortality following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Several pathways exist in North America by which physicians acquire the clinical and technical skills to manage AIS surgically. Previous work has noted that surgeons with pediatric fellowship training tend to perform the bulk of pediatric spine surgeries. However, no study has been performed that examines if pediatric fellowship training (PFT) has an impact on early postoperative outcomes. A total of 14,194 AIS surgical patients were identified from the ACS NSQIP database. A cohort receiving isolated PSF was abstracted from this group and separated into 3 groups according to surgeon training: (1) ped+ (with PFT, n=4455); (2) ped-(without PFT, n=325); and (3) ped+match (patients selected from ped+ matched to ped- for age, sex, and fusion levels, n=325). The groups were compared for 30-day perioperative morbidity and mortality. No significant differences were noted for the 3 groups in terms of wound infections, length of hospital stay, readmissions, and unplanned returns to the operating room. Ped+match and ped- groups had no difference in neurologic injury rates. However, the ped+ and ped+match groups had significantly lower rates of blood transfusion and average volume of blood lost compared with the ped- group. Surgeons with pediatric fellowship training have a significantly lower average blood loss volume and blood transfusion rate in PSF for AIS than surgeons without such training. Understanding that different training pathways for surgeons may directly impact operative outcomes invites further examination of surgical education in North America to improve training consistency. [Orthopedics. 2020;43(5):e454-e459.].
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Kwon SB, Ro DH, Song MK, Han HS, Lee MC, Kim HC. Identifying key gait features associated with the radiological grade of knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:1755-1760. [PMID: 31400498 DOI: 10.1016/j.joca.2019.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Knee osteoarthritis (KOA) is characterized by pain and decreased gait function. This study assessed key features that can be used as mechanical biomarkers for KOA severity and progression. The identified features were validated statistically and were further examined by developing a classification model based on a machine-learning algorithm. METHODS The study included 227 volunteers with various grades of KOA. The severity of KOA was graded using the Kellgren-Lawrence (KL) system. A total of 165 features were extracted from the gait data. The key features were selected using neighborhood component analysis. The selected features were validated using the t-test. Then, the features were examined by building a classification model using a random forest algorithm. RESULTS Twenty features were identified that could discriminate the grade of KOA, including nine features extracted from the knee joint, seven from the hip, two from the ankle and two from the spatiotemporal gait parameters. The t-test showed that some features differed significantly between health and sever group, while some were significantly different among the severe group, and others were significantly different for all KL grades. The areas under the receiver operating characteristic curves for classification were 0.974, 0.992, 0.845, 0.894, and 0.905 for KL grades 0 through 4, respectively. CONCLUSION Key gait features reflecting the grade of KOA were identified. The results of the statistical analysis and machine-learning algorithm show that the features can discriminate the severity of disease according to the KL grade.
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Affiliation(s)
- S B Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, South Korea
| | - D H Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - M K Song
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - H-S Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - M C Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - H C Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, South Korea; Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea.
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Bea JW, de Heer HD, Valdez L, Kinslow B, Yazzie E, Lee MC, Nez P, Dalgai S, Schwartz A. Physical Activity among Navajo Cancer Survivors: A Qualitative Study. Am Indian Alsk Native Ment Health Res 2019; 25:54-73. [PMID: 29889948 DOI: 10.5820/aian.2502.2018.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Physical activity (PA) may improve quality of life and survival among cancer survivors; however, little is known about Navajo cancer survivor PA. We evaluated Navajo cancer survivor PA habits, barriers, and preferences through focus groups and interviews (n = 32). Transcripts were coded in NVivo and major themes summarized by consensus. Survivor exercise guidelines were largely unknown, but movement, resilience and life balance were valued. Most participants reported at ≥1 mode of current PA (n = 24; 71% walking, 46% work/homesteading). Barriers to PA included treatment side effects, limited access to programs, fear of "over doing it," and family/friends encouraging rest. Preferences for PA varied.
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Gratrix J, Smyczek P, Bertholet L, Lee MC, Pyne D, Woods D, Courtney K, Ahmed R. A cross-sectional evaluation of opt-in testing for sexually transmitted and blood-borne infections in three Canadian provincial correctional facilities: a missed opportunity for public health? Int J Prison Health 2019; 15:273-281. [PMID: 31329036 DOI: 10.1108/ijph-07-2018-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Incarceration provides an opportunity for screening and treatment of sexually transmitted and blood-borne infections (STBBIs) in high-risk groups. The purpose of this paper is to determine positivity rates of STBBI screening within correctional facilities using opt-in strategies and estimate the proportion of admissions tested. DESIGN/METHODOLOGY/APPROACH A cross-sectional, retrospective review of testing data from January 2012 to August 2015 from three provincial correctional facilities located in Alberta, Canada was completed. Analysis variables included STBBI, gender, facility, collection year and age. STBBI-stratified analysis was performed to identify correlates for positivity using univariate and logistic regressions. FINDINGS Overall prevalence of chlamydia was 11.2 percent and gonorrhea was 3.5 percent; correlates for both were younger age and facility type. The syphilis prevalence rate was 3.2 percent; correlates included being female, older age, adult facilities, with later years being protective. In total, 14 (0.3 percent) newly diagnosed HIV cases were found, prevalence increased with age. HBV prevalence was 1.7 percent with no significant correlations. Nearly one-tenth (n=422) of those screened for HCV antibody were positive; all variables were significantly correlated. Overall estimates of the proportion of admissions tested by STBBI were low and ranged from 4.8 to 16.1 percent. ORIGINALITY/VALUE This study found high rates of STBBI in correctional facilities and showed that only a small proportion of the population was tested using an opt-in strategy. Shifting to an "opt-out" strategy may be warranted.
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Affiliation(s)
- Jennifer Gratrix
- Department of STI Services, Alberta Health Services, Edmonton, Canada
| | - Petra Smyczek
- Department of STI Services, Alberta Health Services, Edmonton, Canada
| | - Lindsay Bertholet
- Department of STI Services, Alberta Health Services, Edmonton, Canada
| | - M C Lee
- Microbiology Department, DynaLIFE Dx, Edmonton, Canada
| | - Diane Pyne
- Department of Corrections Health, Alberta Health Services, Edmonton, Canada
| | - Dan Woods
- Department of Corrections Health, Alberta Health Services, Edmonton, Canada
| | - Keith Courtney
- Department of Corrections Health, Alberta Health Services, Edmonton, Canada
| | - Rabia Ahmed
- Department of Medicine, University of Alberta , Edmonton, Canada
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Lee MC. The Opaque Sacroiliac Joint: Commentary on an article by Julius Dengler, MD, et al.: "Randomized Trial of Sacroiliac Joint Arthrodesis Compared with Conservative Management for Chronic Low Back Pain Attributed to the Sacroiliac Joint". J Bone Joint Surg Am 2019; 101:e19. [PMID: 30845045 DOI: 10.2106/jbjs.18.01254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark C Lee
- Division of Orthopaedics, Connecticut Children's Medical Center, Hartford, Connecticut
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Liveringhouse CL, Diaz R, Ahmed KA, Lee MC, Czerniecki B, Laronga C, Khakpour N, Weinfurtner RJ, Rosa M, Montejo ME. Abstract OT2-04-05: Phase II trial of pre-operative stereotactic ablative radiotherapy (SABR) in early-stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-05] [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:
Post-operative accelerated partial breast irradiation (APBI) has demonstrated efficacy in preventing in-breast tumor recurrence. Pre-operative administration of APBI may be advantageous as an intact breast tumor is smaller than its corresponding lumpectomy cavity, is easier to distinguish on treatment-planning images, and results in smaller and more accurately delineated target volumes. Pre-operative APBI may reduce the incidence of positive margins following breast-conserving surgery (BCS). Investigation is needed in the correlation of MR imaging with pathologic response 6 weeks after SABR. Also, evidence suggests that SABR induces immune activation in the tumor microenvironment; evaluation of excised tumor tissue will give insight into these processes.
