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Tamai R, Dawit L, Lee P, Simmons OL, Ding L, Yuan L. The Association of Metabolic Risk Factors with Advanced Adenomas in Hispanic Patients. Dig Dis Sci 2024; 69:1403-1410. [PMID: 38363522 PMCID: PMC11026227 DOI: 10.1007/s10620-024-08323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Obesity and metabolic syndrome (MetS) have been implicated as rising risk factors for the development of colorectal cancers. A rapid increase in the prevalence of obesity and severe obesity among Hispanic patients in the United States may present substantially increased risk for advanced colorectal neoplasia in this population. Currently, there is very little research in this area. AIMS We sought to identify metabolic risk factors for advanced adenomas (AA) in Hispanic Americans. METHODS We retrospectively reviewed data from the Los Angeles General (LAG) Medical Center of asymptomatic Hispanic patients above 45 years of age who underwent their first colonoscopies following a positive screening FBT. Patient demographics, metabolic characteristics, as well as colon polyp size and histology were recorded. Polyps were classified as adenomas or AA (including both high-risk adenomas and high-risk serrated polyps). Relative risk for AA was assessed by multivariate logistical regression analyses. RESULTS Of the 672 patients in our study, 41.4% were male, 67% had adenomas, and 16% had AA. The mean BMI was 31.2 kg/m2. The mean HDL-C was 49.5 mg/dL (1.28 mmol/L) and the mean triglyceride level was 151 mg/dL. 44.6% had diabetes and 64.1% had hypertension. When comparing patients with AA to patients with no adenoma, male sex, BMI > 34.9 kg/m2, and elevated fasting triglyceride levels were associated with an increased risk of AA. FIB-4 ≥1.45 was also associated with an increased risk of AA in males. There was no significant difference in the risk of AA with diabetes, hypertension, FIB-4 score, LDL-C level, and HDL-C level. CONCLUSIONS Hispanic patients with a positive FBT were observed to have a high incidence of AA. Class II obesity (BMI ≥ 35 kg/m2), elevated triglyceride levels were identified as risk factors among males in our study. Early interventions to address these modifiable risk factors in at-risk populations, such as multi-disciplinary weight management programs for the treatment of obesity and related co-morbidities, could potentially lead to risk reduction and CRC prevention.
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Affiliation(s)
- Robert Tamai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Lillian Dawit
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Patrick Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Okeefe L Simmons
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Li Ding
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Liyun Yuan
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA.
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2
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He M, Ditto JC, Gardner L, Machesky J, Hass-Mitchell TN, Chen C, Khare P, Sahin B, Fortner JD, Plata DL, Drollette BD, Hayden KL, Wentzell JJB, Mittermeier RL, Leithead A, Lee P, Darlington A, Wren SN, Zhang J, Wolde M, Moussa SG, Li SM, Liggio J, Gentner DR. Total organic carbon measurements reveal major gaps in petrochemical emissions reporting. Science 2024; 383:426-432. [PMID: 38271520 DOI: 10.1126/science.adj6233] [Citation(s) in RCA: 1] [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] [Received: 07/13/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
Anthropogenic organic carbon emissions reporting has been largely limited to subsets of chemically speciated volatile organic compounds. However, new aircraft-based measurements revealed total gas-phase organic carbon emissions that exceed oil sands industry-reported values by 1900% to over 6300%, the bulk of which was due to unaccounted-for intermediate-volatility and semivolatile organic compounds. Measured facility-wide emissions represented approximately 1% of extracted petroleum, resulting in total organic carbon emissions equivalent to that from all other sources across Canada combined. These real-world observations demonstrate total organic carbon measurements as a means of detecting unknown or underreported carbon emissions regardless of chemical features. Because reporting gaps may include hazardous, reactive, or secondary air pollutants, fully constraining the impact of anthropogenic emissions necessitates routine, comprehensive total organic carbon monitoring as an inherent check on mass closure.
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Affiliation(s)
- Megan He
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Jenna C Ditto
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Lexie Gardner
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Jo Machesky
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Tori N Hass-Mitchell
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Christina Chen
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Peeyush Khare
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Bugra Sahin
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - John D Fortner
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Desiree L Plata
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Brian D Drollette
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Katherine L Hayden
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Jeremy J B Wentzell
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Richard L Mittermeier
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Amy Leithead
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Patrick Lee
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Andrea Darlington
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Sumi N Wren
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Junhua Zhang
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | | | - Samar G Moussa
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Shao-Meng Li
- College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - John Liggio
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Drew R Gentner
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
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3
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Ullman JC, Mellem KT, Xi Y, Ramanan V, Merritt H, Choy R, Gujral T, Young LE, Blake K, Tep S, Homburger JR, O’Regan A, Ganesh S, Wong P, Satterfield TF, Lin B, Situ E, Yu C, Espanol B, Sarwaikar R, Fastman N, Tzitzilonis C, Lee P, Reiton D, Morton V, Santiago P, Won W, Powers H, Cummings BB, Hoek M, Graham RR, Chandriani SJ, Bainer R, DePaoli-Roach AA, Roach PJ, Hurley TD, Sun RC, Gentry MS, Sinz C, Dick RA, Noonberg SB, Beattie DT, Morgans DJ, Green EM. Small-molecule inhibition of glycogen synthase 1 for the treatment of Pompe disease and other glycogen storage disorders. Sci Transl Med 2024; 16:eadf1691. [PMID: 38232139 PMCID: PMC10962247 DOI: 10.1126/scitranslmed.adf1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Glycogen synthase 1 (GYS1), the rate-limiting enzyme in muscle glycogen synthesis, plays a central role in energy homeostasis and has been proposed as a therapeutic target in multiple glycogen storage diseases. Despite decades of investigation, there are no known potent, selective small-molecule inhibitors of this enzyme. Here, we report the preclinical characterization of MZ-101, a small molecule that potently inhibits GYS1 in vitro and in vivo without inhibiting GYS2, a related isoform essential for synthesizing liver glycogen. Chronic treatment with MZ-101 depleted muscle glycogen and was well tolerated in mice. Pompe disease, a glycogen storage disease caused by mutations in acid α glucosidase (GAA), results in pathological accumulation of glycogen and consequent autophagolysosomal abnormalities, metabolic dysregulation, and muscle atrophy. Enzyme replacement therapy (ERT) with recombinant GAA is the only approved treatment for Pompe disease, but it requires frequent infusions, and efficacy is limited by suboptimal skeletal muscle distribution. In a mouse model of Pompe disease, chronic oral administration of MZ-101 alone reduced glycogen buildup in skeletal muscle with comparable efficacy to ERT. In addition, treatment with MZ-101 in combination with ERT had an additive effect and could normalize muscle glycogen concentrations. Biochemical, metabolomic, and transcriptomic analyses of muscle tissue demonstrated that lowering of glycogen concentrations with MZ-101, alone or in combination with ERT, corrected the cellular pathology in this mouse model. These data suggest that substrate reduction therapy with GYS1 inhibition may be a promising therapeutic approach for Pompe disease and other glycogen storage diseases.