Trial Design:
Treatment Planning and Delivery: CT simulation and treatment are performed in the prone position. Diagnostic MRI is fused to planning CT. GTV is delineated on registered breast MRI and includes the intact breast tumor. CTV is 15mm expansion of GTV. PTV is 3 mm expansion of CTV. VMAT or IMRT are permitted. Daily image-guidance aligning to tumor and biopsy-fiducial is mandatory. All subjects undergo pre-operative SABR to 28.5 Gy in 3 fractions of 9.5 Gy on different days separated by ≤48 hours. CTCAE v4 is used to assess toxicity 4-5 weeks after SABR. Pre-operative diagnostic MRI is performed 5-6 weeks following SABR. Imaging parameters to be evaluated include changes in tumor size, enhancement, and tumor margin description. BCS will be 6-8 weeks following SABR.
Tissue pathology: Margin status and degree of pathologic response are recorded from breast-conserving excisions, specimens are archived for future analysis.
Eligibility Criteria:
Inclusion criteria are women age ≥50 with biopsy proven invasive breast adenocarcinoma with tumor size ≤2cm on MRI, cN0 M0, ER+/HER2-, without history of invasive malignancy or prior breast/thoracic radiotherapy.
Exclusion criteria are active scleroderma or lupus erythematosus with skin involvement, MRI defined tumor within 10 mm of skin, implanted hardware prohibiting appropriate treatment planning or delivery, neoadjuvant chemotherapy, carrier of BRCA1 or 2 gene mutation, pregnancy.
Specific Aims:
The primary endpoint is pathologic complete response (pCR) in the breast tumor, secondary endpoints are incidence of adequate surgical margins (defined as “no tumor on ink”) and MRI response following SABR. Analyses of tumor immune response and microenvironment on pathologic specimens following SABR will also be performed.
Statistical Methods:
Fisher's exact test will be performed to examine associations between patient/tumor characteristics and pCR and surgical margins; these associations will be explored with multivariable logistic and linear regressions.
Accrual:
Present accrual is 9 subjects.
Expected accrual is 22 subjects; if ≥3 pCR are noted in the initial cohort, accrual will be expanded to 40 subjects.
Citation Format: Liveringhouse CL, Diaz R, Ahmed KA, Lee MC, Czerniecki B, Laronga C, Khakpour N, Weinfurtner RJ, Rosa M, Montejo ME. Phase II trial of pre-operative stereotactic ablative radiotherapy (SABR) in 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 OT2-04-05.
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Affiliation(s)
- CL Liveringhouse
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - R Diaz
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - KA Ahmed
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - MC Lee
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - B Czerniecki
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - C Laronga
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - N Khakpour
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - RJ Weinfurtner
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - M Rosa
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - ME Montejo
- University of South Florida College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Lee MC, Liao CT, Toh HS. P6582Systematic review and network meta-analysis: the efficacy and safety of oral anticoagulants in patients with atrial fibrillation in asian. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6582] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Lee
- Chi-Mei Medical Center, Pharmacy, Tainan, Taiwan ROC
| | - C T Liao
- Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC
| | - H S Toh
- Chi-Mei Medical Center, Intensive care medicine, Tainan, Taiwan ROC
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Lee MC, Jarvis C, Solomito MJ, Thomson JD. Comparison of S2-Alar and traditional iliac screw pelvic fixation for pediatric neuromuscular deformity. Spine J 2018; 18:648-654. [PMID: 28870838 DOI: 10.1016/j.spinee.2017.08.253] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/27/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many pelvic fixation options exist for posterior spinal fusion of pediatric neuromuscular scoliosis, including standard iliac screws (SISs) or a more recently introduced S2-Alar (S2A) technique. However, little data exist comparing the clinical and radiographic outcomes of these techniques. PURPOSE This study aimed to dentify differences in clinical and radiographic outcomes for pediatric neuromuscular scoliosis patients treated with SIS or S2A pelvic fixation. STUDY DESIGN/SETTING This was a retrospective cohort study at a pediatric orthopedic clinic. PATIENT SAMPLE Patients aged 8-19 years undergoing posterior spinal fusion to the pelvis for neuromuscular scoliosis using SIS or S2A technique, with Gross Motor Function Classification System (GMFCS) Level 4 or 5 were included. OUTCOMES MEASURES Postoperative complication rates associated with pelvic fixation method were the outcome measures. METHODS Charts and radiographs were reviewed for demographics, intra- and postoperative course, levels of instrumentation, operative correction, and implant failure (IF). Postoperative complications were classified according to the Accordion scale. RESULTS We studied 50 patients (28 SIS, 22 S2A) aged 14.0±2.8 years and an average follow-up of 3.5±1.7 years. The average number of levels fused was 16.5±1.1 with an average curve correction of 48°±21° postoperatively. A significant difference in radiographic IF rates was noted between SIS and S2A groups (57% vs. 27%, p=.02). No difference was noted between groups for frequency or severity of postoperative complications, inclusive of wound infections. Subgroup analysis demonstrated equivalent IF rates when comparing the S2A group with the SIS group with cross-links. CONCLUSIONS The S2A group generally demonstrated improved rates of radiographic IF compared with the SIS group, but the rates became equivalent when a cross-link was added to an SIS construct. Further, no difference in postoperative complication rates were identified between SIS and S2A groups.
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Affiliation(s)
- Mark C Lee
- Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106.
| | - Casey Jarvis
- University of Connecticut, 375 Astor Drive, Sayville, NY 11782
| | - Matthew J Solomito
- Connecticut Children's Medical Center, 399 Farmington Ave, Farmington, CT 06106
| | - Jeffrey D Thomson
- Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106
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Almiron Bonnin DA, Havrda MC, Lee MC, Liu H, Zhang Z, Nguyen LN, Harrington LX, Hassanpour S, Cheng C, Israel MA. Secretion-mediated STAT3 activation promotes self-renewal of glioma stem-like cells during hypoxia. Oncogene 2018; 37:1107-1118. [PMID: 29155422 PMCID: PMC5851110 DOI: 10.1038/onc.2017.404] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 02/08/2023]
Abstract
High-grade gliomas (HGGs) include the most common and the most aggressive primary brain tumor of adults and children. Despite multimodality treatment, most high-grade gliomas eventually recur and are ultimately incurable. Several studies suggest that the initiation, progression, and recurrence of gliomas are driven, at least partly, by cancer stem-like cells. A defining characteristic of these cancer stem-like cells is their capacity to self-renew. We have identified a hypoxia-induced pathway that utilizes the Hypoxia Inducible Factor 1α (HIF-1α) transcription factor and the JAK1/2-STAT3 (Janus Kinase 1/2 - Signal Transducer and Activator of Transcription 3) axis to enhance the self-renewal of glioma stem-like cells. Hypoxia is a commonly found pathologic feature of HGGs. Under hypoxic conditions, HIF-1α levels are greatly increased in glioma stem-like cells. Increased HIF-1α activates the JAK1/2-STAT3 axis and enhances tumor stem-like cell self-renewal. Our data further demonstrate the importance of Vascular Endothelial Growth Factor (VEGF) secretion for this pathway of hypoxia-mediated self-renewal. Brefeldin A and EHT-1864, agents that significantly inhibit VEGF secretion, decreased stem cell self-renewal, inhibited tumor growth, and increased the survival of mice allografted with S100β-v-erbB/p53-/- glioma stem-like cells. These agents also inhibit the expression of a hypoxia gene expression signature that is associated with decreased survival of HGG patients. These findings suggest that targeting the secretion of extracellular, autocrine/paracrine mediators of glioma stem-like cell self-renewal could potentially contribute to the treatment of HGGs.
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Affiliation(s)
- D A Almiron Bonnin
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - M C Havrda
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - M C Lee
- Department of Biology, Dartmouth College, Hanover, NH, USA
| | - H Liu
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Z Zhang
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - L N Nguyen
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - L X Harrington
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S Hassanpour
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - C Cheng
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - M A Israel
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Lee MC. S2-Alar-Iliac Screw Placement: Who Needs Imaging?: Commentary on an article by Jamal N. Shillingford, MD, et al.: "The Free-Hand Technique for S2-Alar-Iliac Screw Placement. A Safe and Effective Method for Sacropelvic Fixation in Adult Spinal Deformity". J Bone Joint Surg Am 2018; 100:e25. [PMID: 29462047 DOI: 10.2106/jbjs.17.01164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Wang LK, Tsai FM, Chen ML, Wu S, Lee MC, Tsai TC, Chou W, Wang CH. Aqueous Extract of Tournefortia sarmentosa Stem Inhibits ADP-induced Platelet Aggregation. Indian J Pharm Sci 2018. [DOI: 10.4172/pharmaceutical-sciences.1000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sung JS, Jeong YJ, Kim DJ, Lee YY, Jeon YA, Ko HC, Hur OS, Ro NY, Rhee JH, Lee MC, Baek HJ. Comparison of Fatty Acid Compositions and Tocopherols in Perilla germplasm of South Korea. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608351] [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: 10/18/2022]
Affiliation(s)
- JS Sung
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - YJ Jeong
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - DJ Kim
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - YY Lee
- National Institute of Crop Science, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - YA Jeon
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - HC Ko
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - OS Hur
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - NY Ro
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - JH Rhee
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - MC Lee
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
| | - HJ Baek
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea, Republic of (South)
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Baldwin PC, Han E, Parrino A, Solomito MJ, Lee MC. Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures. Orthopedics 2017; 40:e849-e854. [PMID: 28776629 DOI: 10.3928/01477447-20170719-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the rate of cast-related complications when using split or intact casts. A total of 60 patients aged 3 to 13 years with closed shaft or distal third radius and ulna fractures requiring reduction were recruited for this study. Patients underwent closed reduction under sedation and were placed into a long-arm fiberglass cast with 1 of 3 modifications: no valve, univalve, or bivalve. Patients were followed to 6 weeks after reduction or surgical treatment if required. The frequency of neurovascular injury, cast saw injury, unplanned office visits, and cast modifications, the need for operative intervention, and pain levels through the follow-up period were recorded. The results showed no incidents of compartment syndrome or neurovascular injury. Additionally, there were no differences between complications associated with cast type (P=.266), frequency of cast modifications (P=.185), or subsequent need for surgical stabilization (P=.361). Therefore, cast splitting following closed reduction of low-energy pediatric forearm fractures does not change clinical outcomes with respect to neurovascular complications, cast modifications, pain levels, or the need for repeat reduction. Consideration should be given to minimizing cast splitting after reduction of low-energy pediatric forearm fractures for practice efficiency and to potentially decrease saw-related injury. [Orthopedics. 2017; 40(5):e849-e854.].
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Abstract
Plain pelvic radiographs are commonly used for a variety of pediatric orthopedic disorders. Lead shielding is typically placed over the gonads to minimize radiation exposure to these sensitive tissues. However, misplaced shielding can sabotage efforts to protect patients from excessive radiation exposure either by not covering radiosensitive tissues or by obscuring anatomic areas of interest, prompting repeat radiographic examinations. The goal of this study was to determine the incidence of misplaced shielding for pelvic radiographs obtained for pediatric orthopedic evaluation. Children 8 to 16 years old who had an anteroposterior or frog lateral pelvic radiograph between 2008 and 2014 were included. A total of 3400 patients met the inclusion criteria, and 84 boys and 84 girls were randomly selected for review. For both boys and girls, the percentage of incorrectly positioned or missing shields was calculated. Chi-square testing was used to compare the frequency of missing or incorrectly placed shields between sexes and age groups. Pelvic shields were misplaced in 49% of anteroposterior and 63% of frog lateral radiographs. Shielding was misplaced more frequently for girls than for boys on frog lateral radiographs (76% vs 51%; P<.05). Pelvic bony landmarks were often obscured by pelvic shielding, with a frequency of 7% to 43%, depending on the specific landmark. The femoral head and acetabulum were obscured by shielding in up to 2% of all images. The findings suggest that accepted pelvic shielding protocols are ineffective. Consideration should be given to alternative protocols or abandonment of this practice. [Orthopedics. 2017; 40(4):e623-e627.].