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Affiliation(s)
- Julie C. Ullman
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Kevin T. Mellem
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Yannan Xi
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Vyas Ramanan
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Hanne Merritt
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Rebeca Choy
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | - Lyndsay E.A. Young
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, 40506, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Kerrigan Blake
- Maze Therapeutics; South San Francisco, California, 94080 USA
- Present address, Cellarity, Somerville, Massachusetts, 02143, USA
| | - Samnang Tep
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | - Adam O’Regan
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Sandya Ganesh
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Perryn Wong
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | - Baiwei Lin
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Eva Situ
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Cecile Yu
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Bryan Espanol
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Richa Sarwaikar
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Nathan Fastman
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | - Patrick Lee
- Maze Therapeutics; South San Francisco, California, 94080 USA
- Present address, Curie Bio, Boston, Massachusetts, 02115, USA
| | - Daniel Reiton
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Vivian Morton
- Maze Therapeutics; South San Francisco, California, 94080 USA
- Present address, Revolution Medicines, Redwood City, California, 94063, USA
| | - Pam Santiago
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Walter Won
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Hannah Powers
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | - Maarten Hoek
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | | | - Russell Bainer
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | - Anna A. DePaoli-Roach
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Peter J. Roach
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Thomas D. Hurley
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Ramon C. Sun
- Department of Biochemistry & Molecular Biology, University of Florida, Gainesville, FL, 32610, USA
- USA Center for Advanced Spatial Biomolecule Research, University of Florida, Gainesville, FL, 32610, USA
| | - Matthew S. Gentry
- Department of Biochemistry & Molecular Biology, University of Florida, Gainesville, FL, 32610, USA
| | | | - Ryan A. Dick
- Maze Therapeutics; South San Francisco, California, 94080 USA
| | | | | | | | - Eric M. Green
- Maze Therapeutics; South San Francisco, California, 94080 USA
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Arcego DM, Buschdorf JP, O'Toole N, Wang Z, Barth B, Pokhvisneva I, Rayan NA, Patel S, de Mendonça Filho EJ, Lee P, Tan J, Koh MX, Sim CM, Parent C, de Lima RMS, Clappison A, O'Donnell KJ, Dalmaz C, Arloth J, Provençal N, Binder EB, Diorio J, Silveira PP, Meaney MJ. A Glucocorticoid-Sensitive Hippocampal Gene Network Moderates the Impact of Early-Life Adversity on Mental Health Outcomes. Biol Psychiatry 2024; 95:48-61. [PMID: 37406925 DOI: 10.1016/j.biopsych.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/15/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Early stress increases the risk for psychiatric disorders. Glucocorticoids are stress mediators that regulate transcriptional activity and morphology in the hippocampus, which is implicated in the pathophysiology of multiple psychiatric conditions. We aimed to establish the relevance of hippocampal glucocorticoid-induced transcriptional activity as a mediator of the effects of early life on later psychopathology in humans. METHODS RNA sequencing was performed with anterior and posterior hippocampal dentate gyrus from adult female macaques (n = 12/group) that were chronically treated with betamethasone (glucocorticoid receptor agonist) or vehicle. Coexpression network analysis identified a preserved gene network in the posterior hippocampal dentate gyrus that was strongly associated with glucocorticoid exposure. The single nucleotide polymorphisms in the genes in this network were used to create an expression-based polygenic score in humans. RESULTS The expression-based polygenic score significantly moderated the association between early adversity and psychotic disorders in adulthood (UK Biobank, women, n = 44,519) and on child peer relations (ALSPAC [Avon Longitudinal Study of Parents and Children], girls, n = 1666 for 9-year-olds and n = 1594 for 11-year-olds), an endophenotype for later psychosis. Analyses revealed that this network was enriched for glucocorticoid-induced epigenetic remodeling in human hippocampal cells. We also found a significant association between single nucleotide polymorphisms from the expression-based polygenic score and adult brain gray matter density. CONCLUSIONS We provide an approach for the use of transcriptomic data from animal models together with human data to study the impact of environmental influences on mental health. The results are consistent with the hypothesis that hippocampal glucocorticoid-related transcriptional activity mediates the effects of early adversity on neural mechanisms implicated in psychiatric disorders.
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Affiliation(s)
- Danusa Mar Arcego
- Douglas Research Centre, Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada.
| | - Jan-Paul Buschdorf
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore
| | - Nicholas O'Toole
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | - Zihan Wang
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | - Barbara Barth
- Douglas Research Centre, Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Irina Pokhvisneva
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | | | - Sachin Patel
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | | | - Patrick Lee
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore
| | - Jennifer Tan
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore
| | - Ming Xuan Koh
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore
| | - Chu Ming Sim
- Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore
| | - Carine Parent
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | | | - Andrew Clappison
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | - Kieran J O'Donnell
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada; Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Carla Dalmaz
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Janine Arloth
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany; Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nadine Provençal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elisabeth B Binder
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Josie Diorio
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada
| | - Patrícia Pelufo Silveira
- Douglas Research Centre, Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, Quebec, Canada; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
| | - Michael J Meaney
- Douglas Research Centre, Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Translational Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Republic of Singapore; Brain Body Initiative, Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
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Ladbury CJ, Watkins WT, Mason JM, Kalash R, Ronson BB, Ash RB, Mandelin PM, Menzel PL, Li YR, Wong JYC, Lee P, Sampath S, Dandapani SV, Glaser SM. Real-World Toxicity of Conventional Versus Hypofractionated Definitive Prostate Radiotherapy across a Large, Diverse, Academic and Community-Based Enterprise. Int J Radiat Oncol Biol Phys 2023; 117:e402. [PMID: 37785342 DOI: 10.1016/j.ijrobp.2023.06.1537] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Over the past 10-15 years there has been increasing adoption of moderate hypofractionation (HF) for definitive prostate radiotherapy as compared to conventional fractionation (CF). Based on several randomized trials hypofractionation results in equivalent treatment efficacy with similar rates of long-term toxicity. However, some studies suggest higher acute GI toxicity with moderate hypofractionation. We sought to compare the rates of toxicity between these two groups across our enterprise including 16 community-based practices and one academic NCI-designated comprehensive cancer center. MATERIALS/METHODS We retrospectively extracted radiation treatment intent from our network-wide clinical pathways for patients diagnosed with prostate cancer between 3/2019 and 10/2022. Patients treated after prostatectomy and those treated with brachytherapy or SBRT were excluded. For the remaining 1529 patients treated with either conventional fractionation or moderate hypofractionation, we identified and merged physician-graded toxicity data using CTCAE version 5.0 recorded in their electronic medical record at each weekly on-treatment visit and follow-up. A total of 1051 patients had toxicity data available. Rates of toxicities were then compared between the cohort of patients who received CF and those who HF using the Chi-square test. RESULTS Of the 1051 patients, 450 (43%) received CF and 601 (57%) received HF. These patients were treated by 40 different radiation oncologists (median patients per physician = 18, interquartile range = 7-35). Median age in the CF and HF cohorts was 71 (IQR: 66-76) and 71 (IQR: 66-77; p = 0.51), respectively. The CF cohort had more patients with Gleason 8+ disease (39% vs 19%; p<0.01), PSA >20 (26% vs 11%; p<0.01), or T3a+ (18% vs 8%; p<0.01). Rates of any grade 2+ toxicity were significantly higher in patients who received HF at 45.8% vs 39.6% for those treated with CF (p = 0.04). However, the respective rates of any grade 3+ toxicity were no different at 2.0% vs. 1.8% (p = 0.80). The difference in grade 2 toxicities appeared to be primarily driven by the rates of urinary frequency at 27.1% vs. 17.8% (p<0.01) and prostatic obstruction 14.8% vs. 10.2%, p = 0.03). Rates of grade 2 diarrhea were worse with MF at 5.3% vs. 2.8% for CF (p = 0.04). There were no significant differences between HF and CF in the rates of grade 2 dysuria (6% vs 5.2%), urinary urgency (6.5% vs. 4.2%), proctitis (3.0% vs. 3.6%), urinary incontinence (0.5% vs. 1.3%), rectal bleeding (0.3% vs. 0%), hematuria (0% vs. 0.4%), and fatigue (14.1% vs. 15.1%). CONCLUSION In this large network-wide analysis, toxicity was slightly increased among patients with prostate cancer treated with HF compared to CF, consistent with published randomized data. However, the increased toxicity appeared to be primarily GU rather than GI. This study demonstrates the feasibility of analyzing impacts of treatment decisions on a large scale using real-world data through an integrated network of practices.