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Valdez L, de Heer H, Schwartz A, Kinslow B, Yazzie E, Lee MC, Nez P, Delgai S, Bea JW. Physical Activity among Navajo Cancer Survivors. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000520000.61561.ea] [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: 11/21/2022]
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23
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Bea JW, Blew RM, Going SB, Hsu CH, Lee MC, Lee VR, Caan BJ, Kwan ML, Lohman TG. Dual energy X-ray absorptiometry spine scans to determine abdominal fat in postmenopausal women. Am J Hum Biol 2016; 28:918-926. [PMID: 27416964 DOI: 10.1002/ajhb.22892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 06/18/2016] [Indexed: 11/09/2022] Open
Abstract
Body composition may be a better predictor of chronic disease risk than body mass index (BMI) in older populations. OBJECTIVES We sought to validate spine fat fraction (%) from dual energy X-ray absorptiometry (DXA) spine scans as a proxy for total abdominal fat. METHODS Total body DXA scan abdominal fat regions of interest (ROI) that have been previously validated by magnetic resonance imaging were assessed among healthy, postmenopausal women who also had antero-posterior spine scans (n = 103). ROIs were (1) lumbar vertebrae L2-L4 and (2) L2-Iliac Crest (L2-IC), manually selected by two independent raters, and (3) trunk, auto-selected by DXA software. Intra-class correlation coefficients evaluated intra and inter-rater reliability on a random subset (N = 25). Linear regression models, validated by bootstrapping, assessed the relationship between spine fat fraction (%) and total abdominal fat (%) ROIs. RESULTS Mean age, BMI, and total body fat were 66.1 ± 4.8 y, 25.8 ± 3.8 kg/m2 and 40.0 ± 6.6%, respectively. There were no significant differences within or between raters. Linear regression models adjusted for several participant and scan characteristics were equivalent to using only BMI and spine fat fraction. The model predicted L2-L4 (Adj. R2 : 0.83) and L2-IC (Adj. R2 : 0.84) abdominal fat (%) well; the adjusted R2 for trunk fat (%) was 0.78. Model validation demonstrated minimal over-fitting (Adj. R2 : 0.82, 0.83, and 0.77 for L2-L4, L2-IC, and trunk fat, respectively). CONCLUSIONS The strong correlation between spine fat fraction and DXA abdominal fat measures make it suitable for further development in postmenopausal chronic disease risk prediction models. Am. J. Hum. Biol. 28:918-926, 2016. © 2016Wiley Periodicals, Inc.
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Affiliation(s)
- J W Bea
- Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona, 85724-5024.,Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - R M Blew
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - S B Going
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - C-H Hsu
- University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, 85724
| | - M C Lee
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - V R Lee
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, 85721
| | - B J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, 94612
| | - M L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, 94612
| | - T G Lohman
- Department of Physiology, University of Arizona, Tucson, Arizona, 85721
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Abstract
A 10-year-old female Eurasian river otter ( Lutra lutra) died after prolonged anorexia and weight loss in the Seoul Grand Park Zoo, Seoul, Republic of Korea. On necropsy, the liver was found to be swollen and friable with 1 lobe enlarged and necrotic. The other organs showed no significant alterations except for mild atrophy of the right kidney. Microscopically, there was multifocal hepatic necrosis. The hepatocytes around the necrotic areas were swollen and contained large basophilic intranuclear inclusions. Periportal infiltration by plasma cells and lymphocytes was also evident. Transmission electron microscopy revealed characteristic hexagonal virus particles sized approximately 70 nm in diameter in the nuclei of the hepatocytes, which were consistent with an adenovirus. Polymerase chain reaction of the formalin-fixed, paraffin-embedded liver sections was used to determine whether the virus was either the canine adenovirus type 1 (CAV-1), canine adenovirus type 2 (CAV-2), or some other viral agent. The results of these tests showed that the virus was CAV-1. To our knowledge, this is the first report on a CAV-1 infection in an otter.
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Affiliation(s)
- N Y Park
- Department of Veterinary Pathology, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Republic of Korea
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Affiliation(s)
- S J Chung
- Department of Neurology, University of Ulsan, Asan Medical Center, Songpa-gu, Seoul, Korea
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Cheng KI, Lee MC, Tseng KY, Shen YC. Trachway(®) stylet: a perfect tool for nasotracheal intubation - a reply. Anaesthesia 2016; 71:725. [PMID: 27158994 DOI: 10.1111/anae.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K I Cheng
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - M C Lee
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - K Y Tseng
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Y C Shen
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Tsai JP, Lee MC, Le MC, Chen YC, Ho GJ, Shih MH, Hsu BG. Hyperleptinemia Is a Risk Factor for the Development of Central Arterial Stiffness in Kidney Transplant Patients. Transplant Proc 2016; 47:1825-30. [PMID: 26293058 DOI: 10.1016/j.transproceed.2015.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Arterial stiffness could cause adverse outcomes in kidney transplant (KT) patients. Leptin has a role in influencing vascular smooth muscle that may contribute to atherosclerosis. The aim of this study was to evaluate the relationship between fasting serum leptin concentration and carotid-femoral pulse wave velocity (cfPWV) in KT patients. MATERIALS AND METHODS Fasting blood samples were obtained from 55 KT patients and 65 subjects from the outpatient department were enrolled as the control group. The cfPWV values of >10 m/s were used to define as the high arterial stiffness group and <10 m/s as the low arterial stiffness group. The predictive ability of leptin for arterial stiffness of KT was assessed using receiver operating characteristic (ROC) curve and multivariate logistic regression analyses. RESULTS Kidney transplant patients had lower hemoglobin, but higher blood urea nitrogen, creatinine, total cholesterol, diastolic blood pressure, intact parathyroid hormone levels, and leptin levels than controls. Although cfPWV levels were higher in KT patients, there is no difference of cfPWV levels between KT patients and control (P = .595). Fifteen KT patients (27.3%) were defined in the high arterial stiffness group, and serum leptin level was higher in the high arterial stiffness group compared with the low arterial stiffness group in KT patients (P < .001). Multivariate logistic regression analysis showed that leptin (odds ratio: 1.044, 95% confidence interval [CI]: 1.016-1.072, P = .002) was an independent predictor of arterial stiffness in KT patients. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve predicting arterial stiffness in KT patients were 73.33%, 87.5%, 68.7%, 89.7%, and 0.828 (95% CI: 0.703-0.917, P < .001), and the leptin cut-off value was 74.14 ng/mL. CONCLUSION Serum fasting leptin level could predict the development of central arterial stiffness of KT patients.
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Affiliation(s)
- J P Tsai
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Dalin Branch, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | | | - M C Le
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Y C Chen
- Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - G J Ho
- Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - M H Shih
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - B G Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Liang M, Lee MC, O'Neill J, Dickenson AH, Iannetti GD. Brain potentials evoked by intraepidermal electrical stimuli reflect the central sensitization of nociceptive pathways. J Neurophysiol 2016; 116:286-95. [PMID: 27098022 PMCID: PMC4969393 DOI: 10.1152/jn.00013.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/14/2016] [Indexed: 01/19/2023] Open
Abstract
Secondary mechanical punctate hyperalgesia is a cardinal sign of central sensitization (CS), an important mechanism of chronic pain. Our study demonstrates that hyperalgesia from intraepidermal electrical stimulation coexists with mechanical punctate hyperalgesia and elicits electroencephalographic (EEG) potentials that predict the occurrence of punctate hyperalgesia in a human experimental model of CS. These findings inform clinical development of EEG-based biomarkers of CS. Central sensitization (CS), the increased sensitivity of the central nervous system to somatosensory inputs, accounts for secondary hyperalgesia, a typical sign of several painful clinical conditions. Brain potentials elicited by mechanical punctate stimulation using flat-tip probes can provide neural correlates of CS, but their signal-to-noise ratio is limited by poor synchronization of the afferent nociceptive input. Additionally, mechanical punctate stimulation does not activate nociceptors exclusively. In contrast, low-intensity intraepidermal electrical stimulation (IES) allows selective activation of type II Aδ-mechano-heat nociceptors (II-AMHs) and elicits reproducible brain potentials. However, it is unclear whether hyperalgesia from IES occurs and coexists with secondary mechanical punctate hyperalgesia, and whether the magnitude of the electroencephalographic (EEG) responses evoked by IES within the hyperalgesic area is increased. To address these questions, we explored the modulation of the psychophysical and EEG responses to IES by intraepidermal injection of capsaicin in healthy human subjects. We obtained three main results. First, the intensity of the sensation elicited by IES was significantly increased in participants who developed robust mechanical punctate hyperalgesia after capsaicin injection (i.e., responders), indicating that hyperalgesia from IES coexists with punctate mechanical hyperalgesia. Second, the N2 peak magnitude of the EEG responses elicited by IES was significantly increased after the intraepidermal injection of capsaicin in responders only. Third, a receiver-operator characteristics analysis showed that the N2 peak amplitude is clearly predictive of the presence of CS. These findings suggest that the EEG responses elicited by IES reflect secondary hyperalgesia and therefore represent an objective correlate of CS.
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Affiliation(s)
- M Liang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China; Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; and
| | - M C Lee
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - J O'Neill
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; and
| | - A H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; and
| | - G D Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom; and
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Dossett LA, Lowe J, Sun W, Lee MC, Smith PD, Jacobsen PB, Laronga C. Prospective evaluation of skin and nipple-areola sensation and patient satisfaction after nipple-sparing mastectomy. J Surg Oncol 2016; 114:11-6. [PMID: 27087574 DOI: 10.1002/jso.24264] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sensation and quality of life (QOL) before and after nipple sparing mastectomy (NSM) are poorly understood. METHODS Women electing mastectomy with immediate reconstruction and eligible for NSM were prospectively enrolled in a sensation and satisfaction/QOL study. Women self-selected skin-sparing mastectomy (SSM) or NSM. Skin sensation testing using Semmes Weinstein monofilaments and patient satisfaction/QOL surveys were administered preoperatively and at 1 year postoperatively. RESULTS 53 patients were enrolled (n = 38, 72% NSM and n = 15, 28% SSM). Both groups had significant reduction in postoperative skin sensation. For NSM, measurable NAC sensation was preserved in both NAC for 26% of patients and in one NAC for 68%. QOL and satisfaction was similar between groups. Neither group was satisfied with sexual arousal with breast or nipple stimulation after surgery. CONCLUSION Patients undergoing SSM and NSM have considerable loss in skin and NAC sensation following surgery. Satisfaction and QOL did not differ between groups. J. Surg. Oncol. 2016;114:11-16. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lesly A Dossett
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Janell Lowe
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Weihong Sun
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - M C Lee
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Paul D Smith
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida.,Division of Plastic Surgery, Department of Surgery, University of South Florida, Tampa, Florida
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Pang R, Wang S, Tian L, Lee MC, Do A, Cutshall SM, Li G, Bauer BA, Thomley BS, Chon TY. Complementary and Integrative Medicine at Mayo Clinic. Am J Chin Med 2016; 43:1503-13. [DOI: 10.1142/s0192415x15500858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.
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Affiliation(s)
- Ran Pang
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Shihan Wang
- Department of Internal Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Lin Tian
- Department of Internal Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Mark C. Lee
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Do
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susanne M. Cutshall
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guangxi Li
- Department of Internal Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brent A. Bauer
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara S. Thomley
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tony Y. Chon
- Section of Complementary and Integrative Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lee MC. The Distance from Bench to Bedside: Commentary on an article by Benjamin D. Roye, MD, MPH, et al.: "An Independent Evaluation of the Validity of a DNA-Based Prognostic Test for Adolescent Idiopathic Scoliosis". J Bone Joint Surg Am 2015; 97:e79. [PMID: 26677243 DOI: 10.2106/jbjs.o.00869] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark C Lee
- Division of Orthopaedics, Connecticut Children's Medical Center, Hartford, Connecticut
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Chaudhry S, Kang K, Lee MC. Reinforcing a spica cast with a fiberglass bar. Am J Orthop (Belle Mead NJ) 2015; 44:E423-E426. [PMID: 26566556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hip spica casting is used in the treatment of femur fractures and hip dysplasia in children 1 to 6 years old. A bar connecting the legs of the cast has been shown to improve cast integrity and assist in patient transport. We present a simple and low-cost technique that can be used to create a connecting bar and that can be performed with readily available casting materials.
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Affiliation(s)
- Sonia Chaudhry
- Department of Orthopaedic Surgery, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT.
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Abstract
Malignant mucosal melanoma is very rare entity. It comprises about 1% of all malignant melanoma and exhibit more aggressive behaviour than that of skin melanomas. Mucosal melanoma arises mainly from the mucous membranes of head and neck, the female genital organs or the anorectal and the urinary tracts. Laryngeal malignant melanoma constitutes 3.8% to 7.4% of all cases of malignant mucosal melanoma of head and neck. In this article we report a case of primary malignant mucosal melanoma of larynx in 27 years old male who was treated with radical surgery and adjuvant chemotherapy in BPKM Cancer Hospital, Chitwan.