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Affiliation(s)
- C J Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - W T Watkins
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | | | - Y R Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | | | - S Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S V Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - S M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
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Lee P, Reeves RA, Lee P, Leung SS, Rao V, Ford RW. Updated trends in percutaneous renal arteriography among radiologists and other specialties. Clin Imaging 2023; 102:14-18. [PMID: 37453303 DOI: 10.1016/j.clinimag.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 06/10/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Prior studies have demonstrated an overall decline in percutaneous renal artery angioplasty with and without stenting from 1988 to 2009. We evaluated the recent utilization trends in percutaneous renal arteriography (PTRA) among radiologists and non-radiologist providers from 2010 to 2018. METHODS Data from the 2010-2018 nationwide Medicare Part B fee-for-service database were used to tabulate case volumes for PTRA. Annual utilization rates per 10,000 Medicare beneficiaries were calculated and aggregated based on physician specialty: radiologists, cardiologists, vascular surgeons, general surgeons, or others. RESULTS From 2010 to 2018, the overall utilization rate of PTRA markedly declined (-72% change; from 15.5 to 4.3 cases per 10,000 Medicare beneficiaries). Proportionally, the cardiologist share of PTRA saw the greatest decline, falling from 74% market share in 2010 (11.4/15.5 cases) to only 36% market share in 2018 (1.6/4.3 cases). The market share of PTRA performed by radiologists grew from 12% market share in 2010 (1.9/15.5 cases) to 28% in 2018 (1.2/4.3 cases); despite this, the absolute number of PTRA performed by radiologists saw a smaller decline over this period (-34%; 1.9 to 1.2 cases). CONCLUSION The total utilization rates of PTRA in the Medicare population has continued to decline from 2010 to 2018, likely due to clinical trials suggesting limited efficacy of angioplasty and stenting in the treatment of renovascular hypertension and other factors such as declining reimbursement. The overall and per-specialty rates continue to decline, reflecting an overarching trend away from procedural management of renovascular hypertension.
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Affiliation(s)
- Philip Lee
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Russell A Reeves
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America
| | - Patrick Lee
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Stephan S Leung
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Vijay Rao
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Robert W Ford
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
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7
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Kincaid CM, Horton L, Mesinkovska NA, Lee P. Trends in Medicare claims and costs for field therapies by dermatologists. J Am Acad Dermatol 2023; 89:810-811. [PMID: 37269924 DOI: 10.1016/j.jaad.2023.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Colin M Kincaid
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Luke Horton
- Department of Dermatology, University of California, Irvine, Irvine, California
| | | | - Patrick Lee
- Department of Dermatology, University of California, Irvine, Irvine, California
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8
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Siva S, Wallace N, Hardcastle N, Kothari G, Crombag L, Rangamuwa K, Annema J, Lee P, Dieleman EM, Jennings B, Yo S, Nguyen P, Bashirzadeh F, Fielding D, Yasufuku K, Ost D, Irving L, Steinfort D. Dosimetric Impact of Systematic Mediastinal Staging via Endobronchial Ultrasound for Patients with Locally Advanced Lung Cancer: The SEISMIC Trial. Int J Radiat Oncol Biol Phys 2023; 117:S29. [PMID: 37784468 DOI: 10.1016/j.ijrobp.2023.06.290] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The SEISMIC trial aims to find the best method for mediastinal staging in patients with lung cancer receiving chemoradiotherapy. Currently, CT or PET-CT scans are standard in clinical practice, but histological evaluation of the mediastinum is performed on a case-by-case basis. The study will examine the effect of systematic histological evaluation using Endobronchial Ultrasound (EBUS) on radiotherapy target volumes. The hypothesis of this study is that differences in staging between the diagnostic PET-CT and EBUS would result in reduced tumor coverage and/or increased doses to organs at risk (OAR). MATERIALS/METHODS SEISMIC is a prospective multicenter international cohort study. Patients were enrolled from Australia, the Netherlands, USA and Canada after regional IRB approvals. Patients were treated with 4DCT simulation. Two iGTV and PTV target volumes were delineated for each patient with discordant staging according to both PET-CT and EBUS, as were OARs. Two VMAT plans were generated for each patient based on either PET-CT or EBUS target volumes using knowledge-based planning methodology. Plans aimed to achieve institutional guidelines for target coverage and OAR dose constraints, with a prescribed dose of 60 Gy in 30 fractions. Target coverage and OAR doses for the PET- and EBUS-defined volumes were compared. RESULTS In 156 patients, EBUS showed a larger extent of disease than PET in 18 (11.5%) and a smaller extent of lymph node (LN) involvement than PET in 49 (31.4%). Out of 67 patients with PET-EBUS discordant results, 25 underwent upfront radiotherapy and were included in the study. EBUS revealed PET-occult LN involvement in 11/25 patients (44%). In these patients, 10/11 patients received <95% of the prescribed dose to PET-occult LN iGTVs; the median [range] minimum dose to the EBUS iGTV was 9.2 Gy [0.1 - 57.9 Gy]. When planning based on EBUS LN involvement, all patients received ≥95% of the prescribed dose to the iGTV (the median [range] minimum dose to the EBUS iGTV was 58.9 Gy [58.1 - 60.5 Gy]). This resulted in increased median [range] doses to OARs; mean lung dose increased by 1.1 Gy [0.3 - 8.4 Gy], esophagus mean dose increased by 3.6 Gy [0.2 - 24.8 Gy], and mean heart dose increased by 0.5 Gy [-0.6 - 8.5 Gy]. CONCLUSION Systematic endoscopic evaluation of the mediastinum had a significant effect on tumor coverage in a clinically meaningful proportion of cases and consequent plan adaptation impacted on organ-at-risk (OAR) doses. Results suggest systematic mediastinal LN staging should be considered in all patients prior to curative-intent radiotherapy. CLINICAL TRIAL ID ACTRN12617000333314.
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Affiliation(s)
- S Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - N Wallace
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - N Hardcastle
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - G Kothari
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - L Crombag
- Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
| | - K Rangamuwa
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J Annema
- Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
| | - P Lee
- MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - E M Dieleman
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, Netherlands
| | - B Jennings
- Department of Lung and Sleep, Monash Health, Melbourne, VIC, Australia
| | - S Yo
- Department of Lung and Sleep, Monash Health, Melbourne, VIC, Australia
| | - P Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, VIC, Australia
| | - F Bashirzadeh
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - D Fielding
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, VIC, Australia
| | - K Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - D Ost
- MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - L Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - D Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
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9
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Lee P, Ayub M, Meyer JE, Price JG. Pre-Treatment Trends in Child-Pugh Score as an Indicator of Post-Treatment Survival in Patients Receiving Liver SBRT for HCC. Int J Radiat Oncol Biol Phys 2023; 117:e313. [PMID: 37785128 DOI: 10.1016/j.ijrobp.2023.06.2342] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We sought to understand the value of Child-Pugh (CP) score trends prior to undergoing stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma in patients with advanced cirrhosis, as an indicator of post-treatment morbidity and mortality. We hypothesize that an uptrend in CP score prior to RT increases risk of post-treatment cirrhosis progression, or death. MATERIALS/METHODS We retrospectively reviewed all patients who underwent definitive SBRT for HCC between 2014-2022 in our health system. Most patients were referred for treatment in the 2nd or 3rd line setting, allowing us to determine CP score at multiple points before SBRT. Response to treatment was evaluated with RECIST or mRECIST criteria. Acute treatment toxicities were assessed by CTCAE v5. OS was assessed using the Kaplan-Meier method, and differences between groups were evaluated using log-rank test. RESULTS A total of 61 patients were identified, 26 had an immediate pre-SBRT CP score of A5, 11 with A6, 10 with B7, 4 with B8, 4 with B9, 5 with C10, and 1 with C11. Median prescribed dose was 40Gy in 5fx. Median OS of all patients was 24 months. When stratified by CP category, median OS for CP A was not reached (NR) at time of analysis, CP B had a median OS of 14.8mo, and CP C with 1.9mo (p < 0.01). Local control rate at 6mo was 87.5%. 5 patients (8.3%) had CTCAE grade 2 acute toxicity. 10 patients had CP score progression of 2pts or more within 6mo after treatment, and 7 patients had a cause of death attributed to end stage liver disease. Median time interval between HCC diagnosis and start of RT was 338 days. In this time interval, patients with a CP score increase of 2 pts or more prior to starting RT had a median OS of 362 days, compared to NR for patients without increase (p = 0.02). When excluding the CP A group, patients with 2 pt increase had median OS of 362 days vs 445 days (p = 0.34). Again excluding the CP A group, patients with a 1 pt increase had median OS of 362 days vs NR (p = 0.23). Of 9 patients who had a pre-RT CP score increase of 2 pts or more, 7 experienced continued CP progression after treatment. CONCLUSION In this multi-institutional retrospective analysis, we found 24 patients with advanced CP B/C cirrhosis who underwent SBRT, none of whom received orthotopic liver transplant. While CP C patients did relatively poorly, we find that some patients with CP B cirrhosis may tolerate SBRT well with good oncologic effect. When taking pre-treatment CP score increase into consideration, we saw a trend but no statistical significance indicating that a pre-SBRT increase in CP score may be associated with worse OS after treatment among CP B/C patients. We conclude that there may be a subset of patients with advanced cirrhosis who, if well selected, are appropriate candidates for SBRT. We suggest a novel use of the CP score and pre-RT trends as an additional clinical tool to aid in decision making when selecting patients. We also suggest that patients with marked up-trending scores pre-treatment have a high likelihood of continued cirrhosis progression after treatment.
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Affiliation(s)
- P Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - M Ayub
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - J E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - J G Price
- Fox Chase Cancer Center at Temple University Hospital, Philadelphia, PA
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10
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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11
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McIver KG, Lee P, Bucherl S, Talavage TM, Myer GD, Nauman EA. Design Considerations for the Attenuation of Translational and Rotational Accelerations in American Football Helmets. J Biomech Eng 2023; 145:061008. [PMID: 36628996 PMCID: PMC10782865 DOI: 10.1115/1.4056653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
Participants in American football experience repetitive head impacts that induce negative changes in neurocognitive function over the course of a single season. This study aimed to quantify the transfer function connecting the force input to the measured output acceleration of the helmet system to provide a comparison of the impact attenuation of various modern American football helmets. Impact mitigation varied considerably between helmet models and with location for each helmet model. The current data indicate that helmet mass is a key variable driving force attenuation, however flexible helmet shells, helmet shell cutouts, and more compliant padding can improve energy absorption.
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Affiliation(s)
- Kevin G. McIver
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Patrick Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Sean Bucherl
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Thomas M. Talavage
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907
| | - Gregory D. Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA 30542; Emory Sports Medicine Center, Atlanta, GA 30329; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30329; The Micheli Center for Sports Injury Prevention, Waltham, MA 02452
| | - Eric A. Nauman
- Dane A. and Mary Louise Miller Professor Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45221
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12
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Lee P, Tahmasebi A, Dave JK, Parekh MR, Kumaran M, Wang S, Eisenbrey JR, Donuru A. Comparison of Gray-scale Inversion to Improve Detection of Pulmonary Nodules on Chest X-rays Between Radiologists and a Deep Convolutional Neural Network. Curr Probl Diagn Radiol 2023; 52:180-186. [PMID: 36470698 DOI: 10.1067/j.cpradiol.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/08/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Detection of pulmonary nodules on chest x-rays is an important task for radiologists. Previous studies have shown improved detection rates using gray-scale inversion. The purpose of our study was to compare the efficacy of gray-scale inversion in improving the detection of pulmonary nodules on chest x-rays for radiologists and machine learning models (ML). We created a mixed dataset consisting of 60, 2-view (posteroanterior view - PA and lateral view) chest x-rays with computed tomography confirmed nodule(s) and 62 normal chest x-rays. Twenty percent of the cases were separated for a testing dataset (24 total images). Data augmentation through mirroring and transfer learning was used for the remaining cases (784 total images) for supervised training of 4 ML models (grayscale PA, grayscale lateral, gray-scale inversion PA, and gray-scale inversion lateral) on Google's cloud-based AutoML platform. Three cardiothoracic radiologists analyzed the complete 2-view dataset (n=120) and, for comparison to the ML, the single-view testing subsets (12 images each). Gray-scale inversion (area under the curve (AUC) 0.80, 95% confidence interval (CI) 0.75-0.85) did not improve diagnostic performance for radiologists compared to grayscale (AUC 0.84, 95% CI 0.79-0.88). Gray-scale inversion also did not improve diagnostic performance for the ML. The ML did demonstrate higher sensitivity and negative predictive value for grayscale PA (72.7% and 75.0%), grayscale lateral (63.6% and 66.6%), and gray-scale inversion lateral views (72.7% and 76.9%), comparing favorably to the radiologists (63.9% and 72.3%, 27.8% and 58.3%, 19.5% and 50.5% respectively). In the limited testing dataset, the ML did demonstrate higher sensitivity and negative predictive value for grayscale PA (72.7% and 75.0%), grayscale lateral (63.6% and 66.6%), and gray-scale inversion lateral views (72.7% and 76.9%), comparing favorably to the radiologists (63.9% and 72.3%, 27.8% and 58.3%, 19.5% and 50.5%, respectively). Further investigation of other post-processing algorithms to improve diagnostic performance of ML is warranted.
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Affiliation(s)
- Patrick Lee
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Aylin Tahmasebi
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Maansi R Parekh
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Maruti Kumaran
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Shuo Wang
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.
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13
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Chen MF, Richards A, Evans P, Lee P, Price A, Repetto M, Yang SR, Chang J, Brannon R, Rosen E, Brown D, Rudin C, Raj N, Kris MG, Reis-Filho J, Donoghue M, Drilon AE, Choudhury NJ. Abstract 1394: Comprehensive clinical and genomic analysis for patients with MYC, MYCN, and MYCL amplified solid tumors. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1394] [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: 04/07/2023]
Abstract
Abstract
Introduction: The MYC gene family (MYCf), which includes MYC, MYCN, and MYCL, is deregulated in ~70% of cancers and is associated with treatment resistance. Whereas older investigational therapies for MYC amplified tumors were unsuccessful, promising novel targeted therapies are in early phase clinical trials. Unfortunately, it remains unclear how to select patients whose cancers may harbor true MYC addiction. We thus sought to characterize factors such as amplification level, focality, and clonality that may correlate with increased MYC dependence.
Methods: Utilizing a center-wide next generation sequencing (NGS) program of >71,000 sequenced patients, genomic and clinical data from pediatric and adult patients with MYC, MYCN, and MYCL amplifications were identified between 2014 and 2022. Patients were characterized as harboring MYC, MYCN, and MYCL amplification based on a read-depth methodology using a DNA-based hybrid-capture NGS (MSK-IMPACT) and Fraction and Allele-Specific Copy Number Estimates from the Tumor Sequencing (FACETS). All cases underwent clinical data curation including baseline demographic, tumor characteristics, and treatment histories.
Results: We identified 3911 cancers with MYCf amplification (n=3257 (82%) MYC; n=364 (9%) MYCL; n=330 (8%) MYCN) across 40 malignancies, for an overall 5.5% incidence. The most frequent tumor types with MYCf amplification were breast (22%), non-small cell lung (NSCLC) (11%), colorectal (8%), ovarian (8%), prostate (7%), brain (5%), and small cell lung cancers (SCLC) (2%). Cancers with MYC amplification had longer segment lengths than MYCL and MYCN amplification, which appeared more focal (median = 19, 4.3 and 4.5 MB, respectively, p < 0.001). MYCN amplified cancers had higher total copy number than MYC and MYCL amplified cancers (median = 19, 8, 9, respectively, p < 0.001). MYC, MYCN, and MYCL samples were predominantly clonal (median clonal fraction > 99% for all genes). Most NSCLC, squamous cell lung cancers, and pulmonary carcinoids had MYC amplifications (93%, 70%, and 67% respectively). Conversely, SCLCs most often had MYCL amplifications (49%). No concurrent targetable driver alterations were found in 33% of metastatic NSCLCs with MYC, 75% of MYCN, and 6% of MYCL amplifications.