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Lee MC, Ha CW, Elmallah RK, Cherian JJ, Cho JJ, Kim TW, Bin SI, Mont MA. A placebo-controlled randomised trial to assess the effect of TGF-ß1-expressing chondrocytes in patients with arthritis of the knee. Bone Joint J 2015; 97-B:924-32. [DOI: 10.1302/0301-620x.97b7.35852] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to assess the effect of injecting genetically engineered chondrocytes expressing transforming growth factor beta 1 (TGF-β1) into the knees of patients with osteoarthritis. We assessed the resultant function, pain and quality of life. A total of 54 patients (20 men, 34 women) who had a mean age of 58 years (50 to 66) were blinded and randomised (1:1) to receive a single injection of the active treatment or a placebo. We assessed post-treatment function, pain severity, physical function, quality of life and the incidence of treatment-associated adverse events. Patients were followed at four, 12 and 24 weeks after injection. At final follow-up the treatment group had a significantly greater improvement in the mean International Knee Documentation Committee score than the placebo group (16 points; -18 to 49, vs 8 points; -4 to 37, respectively; p = 0.03). The treatment group also had a significantly improved mean visual analogue score at final follow-up (-25; -85 to 34, vs -11 points; -51 to 25, respectively; p = 0.032). Both cohorts showed an improvement in Western Ontario and McMaster Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome Scores, but these differences were not statistically significant. One patient had an anaphylactic reaction to the preservation medium, but recovered within 24 hours. All other adverse events were localised and resolved without further action. This technique may result in improved clinical outcomes, with the aim of slowing the degenerative process, leading to improvements in pain and function. However, imaging and direct observational studies are needed to verify cartilage regeneration. Nevertheless, this study provided a sufficient basis to proceed to further clinical testing. Cite this article: Bone Joint J 2015;97-B:924–32.
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Affiliation(s)
- M C Lee
- Seoul National University Hospital, Seoul
National University College of Medicine, Seoul, Korea
| | - C-W Ha
- Department of Orthopaedic Surgery, Samsung
Medical Center, Stem Cell and Regenerative Medicine
Research Center, Department of Health Sciences
and Technology, SAI HST, Sungkyunkwan University
School of Medicine, Seoul, Korea
| | - R. K. Elmallah
- Sinai Hospital of Baltimore, Baltimore, Maryland
21215, USA
| | - J. J. Cherian
- Sinai Hospital of Baltimore, Baltimore, Maryland
21215, USA
| | - J J Cho
- Kolon Life Science Inc., Seoul, Korea
| | - T W Kim
- Kolon Life Science Inc., Seoul, Korea
| | | | - M. A. Mont
- Sinai Hospital of Baltimore, Baltimore, Maryland
21215, USA
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Liao CC, Yeh CJ, Lee SH, Liao WC, Liao MY, Lee MC. Providing instrumental social support is more beneficial to reduce mortality risk among the elderly with low educational level in Taiwan: a 12-year follow-up national longitudinal study. J Nutr Health Aging 2015; 19:447-53. [PMID: 25809809 DOI: 10.1007/s12603-014-0545-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND To evaluate whether the effects of providing or receiving social support are more beneficial to reduce mortality risk among the elderly with different educational levels. METHODS In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 1492 males and 1177 females aged ≥67 years were retrieved. Participants received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others and involved in social engagement. Education attainment was divided into two levels: high and low. The low education level included illiterate and elementary school. The high education level included junior high school to senior high school and above college. Cox regression analysis was used to examine the association between providing or receiving social support on mortality with different educational levels. RESULTS The average age of the participants in 1996 was 73.0 (IQR=8.0) years, and the median survival following years (1996-2007) of participants was 10.3 (IQR=6.7) years. Most participants were low educational level including illiterate (39.3%) and elementary school (41.2%). Participants with high educational level tend to be younger and more male significantly. On the contrary, participants with low educational level tend to have significant more poor income, more depression, more cognition impairment, more with IADL and ADL disability than high educational level. Most participants received instrumental support from others (95.5%) and also provided emotional support to others (97.7%). Providing instrumental support can reduce 17% of mortality risk among the elderly with a low level of education after adjusting several covariates [Hazard ratio (HR) = 0.83; 95% confidence interval (CI) = 0.70-0.99; p = 0.036]. CONCLUSIONS Providing instrumental social support to others confer benefits to the giver and prolong life expectancy among the elderly with low educational levels.
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Affiliation(s)
- C C Liao
- Meng-Chih Lee, Department of Family Medicine, Taichung Hospital, No. 199, Sec. 1, San-Min Road, Taichung, Taiwan. Fax:(+886)-4-22255037. Tel: (+886)-4-22294411 ext. 3200.
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Lee MC. To culture or not to culture: commentary on an article by Jarren Section, MS, et al.: "Microbiological culture methods for pediatric musculoskeletal infection. a guideline for optimal use". J Bone Joint Surg Am 2015; 97:e32. [PMID: 25788313 DOI: 10.2106/jbjs.n.01204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark C Lee
- Department of Orthopaedics, Connecticut Children's Medical Center, Hartford, Connecticut
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Lee SM, Lee MC, Reed DA, Halvorsen AJ, Berbari EF, McDonald FS, Beckman TJ. Success of a Faculty Development Program for Teachers at the Mayo Clinic. J Grad Med Educ 2014; 6:704-8. [PMID: 26140122 PMCID: PMC4477566 DOI: 10.4300/jgme-d-14-00139.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/09/2014] [Accepted: 07/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There has been limited research on the improvement of underperforming clinical teachers. OBJECTIVE To determine whether a faculty development program could improve the evaluations of clinical teachers in an internal medicine residency program. METHODS A total of 123 teachers completed faculty development at the Mayo Clinic from 2009 to 2012. The faculty enhancement and education development program (FEED) consists of 6 interactive, small group, 2-hour sessions taught by experienced Mayo Clinic faculty over 1 year. These sessions address the following competencies: asking questions, diagnosing learners, giving feedback, using teaching frameworks, recognizing learning styles, and providing clinical supervision. Resident-of-faculty Mayo teaching effectiveness (MTE) scores have previously demonstrated content, internal structure, and criterion validity. Teachers were grouped into the top 80% or the bottom 20%, according to baseline MTE scores. Mixed linear models were used to compare these groups regarding changes in MTE scores after completion of FEED. Results were adjusted for teacher age, sex, medical specialty, academic rank, and teaching awards. RESULTS For all participants combined, the adjusted MTE scores (mean; standard error) improved from baseline (3.80; 0.04) to completion of FEED (3.93; 0.04; P < .001). However, the bottom 20% had a significantly greater improvement in scores than the top 80% (score-change difference = 0.166, P < .001). CONCLUSIONS We describe a low-intensity faculty development intervention that benefited all clinical teachers, but was particularly effective for underperforming teachers in internal medicine. The approach may be suitable for adoption or adaptation in other graduate medical education programs.
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Lee MC. Luau Limbo and the Age for Rigid Nailing of Pediatric Femoral Fractures: How Low Can You Go? Commentary on an article by Samuel N. Crosby Jr., MD, et al.: "Twenty-Year Experience with Rigid Intramedullary Nailing of Femoral Shaft Fractures in Skeletally Immature Patients". J Bone Joint Surg Am 2014; 96:e116. [PMID: 24990990 DOI: 10.2106/jbjs.n.00298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mark C Lee
- Connecticut Children's Medical Center Hartford, Connecticut
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Jin D, Lee MC. Establishing Korean Polar Data Management Policy and Its Future Directions. Data Sci J 2014. [DOI: 10.2481/dsj.ifpda-03] [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: 11/20/2022] Open
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Wahner-Roedler DL, Lee MC, Chon TY, Cha SS, Loehrer LL, Bauer BA. Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: 8-year follow-up at an academic medical center. Complement Ther Clin Pract 2013; 20:54-60. [PMID: 24439646 DOI: 10.1016/j.ctcp.2013.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine changes in attitude toward complementary and alternative medicine (CAM) therapies and knowledge of specific CAM therapies among internists at our institution. We compared the results of a survey given in 2004 and 2012. During this time period, the attitudes of physicians in our department of medicine toward CAM became much more positive, and physicians showed an increased willingness to use CAM to address patient care needs. However, knowledge of and experience with many specific CAM treatments did not change. These results will be used to develop further educational interventions and research studies.