Conclusions: While MYCf amplification is observed across a broad range of cancer types, factors such as gene type (MYC, MYCN, MYCL), focality, total copy number, clonality, and concurrent oncogenic drivers vary widely. Novel MYC-directed trials may consider enrichment for a subpopulation of cancers with higher-level, focal, and clonal MYCf amplifications without concurrent other drivers.
Citation Format: Monica F. Chen, Allison Richards, Patrick Evans, Patrick Lee, Adam Price, Matteo Repetto, Soo Ryum Yang, Jason Chang, Rose Brannon, Ezra Rosen, David Brown, Charles Rudin, Nitya Raj, Mark G. Kris, Jorge Reis-Filho, Mark Donoghue, Alexander E. Drilon, Noura J. Choudhury. Comprehensive clinical and genomic analysis for patients with MYC, MYCN, and MYCL amplified solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1394.
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Affiliation(s)
| | | | - Patrick Evans
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patrick Lee
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adam Price
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Soo Ryum Yang
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jason Chang
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rose Brannon
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ezra Rosen
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Brown
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles Rudin
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nitya Raj
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark G. Kris
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mark Donoghue
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Brock J, Sale A, Jayaraju U, Chandetreya A, Lee P. A cost-consequence analysis of eLearning videos designed to supplement the consent process in lower limb arthroplasty. Ann R Coll Surg Engl 2023; 105:278-282. [PMID: 36260293 PMCID: PMC9974341 DOI: 10.1308/rcsann.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Since the Montgomery ruling in 2015 surgeons have been tasked with identifying material risk when taking informed consent. Despite this, there has been limited uptake of technological aids to supplement the consent process although such aids are shown to improve patient knowledge and satisfaction. ConsentPLUS is a free-to-access website with bite-sized educational videos designed to clearly explain lower limb arthroplasty procedures to patients and aid their consent. METHODS The authors performed a prospective cost-consequence analysis, outlining any costs associated with the intervention and any quantitative or qualitative impacts the intervention may have on patients. RESULTS A total of 3,143 consecutive patients were identified who were undergoing total knee or hip replacement in 25 elective NHS orthopaedic units. The total cost of development and projected 10-year running fees for ConsentPLUS total £75,000. Health Foundation support means the service is free-to-access for centres throughout the UK. Mean exposure time per patient was 10min 29s, equivalent to £185,437 of additional contact time according to the National Tariff. Mean clinic time was reduced by 17min owing to the earlier identification of material risk. Patient knowledge on pre- and post-video quizzes increased from 7.01 to 9.08 following eLearning (paired t-test = 0.998). The process had an overall satisfaction rate of 97%. CONCLUSION Educational eLearning videos are an accessible and digestible way to supplement the consent process. This enables earlier identification of material risk in clinics owing to improved patient knowledge, leading to increased patient satisfaction with arthroplasty consenting.
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Affiliation(s)
| | | | | | | | - P Lee
- Cwm Taf Morgannwg University Health Board, UK
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15
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Lee P, Sun G, Lee P, Brittingham C, Shaw C. Abstract No. 553 Outcomes of Percutaneous Ablation of Synchronous and Metachronous Small Renal Masses (SRM). J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Abstract
Chimeric Antigen Receptor (CAR) T-cell therapy is a promising treatment option for patients suffering from B-cell- and plasma cell-derived hematologic malignancies and is being adapted for the treatment of solid cancers. However, CAR T is associated with frequently severe toxicities such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), macrophage activation syndrome (MAS), and prolonged cytopenias-a reduction in the number of mature blood cells of one or more lineage. Although we understand some drivers of these toxicities, their mechanisms remain under investigation. Since the CAR T regimen is a complex, multi-step process with frequent adverse events, ways to improve the benefit-to-risk ratio are needed. In this review, we discuss a variety of potential solutions being investigated to address the limitations of CAR T. First, we discuss the incidence and characteristics of CAR T-related cytopenias and their association with reduced CAR T-cell efficacy. We review approaches to managing or mitigating cytopenias during the CAR T regimen-including the use of growth factors, allogeneic rescue, autologous hematopoietic stem cell infusion, and alternative conditioning regimens. Finally, we introduce novel methods to improve CAR T-cell-infusion products and the implications of CAR T and clonal hematopoiesis.
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Affiliation(s)
- Bryanna Reinhardt
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Patrick Lee
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joshua P. Sasine
- Department of Medicine, Division of Hematology and Cellular Therapy, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Hochster HS, Liu H, Berim LD, Spencer KR, Gulhati P, DiRubbo M, Cohen SD, Lee P, Leitner SP, Radovich D, Misdary C, Perez C, Datta S, Gonzalez A, Saunders T, Boland PM. Phase II study of TAS-OX (TAS-102 and oxaliplatin) plus bevacizumab for late-line colorectal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.144] [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: 01/26/2023] Open
Abstract
144 Background: TAS-102 (trifluridine/tipiracil) is a novel oral antimetabolite for late line metastatic colorectal cancer (CRC) approved in 2018. Many patients are treated early in their course with oxaliplatin (OX), particularly adjuvant, and may benefit from re-treatment. In this trial we combine the typical late line use of TAS with OX (BEV [bevacizumab] added at investigator discretion) with goal of improved response. Methods: Eligibility included measurable CRC previously treated with all approved drugs per TAS package insert (irinotecan, oxaliplatin, 5FU, anti-VEGF, anti-EGF) as appropriate, PS = 0-1, labs within usual range, neuropathy < grade 2, ability to take oral meds, appropriate contraception. If no contraindication to BEV, this could be added at patient. TAS was dosed at 35 mg/m2 days 1-5 with OX 85/m2 d1 every 14 days (and BEV 5 mg/kg, if given). All supportive care was allowed including growth factors. Results: 47 patients (pts, median age 55) were enrolled in a Simon mini-max design, including 45% female, 21% black, 11% Asian, 11% Hispanic and 5% mixed. 26 pts received BEV. For the first 40 pts, 385 cycles were given (mean = 7 cycles, median 8) with 18 pts (45%) requiring dose reductions (1 dose reduction = 9 pts, 2 = 6, 3 = 3), and 9 receiving (peg)/filgrastim. Toxicities leading to SAEs included gr 3 heme (2), heart failure, abd pain/n/v (6), sepsis (2), urinary (4); and related gr 3 included one gr 3 vomiting and one gr 3 neutropenia. Independently reviewed RECIST Response (N = 32) included PR 2(6%), SD 23 (72%), PD 7 (22%). Mean TTP was 4.5 m (median 4, range 1 – 18) with 9 (28%) pts more than 6 months. Conclusions: In patients with late-line CRC and candidates for TAS (trifluridine/tipiracil), treatment with TAS plus OX is both well tolerated and active. RR is higher than single agent and 78% (95% CI, 60-91%) of patients had stable disease or response, with 60% receiving 8 or more cycles. Randomized trials comparing to single agent TAS are warranted in this setting. Clinical trial information: NCT04294264 .