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Affiliation(s)
| | - Mark C Lee
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Stephen S Cha
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura L Loehrer
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
Worldwide, acupuncture is integral to everyday medical practice. In recent decades its practice has gained popularity in the United States. With increasing evidence of its clinical efficacy, acupuncture is now a widely practiced treatment modality in complementary and integrative medicine. According to the 2007 National Health Interview Survey, an estimated 3.1 million US adults and 150,000 children had acupuncture in the previous year. The National Health Interview Survey also estimated that between 2002 and 2007, acupuncture use among adults increased by approximately 1 million people. Patients want more information from their clinicians about the use of acupuncture and its safety and efficacy. Although many clinicians may recommend acupuncture, they often believe they are not sufficiently informed to discuss acupuncture with their patients. This article provides answers to the most frequently asked questions regarding acupuncture.
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Affiliation(s)
- Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
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Affiliation(s)
- Nicole M Loo
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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Abstract
Chronic pain is a state of physical suffering strongly associated with feelings of anxiety, depression and despair. Disease pathophysiology, psychological state, and social milieu can influence chronic pain, but can be difficult to diagnose based solely on clinical presentation. Here, we review brain neuroimaging research that is shaping our understanding of pain mechanisms, and consider how such knowledge might lead to useful diagnostic tools for the management of persistent pain in individual patients.
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Affiliation(s)
- M C Lee
- Nuffield Division of Anaesthetics and Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK.
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Chang CB, Han SA, Kim EM, Lee S, Seong SC, Lee MC. Chondrogenic potentials of human synovium-derived cells sorted by specific surface markers. Osteoarthritis Cartilage 2013; 21:190-9. [PMID: 23069852 DOI: 10.1016/j.joca.2012.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 09/25/2012] [Accepted: 10/04/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to evaluate expression levels of nine candidate surface markers for chondrogenic potential in human synovial cells and to determine whether cell pellets positively sorted by each specific marker would have valuable chondrogenic potential. METHODS The expression levels of the selected nine leading surface markers in synovial cells from knee joints in 15 patients with primary knee osteoarthritis were evaluated at the stage of isolation and after cultivation using flow cytometry. We obtained positive and negative cells for each surface marker using a magnetically activated cell sorting method and compared chondrogenic potentials between the positive and the negative cell pellets. RESULTS CD29, CD44, CD73, and CD90 were expressed on the most synovial cells at the isolation stage and on almost all cells at stage of P0 and P1. CD133 was rarely expressed at any stages of the evaluated cells. CD166 was expressed in 7.1% of cells at the isolation stage on average, but this expression increased after cell passages. The expressions of CD10 and CD105 also increased after cell passages while the expression of CD49a made no significant difference at progressive stages of isolation and passage. Comparison of chondrogenic potentials between positive and negative cell pellets for each marker revealed that only CD105- and CD166-positive cell pellets showed better chondrogenic potentials (type II collagen gene expression, cartilage matrix formation, and GAG expression) than the corresponding negative cell pellets. CONCLUSION Our study suggests that CD105 and CD166 would be valuable surface markers associated with chondrogenic potential; thus, CD105- and CD166-enriched cells derived from human synovium would be practical and valuable sources for cartilage regeneration.
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Affiliation(s)
- C B Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Shrestha S, Pun CB, Basyal R, Pathak T, Bastola S, Neupane S, Lee MC. Polymorphous low grade adenocarcinoma of the parotid gland: A case report with cytohistological correlation and its immunohistochemical study. J Pathol Nep 2012. [DOI: 10.3126/jpn.v2i4.6890] [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: 11/18/2022] Open
Abstract
Polymorphous low-grade adenocarcinoma is a rare salivary gland malignant tumor of low aggressiveness, commonly occurring in minor salivary glands. Its origin in major salivary glands is considered exceedingly rare. We report a case of polymorphous low grade adenocarcinoma arising from left parotid in a 21-yearold female patient.Journal of Pathology of Nepal (2012) Vol. 2, 331-334DOI: http://dx.doi.org/10.3126/jpn.v2i4.6890
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Pun CB, Aryal G, Basyal R, Shrestha S, Pathak T, Bastola S, Neupane S, Shrestha BM, Thakur BK, Lee MC. Histological pattern of esophageal cancer at BP Koirala memorial cancer hospital in Nepal: a three year retrospective study. J Pathol Nep 2012. [DOI: 10.3126/jpn.v2i4.6877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The incidence of esophageal adenocarcinoma is increasing in trends. Squamous cell carcinoma is associated with tobacco and alcohol consumption. Adenocarcinoma is often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. The aim of this study was to find out the histological pattern of esophageal cancer in one of the largest Cancer center in Nepal.Materials and Methods: Between January 2008 and December 2011, a total of 106 cases of esophageal cancer were received in the department of pathology, BP Koirala Memorial Cancer Hospital. Relevant clinical data were retrieved from computer database of the hospital.Results: A total of 106 cases of esophageal carcinomas were diagnosed during a three years period. There were 68 (64.15%) cases of squamous cell carcinoma, 33 (31.13%) cases of adenocarcinoma including signet ring cell carcinoma, 4 (3.76%) cases of undifferentiated carcinoma and 1 (0.94%) case of small cell carcinoma. The esophageal cancer was most common in the age group of 61-70 years of age. Distal third of esophagus was the most common site for esophageal carcinoma, followed by middle esophagus and proximal esophagus.Conclusion: The most frequent type of esophageal carcinoma is squamous cell carcinoma followed by adenocarcinoma. Distal esophagus is the most common site with male preponderance.Journal of Pathology of Nepal (2012) Vol. 2, 277-281DOI: http://dx.doi.org/10.3126/jpn.v2i4.6877
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Affiliation(s)
- William McKinnon
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030
| | - Mark C Lee
- Department of Orthopaedics (M.C.L.), Department of Neurosurgery (P.K.), Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106.
| | - Paul Kanev
- Department of Orthopaedics (M.C.L.), Department of Neurosurgery (P.K.), Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106.
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Joh JE, Acs G, Kiluk JV, Laronga C, Khakpour N, Lee MC. P5-11-14: Flat Epithelial Atypia of the Breast: A Single Institution Experience. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-11-14] [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: Flat epithelial atypia of the breast is a relatively new entity of unknown significance. Our objective is to evaluate our surgical experience with this diagnosis.
Methods: A single institution database of breast patients from 2005–2010 was used to identify women who were diagnosed with flat epithelial atypia on core biopsy and subsequently underwent surgical excision. Patient data regarding history, type and reason for biopsy, and associated pathology was collected. Individuals diagnosed with flat epithelia atypia and cancer on core biopsies in the same breast were excluded.
Results: There were 52 patients who underwent surgical excision for the primary diagnosis of flat epithelial atypia. There were 3 (6%) patients with a personal history of breast cancer, 14 (27%) patients with a family history of breast cancer, and 11 (21%) patients with a concurrent new diagnosis of breast cancer in the contralateral breast. Core biopsy was recommended in most (81%) cases because of suspicious calcifications on mammography. Twenty-eight (54%) patients were found to have flat epithelial atypia associated with other atypical breast hyperplasia and 24 (46%) had flat epithelial atypia as the most significant lesion on core biopsy. In 8 (15%) patients, there was a sonographic correlate that was biopsied; 5 had only flat epithelial atypia and 3 had flat epithelial atypia associated with other atypical hyperplasia. Of the 52 patients there were 4 (8%) patients who upstaged to ductal carcinoma in-situ on surgical excision. There were no cases of invasive carcinoma. All ductal carcinoma in-situ cases were associated with other atypical breast hyperplasia, not flat epithelial atypia alone.
Conclusion: Though flat epithelial atypia may be associated with an increased risk of breast cancer, surgical excision of pure flat epithelial atypia may not be necessary. Larger studies are needed to corroborate these findings.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-14.
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Affiliation(s)
- JE Joh
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - G Acs
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - JV Kiluk
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - C Laronga
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - N Khakpour
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - MC Lee
- 1Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Lee MC, Stone NE, Ritting AW, Silverstein EA, Pierz KA, Johnson DA, Naujoks R, Smith BG, Thomson JD. Mini-C-arm fluoroscopy for emergency-department reduction of pediatric forearm fractures. J Bone Joint Surg Am 2011; 93:1442-7. [PMID: 21915550 DOI: 10.2106/jbjs.j.01052] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reduction of pediatric forearm fractures with the patient under sedation in the emergency department is a common practice throughout the United States. We hypothesized that the use of a mini-c-arm fluoroscopy device as an alternative to routine radiographs for evaluation of fracture reduction would (1) allow a more anatomic fracture reduction, (2) decrease the number of repeat reductions or subsequent procedures, (3) reduce overall radiation exposure to the patient, and (4) decrease the orthopaedic consultation time in the emergency department. METHODS A retrospective cohort analysis of 279 displaced forearm and wrist fractures treated with closed reduction and casting with the patient under sedation in the emergency department of a level-I pediatric trauma center was performed, and the data were compared with historical controls. One hundred and thirteen fracture reductions were assessed with a mini-c-arm device, and 166 fracture reductions were evaluated with radiographs. All patients had radiographs of the injury. Blinded, independent reviewers graded the quality of reduction for residual angulation and translation of the reduced fracture. Radiation exposure was determined by the average number of radiographs made through either modality. Emergency department and outpatient charts were reviewed to determine the total orthopaedic consultation time and the need for repeat reductions or operative intervention. RESULTS Pediatric forearm fractures undergoing closed reduction with assistance of the mini c-arm had a significant improvement in reduction quality (average angulation [and standard deviation], 6° ± 4° vs. 8 ± 6°; p = 0.02), a decrease in repeat fracture reduction and need for subsequent operative treatment (two [2%] of 113 fractures vs. fourteen [8.4%] of 166 fractures; p = 0.0001), and a decrease in radiation exposure to the patient (mean, 14.0 ± 10.3 mrem vs. 50.0 ± 12.7 mrem). The average orthopaedic consultation time was decreased with use of a mini c-arm (28 ± 12 min vs. 47 ± 19 min, p < 0.001). CONCLUSIONS Use of the mini c-arm to assist in the closed reduction of pediatric forearm and wrist fractures in the emergency department can improve the quality of the reduction, decrease the radiation exposure to the patient, and decrease the need for repeat fracture reduction or additional procedures. Mini-c-arm imaging can also decrease the average orthopaedic consultation time for fracture reduction.
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Affiliation(s)
- Mark C Lee
- Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
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Mueller PS, McConahey LL, Orvidas LJ, Lee MC, Bowen JM, Beckman TJ, Kasten MJ. Visiting medical student elective and clerkship programs: a survey of US and Puerto Rico allopathic medical schools. BMC Med Educ 2010; 10:41. [PMID: 20529301 PMCID: PMC2893187 DOI: 10.1186/1472-6920-10-41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 06/07/2010] [Indexed: 05/25/2023]
Abstract
BACKGROUND No published reports of studies have provided aggregate data on visiting medical student (VMS) programs at allopathic medical schools. METHODS During 2006, a paper survey was mailed to all 129 allopathic medical schools in the United States and Puerto Rico using a list obtained from the Association of American Medical Colleges. Contents of the survey items were based on existing literature and expert opinion and addressed various topics related to VMS programs, including organizational aspects, program objectives, and practical issues. Responses to the survey items were yes-or-no, multiple-choice, fill-in-the-blank, and free-text responses. Data related to the survey responses were summarized using descriptive statistics. RESULTS Representatives of 76 schools (59%) responded to the survey. Of these, 73 (96%) reported their schools had VMS programs. The most common reason for having a VMS program was "recruitment for residency programs" (90%). "Desire to do a residency at our institution" was ranked as the leading reason visiting medical students choose to do electives or clerkships. In descending order, the most popular rotations were in internal medicine, orthopedic surgery, emergency medicine, and pediatrics. All VMS programs allowed fourth-year medical students, and approximately half (58%) allowed international medical students. The most common eligibility requirements were documentation of immunizations (92%), previous clinical experience (85%), and successful completion of United States Medical Licensing Examination Step 1 (51%). Of the programs that required clinical experience, 82% required 33 weeks or more. Most institutions (96%) gave priority for electives and clerkships to their own students over visiting students, and a majority (78%) reported that visiting students were evaluated no differently than their own students. During academic year 2006-2007, the number of new resident physicians who were former visiting medical students ranged widely among the responding institutions (range, 0-76). CONCLUSIONS Medical schools' leading reason for having VMS programs is recruitment into residency programs and the most commonly cited reason students participate in these programs is to secure residency positions. However, further research is needed regarding factors that determine the effectiveness of VMS programs in residency program recruitment and the development of more universal standards for VMS eligibility requirements and assessment.
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Affiliation(s)
- Paul S Mueller
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Linda L McConahey
- Mayo School of Graduate Medical Education, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Laura J Orvidas
- Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Mark C Lee
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Juan M Bowen
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Mary J Kasten
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
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