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Affiliation(s)
| | - Hao Liu
- Biostatistics Shared Resource, Rutgers Cancer Institute of New Jersey, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ
| | | | | | - Pat Gulhati
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Manda DiRubbo
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | | | | | | | - Sutirtha Datta
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Combes A, March B, Mccarthy A, Austin K, Lee P, Solomon M, Eisinger D, Jeffery N. Ureteric reconstruction during posterior or lateral pelvic exenteration for locally advanced and recurrent malignancy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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19
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Lee P, Kurscheid JM, Laksono B, Park MJ, Clements ACA, Lowe C, Stewart DE, Gray DJ. Model validation for a knowledge and practices survey towards prevention of soil-transmitted helminth infections in rural villages in Indonesia. Sci Rep 2023; 13:1444. [PMID: 36697451 PMCID: PMC9876981 DOI: 10.1038/s41598-023-27781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
The rate of soil-transmitted helminth (STH) infection is estimated to be around 20% in Indonesia. Health promotion and health education are cost-effective strategies to supplement STH prevention and control programs. Existing studies suggest that quantitative tools for knowledge, attitudes and practices (KAP) are important to monitor effective community-based STH interventions. However, evidence is limited regarding the applicability of such tools. This study aims to identify the socio-demographic predictors for STH-related knowledge and practices and validate the quantitative tools in population use. A cross-sectional study design was conducted among residents of 16 villages in Central Java, Indonesia. Adult and child respondents were interviewed to assess general knowledge and practices in relation to STH. Two mixed effects models identified the significant factors in predicting knowledge and practice scores. The model predicted knowledge and practice scores were compared with the observed scores to validate the quantitative measurements developed in this study. Participants' socio-demographic variables were significant in predicting an individual's STH-related knowledge level and their hand washing and hygiene practices, taking into account household-level variability. Model validation results confirmed that the quantitative measurement tools were suitable for assessing STH associated knowledge and behaviour. The questionnaire developed in this study can be used to support school- and community-based health education interventions to maximize the effect of STH prevention and control programs.
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Affiliation(s)
- P Lee
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - J M Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Health Systems Support Unit, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland
| | - B Laksono
- Faculty of Medicine, Universitas Diponegoro, Semarang, 50275, Indonesia
| | - M J Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea
| | - A C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - C Lowe
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.
| | - D E Stewart
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - D J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
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Mendoza-Cedeno S, Embabi M, Chang E, Kweon MS, Shivokhin M, Pehlert G, Lee P. Influence of molecular weight on high- and low-expansion foam injection molding using linear polypropylene. POLYMER 2022. [DOI: 10.1016/j.polymer.2022.125611] [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: 12/23/2022]
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Parikh P, Lee P, Low D, Kim J, Mittauer K, Bassetti M, Glide-Hurst C, Raldow A, Yang Y, Portelance L, Zaki B, Kim H, Mancias J, Ng J, Pfeffer R, Mueller A, Kelly P, Boldrini L, Fuss M, Chuong M. Stereotactic MR-Guided On-Table Adaptive Radiation Therapy (SMART) for Patients with Borderline or Locally Advanced Pancreatic Cancer: Primary Endpoint Outcomes of a Prospective Phase II Multi-Center International Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Weng J, Dabaja B, Das P, Gunn G, Chronowski G, Bloom E, Lee P, Koong A, Ning M, Semien K, Sanders C, Ritchey R, Nguyen K, Hoffman K, Robinson I, Kerr A, Brokaw J, Liao Z, Nguyen Q. Radiation Therapy Decision Making Process and Operations for COVID-19 Positive Patients. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595469 DOI: 10.1016/j.ijrobp.2022.07.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose/Objective(s) A challenging clinical dilemma during the COVID-19 pandemic is management of cancer patients who test positive for COVID. Given the need to balance the risk of disease progression with the risk of transmission to other patients and staff, radiation therapy for these patients requires careful consideration and modification of standard workflows. It is also critical to develop processes to mitigate radiation treatment interruption, which can affect patient outcomes. The objective of this study was to report the clinical operations and outcomes for COVID positive patients receiving radiation therapy during the pandemic at a tertiary cancer center including 2 network locations. Materials/Methods During March 2020 to March 2022, the Radiation Oncology COVID committee (RO COVID) developed an integrated process to triage patients, provide treatment recommendations, and implement infection control procedures to safely deliver radiation therapy to COVID positive patients. Policies were created for each center with multidisciplinary input from infectious disease, radiation oncology, radiation therapy, and nursing. All COVID positive patients were presented to the RO COVID group and evaluated for clinical urgency, benefit with radiation, and life expectancy. If deemed necessary, a limited planned break or hypofractionated regimen was recommended to minimize staff exposure. We conducted a retrospective review of COVID positive patients with different primary malignancies treated through the COVID positive pathway. Results A total of 68 COVID positive patients were treated with the COVID positive pathway (HN 15, Breast 9, CNS 8, GU 8, GYN, 7, Thoracic 6, GI 5, HEME 5, PED 3, SARC 2). The median age was 57.1 years (IQR 45.8-63.4) and 47% were female. There were 39 patients (57%) who were asymptomatic and were tested for routine pre-radiation screening or due to concerns of COVID exposure. Twenty-three (34%) patients were treated with palliative intent and 8 (12%) were treated for an emergent indication (i.e., spinal cord compression, bleeding). Thirteen (19%) patients were receiving radiation treatment, had a treatment break (7-21 days), and then resumed their radiation course. All treatments were successfully completed without known nosocomial spread of COVID to staff or other patients. Among this heterogenous group of patients, 58 (85%) were alive with a median follow up of 2 months (IQR 0.5-7.5). COVID infection may have contributed to 3 out of 10 deaths (4% of total cohort). The remaining deaths were due to progression of disease or other non-COVID causes. Conclusion In this study, COVID positive patients were safely treated with radiation therapy through a comprehensive decision making and clinical operations pathway taking into account evolving COVID guidelines for three different variant surges. Although limited in follow up, patient outcomes are promising with few COVID-related deaths and low overall mortality rates, even with hypofractionated regimens.
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Affiliation(s)
- J. Weng
- MD Anderson Cancer Center, Houston, TX,Corresponding author:
| | - B. Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G.B. Gunn
- MD Anderson Cancer Center, Houston, TX
| | - G.M. Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - P. Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A.C. Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M.S. Ning
- MD Anderson Cancer Center, Houston, TX
| | - K. Semien
- MD Anderson Cancer Center, Houston, TX
| | | | | | - K. Nguyen
- MD Anderson Cancer Center, Houston, TX
| | - K.E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I. Robinson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A. Kerr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Brokaw
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Z. Liao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Q.N. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ma T, Philipson R, Kishan A, Lee P, Raldow A. Web-Based Symptom Monitoring with Patient-Reported Outcomes during Definitive Radiation Therapy with Chemotherapy (SYMPATHY): A Prospective Single-Center Phase I Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.959] [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: 11/16/2022]
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Ridge N, Newman N, Barsoumian H, Hong D, Bertolet G, Comeaux N, Chang J, Lee P, Shah S, Welsh J. FDG PET SUV as a Biomarker of Abscopal and Low-Dose Radiation Responses in Checkpoint Inhibitor Resistant Tumors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Voruganti I, Cunningham C, McLeod L, Chaudhuri N, Chua K, Evison M, Faivre-Finn C, Franks K, Harden S, Kruser J, Kruser T, Lee P, Peedell C, Phillips I, Robinson C, Senan S, Videtic G, Wright A, Harrow S, Louie A. Final Results of an International Delphi Consensus Study Regarding the Optimal Management of Radiation Pneumonitis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Odwuor A, Lee P, Chang J, Liao Z, Gandhi S, Jeter M, Lin S, Chen A, Welsh J, Nguyen Q, O'Reilly M, Chun S, Ning M. Outcomes and Toxicity Following Three or More Definitive Courses of Thoracic Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lee P, Burbure N, Deng M, Handorf E, Kumar S. Increasing Radiation Dose in the Setting of Treatment Prolongation for Stage III Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ridge N, Newman N, Comeaux N, Bertolet G, Barsoumian H, Hong D, Chang J, Lee P, Shah S, Welsh J. Predictors of Response to Salvage High-Dose plus Low-Dose Radiation in Checkpoint-Inhibitor Resistant Patients. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Odwuor A, Lee P, Chang J, Liao Z, Gandhi S, Jeter M, Lin S, Chen A, Welsh J, Nguyen Q, O'Reilly M, Chun S, Ning M. Salvage Re-Irradiation with Proton Beam Therapy for New or Locoregionally Recurrent Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liu Y, Zhang Z, Rinsurongkawong W, Gay C, Lewis J, Rinsurongkawong V, Lee J, Lee P, Zhang J, Gibbons D, Vaporciyan A, Heymach J, Lin S. Patterns of Failure by Driver Mutation Status for Patients with Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiation and Consolidative Durvalumab. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ridge N, Newman N, Bertolet G, Barsoumian H, Comeaux N, Hong D, Chang J, Lee P, Shah S, Welsh J. Predictors of Systemic Responses Induced by Salvage Radiation after Progression on Immunotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1627] [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: 11/16/2022]
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Kim K, Lee K, Jung J, Choi I, Lee J, Lee J, Lee S, Lee P, Lee S, Yoo K, Yun K, Lee H, Her S. Clinical outcomes of percutaneous coronary intervention and rotational atherectomy using second generation drug eluting stents: a Korean multicentre analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1258] [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: 11/14/2022] Open
Abstract
Abstract
Background
The aim of this study was to compare the clinical outcomes of different second generation drug-eluting stents (DES) in patients with calcified coronary lesions who underwent percutaneous coronary intervention using rotational atherectomy.
Methods
This study was based on a multicentre registry which enrolled patients with calcified coronary artery disease who received RA during between January 2010 and October 2019 from 9 tertiary centres in Korea. The primary outcome was target-vessel failure (TVF), defined as the compositae of cardiac death, target-vessel myocardial infarction (MI), and target-vessel revascularisation (TVR). The secondary outcomes were all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.
Results
540 patients who underwent PCI after RA were enrolled and followed up for a median period of 16.1 months. From this registry, 439 patients who were treated using second generation DES were selected for further analysis. They were divided into four groups based on the characteristics of the stents used during the procedure. [Group I cobalt-chromium sirolimus eluting stent (CoCr-SES): Ultimaster 48 & Orsiro 30, Group II platinum-chromium everolimus eluting stent (PtCr-EES): Synergy 93 & Promus 70, Group III cobalt-chromium everolimus eluting stent (CoCr-EES): Xience 105, Group IV zotarolimus eluting stent (ZES): Resolute 93] There was no inter-group difference in procedural success rates, and the primary outcome of TVF showed no difference across the four groups (I: 10.3%, II: 13.5%, III: 13.3%, IV: 15.1%, log-rank p=0.922). Even after multivariate Cox regression analysis, there was no significant difference in TVF, or the secondary outcomes of all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.
Conclusions
There was no difference in procedural success rates and clinical outcomes between four different types of second-generation DES (CoCr-SES, PtCr-EES, CoCr-EES, ZES) in patients who underwent PCI using RA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kim
- Seoul St. Mary's Hospital , Seoul , Korea (Republic of)
| | - K Lee
- Daejeon St. Mary's Hospital , Daejeon , Korea (Republic of)
| | - J Jung
- Korea Institute of Toxicology , Daejeon , Korea (Republic of)
| | - I Choi
- St.Marys Hospital , Incheon , Korea (Republic of)
| | - J Lee
- Chungnam National University Hospital , Daejeon , Korea (Republic of)
| | - J Lee
- Kyungpook National University Hospital , Daegu , Korea (Republic of)
| | - S Lee
- Chonbuk National University Hospital , Jeonju , Korea (Republic of)
| | - P Lee
- Asan Medical Center , Seoul , Korea (Republic of)
| | - S Lee
- Asan Medical Center , Seoul , Korea (Republic of)
| | - K Yoo
- St. Vincent's Hospital , Suwon , Korea (Republic of)
| | - K Yun
- Wonkwang University Hospital , Iksan , Korea (Republic of)
| | - H Lee
- Sejong General Hospital , Bucheon , Korea (Republic of)
| | - S Her
- St. Vincent's Hospital , Suwon , Korea (Republic of)
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Berrian KM, Lee P, Issack PS. Simultaneous Displaced Anterior and Posterior Cruciate Ligament Avulsion Fractures After Fall From a Bicycle: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00047. [PMID: 36480652 DOI: 10.2106/jbjs.cc.22.00620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022]
Abstract
CASE We present the case of a 31-year-old man who sustained simultaneous displaced anterior and posterior cruciate ligament (PCL) tibial avulsion fractures after falling from a bicycle. CONCLUSION Combined avulsion fractures of the anterior and PCLs is an extremely unusual event and has rarely been reported. The displaced fragments pulled proximally by their respective cruciate ligaments required open reduction and internal fixation to prevent impingement and instability. The patient had excellent clinical and radiographic results after open reduction internal fixation of both fractures.
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Affiliation(s)
- Kaitlyn M Berrian
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
| | - Patrick Lee
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York
| | - Paul S Issack
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, New York.,Department of Trauma, Richmond University Medical Center, Staten Island, New York
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35
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Moyer JD, Lee P, Bernard C, Henry L, Lang E, Cook F, Planquart F, Boutonnet M, Harrois A, Gauss T. Machine learning-based prediction of emergency neurosurgery within 24 h after moderate to severe traumatic brain injury. World J Emerg Surg 2022; 17:42. [PMID: 35922831 PMCID: PMC9351267 DOI: 10.1186/s13017-022-00449-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Machine Learning-based models to establish to predict the need for neurosurgery procedure within 24 h after moderate to severe TBI. Methods Retrospective multicenter cohort study using data from a national trauma registry (Traumabase®) from November 2011 to December 2020. Inclusion criteria correspond to patients over 18 years old with moderate or severe TBI (Glasgow coma score ≤ 12) during prehospital assessment. Patients who died within the first 24 h after hospital admission and secondary transfers were excluded. The population was divided into a train set (80% of patients) and a test set (20% of patients). Several approaches were used to define the best prognostic model (linear nearest neighbor or ensemble model). The Shapley Value was used to identify the most relevant pre-hospital variables for prediction. Results 2159 patients were included in the study. 914 patients (42%) required neurosurgical intervention within 24 h. The population was predominantly male (77%), young (median age 35 years [IQR 24–52]) with severe head injury (median GCS 6 [3–9]). Based on the evaluation of the predictive model on the test set, the logistic regression model had an AUC of 0.76. The best predictive model was obtained with the CatBoost technique (AUC 0.81). According to the Shapley values method, the most predictive variables in the CatBoost were a low initial Glasgow coma score, the regression of pupillary abnormality after osmotherapy, a high blood pressure and a low heart rate. Conclusion Machine learning-based models could predict the need for emergency neurosurgery within 24 h after moderate and severe head injury. Potential clinical benefits of such models as a decision-making tool deserve further assessment. The performance in real-life setting and the impact on clinical decision-making of the model requires workflow integration and prospective assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00449-5.
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Affiliation(s)
- Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| | - Patrick Lee
- Capgemini Invent, Insight Driven Enterprise, Focused on Data and Artificial Intelligence Services, Paris, France
| | - Charles Bernard
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Lois Henry
- Department of Anesthesiology and Critical Care, Lille, France
| | - Elodie Lang
- Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabrice Cook
- Department of Anesthesiology and Critical Care, Hôpital Henri Mondor, Créteil, France
| | - Fanny Planquart
- Department of Anesthesiology and Critical Care, Strasbourg, France
| | - Mathieu Boutonnet
- Intensive Care Unit, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France.,Val de Grace Academy, Place Alphonse Laveran, 75005, Paris, France
| | - Anatole Harrois
- Department of Anesthesiology and Critical Care, APH-HP, Bicêtre Hôpitaux Universitaires Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Tobias Gauss
- Déchocage- Bloc des urgences, Pole Anesthésie- Réanimation, CHU Grenoble Alpes, La Tronche, France
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Saeedi Saravi S, Karsai G, Lee P, Beer J. Acetate reverses the gut microbiota metabolite phenylacetyl glutamine (PAG)-induced endothelial senescence by epigenetic and SASP modulation. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee P, Blais EM, Gong J, Osipov A, Moshayedi N, Thomassian S, Ng C, Chuy JW, Matrisian LM, Petricoin E, Pishvaian MJ, Hendifar AE. Genomic correlates of response to capecitabine and temozolomide (CAPTEM) in pancreatic neuroendocrine tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4124] [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: 11/20/2022] Open
Abstract
4124 Background: Despite the frequent use of capecitabine and temozolomide (CAPTEM) to treat metastatic, well-differentiated pancreatic neuroendocrine tumors (PNETs), no reliable genomic predictors of response currently exist. PNETs commonly harbor mutations in MEN1, ATRX, DAXX, and the PI3K/AKT/mTOR pathway. We sought to determine whether the mutational status of these genes correlates with response to CAPTEM. Methods: A retrospective cohort of PNET cases seen at Cedars-Sinai Medical Center or from Perthera’s Real-World Evidence Database included 23 patients who were treated with CAPTEM in 1st or 2nd line and had targeted next-generation sequencing (NGS) of their tumors available. Genomic alterations were correlated with progression-free survival (PFS) using multivariate Cox regression analysis. Results: We analyzed 23 PNET patients, 4 (17.4%) of whom had documented functional tumors. We identified MEN1 mutations as positively associated with CAPTEM response, but this effect was less pronounced for the subset with co-occurring DAXX mutations, which are commonly found alongside MEN1 alterations. With and without accounting for line of therapy, we found that PFS on CAPTEM was significantly longer in MEN1-mutated, DAXX-wildtype tumors compared to other mutation profiles ( P < 0.01, see Table). ATRX (67%) and PTEN (33%) alterations were also enriched in the MEN1-mutated/ DAXX-wildtype subset; however, other PI3K/AKT/mTOR alterations were common across all MEN1-mutated cases. Conclusions: We describe a novel genomic signature ( MEN1 mut/ DAXX wt) that correlates with PNET response to CAPTEM therapy and is exploratory in nature. Prospective validation of these associations is warranted while taking into account other therapies, histopathologic factors, and other genomic correlates. [Table: see text]
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Affiliation(s)
- Patrick Lee
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Arsen Osipov
- Johns Hopkins University School of Medicine, Department of Oncology, Balimore, MD
| | | | | | - Camille Ng
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer W. Chuy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Lee P, Naringrekar H, Balasubramanya R, Tantawi M, Makkena A, Rodgers S, Lyshchik A, Anton K, Shaw C, Eisenbrey J. Abstract No. 560 Diagnostic performance of the 2018 LI-RADS treatment response algorithm for evaluation of hepatocellular carcinoma treated with radioembolization (Y-90). J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wood T, Iyer D, Gorman W, Bakir A, Blanco C, Lakshmireddy H, Juang CV, Nguyen D, Giedlin M, Lee P. Process Development and Manufacturing: PROCESS DEVELOPMENT AND SCALE-UP FOR GENE CIRCUIT ENGINEERED CAR-NK CELL MANUFACTURING. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhao L, Singh V, Ricca A, Lee P. Survival Benefit of Pembrolizumab for Patients With Pancreatic Adenocarcinoma: A Case Series. J Med Cases 2022; 13:240-243. [PMID: 35655630 PMCID: PMC9119368 DOI: 10.14740/jmc3918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with 5-year survival rate of 10%. Evidence about pembrolizumab usage for PDAC is limited even though it is Food and Drug Administration (FDA)-approved for treatment of advanced pancreatic cancer with deficient mismatch repair expression (dMMR) or high tumor mutational burden (TMB) where as there is limited evidence for programmed death-ligand 1 (PD-L1)-positive PDACs. We present three patients with different stages of advanced PDAC treated with pembrolizumab as single maintenance therapy or combination with other therapy. Case 1 is a patient with borderline resectable PDAC, treated with neoadjuvant chemotherapy and surgical resection, followed with pembrolizumab as maintenance therapy with no progression for 4 years after test showed patient was dMMR positive. Case 2 is a patient who was found to have locally advanced PDAC, treated with neoadjuvant chemotherapy and surgical resection followed by multiple line of treatment with programmed cell death-1 (PD-1) and breast cancer gene 2 (BRCA2)-positive status treated with pembrolizumab and olaparib maintenance without any evidence of progression for more than 3 years. Case 3 is a patient with metastatic PDAC with PD-1 and BRCA2-positive status initially treated with FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan and oxaliplatin) and gemcitabine plus nab-paclitaxel switched to irinotecan liposomal, at the same time was started on maintenance pembrolizumab and olaparib with no progression on computed tomography (CT) surveillance for 8 months. For patient with different stages of PDAC with dMMR mutation or PD-1 expression, pembrolizumab should be explored more as maintenance therapy for patients with surgical operable PDAC to decrease recurrence, or as a combination with targeted therapy or chemotherapy to prolong survival in patients with advanced PDAC.
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Affiliation(s)
- Li Zhao
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
- Corresponding Author: Li Zhao, Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA.
| | - Vinit Singh
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | - Anthony Ricca
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | - Patrick Lee
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Singh V, Gor D, Padappayil RP, Jaffery A, Lee P. A Trilogy of Submassive Pulmonary Embolism, Non-Small Cell Lung Cancer with Brain Metastasis, Kartagener’s Syndrome and its Management with Aspiration Thrombectomy. Eur J Case Rep Intern Med 2022; 9:003149. [PMID: 35402339 PMCID: PMC8988494 DOI: 10.12890/2022_003149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/05/2022] Open
Abstract
Venous thromboembolism is a common cause of morbidity and mortality in cancer patients. Given the bleeding risks, determining treatment for malignancy-related thrombosis is challenging, especially in the case of submassive pulmonary embolism (PE) because the risk-benefit ratio in terms of bleeding risk is uncertain. Here we discuss the case of a 53-year-old man with Kartagener syndrome with situs inversus totalis and stage IV non-small cell lung cancer with a recent brain mass resection, presenting with dyspnoea and palpitations. The patient was diagnosed with a submassive PE and only underwent suction thrombectomy through the left internal jugular vein with excellent response. In conclusion, when treating submassive PE, aspiration thrombectomy without thrombolysis is preferable to thrombolysis, which may be contraindicated due to the higher risk of bleeding.
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Affiliation(s)
- Vinit Singh
- Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
| | - Dhairya Gor
- Internal Medicine Department, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | | | - Ali Jaffery
- Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
| | - Patrick Lee
- Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
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Mercader J, Belev G, Bushozi P, Clarke S, Favreau J, Itambu M, Jianfeng Z, Koromo S, Larter F, Lee P, Maley J, Fernández-Marchena JL, Mohamed A, Mwambwiga A, Ngisaruni B, Kingi M, Olesilau L, Patalano R, Pedergnana A, Sammynaiken R, Siljedal J, Soto M, Tucker L, Walde D, Ollé A. Microbotanical residues for the study of early hominin tools. Sci Rep 2022; 12:2951. [PMID: 35194092 PMCID: PMC8863820 DOI: 10.1038/s41598-022-06959-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 12/02/2022] Open
Abstract
More than 2 million years ago in East Africa, the earliest hominin stone tools evolved amidst changes in resource base, with pounding technology playing a key role in this adaptive process. Olduvai Gorge (now Oldupai) is a famed locality that remains paramount for the study of human evolution, also yielding some of the oldest battering tools in the world. However, direct evidence of the resources processed with these technologies is lacking entirely. One way to obtain this evidence is through the analysis of surviving residues. Yet, linking residues with past processing activities is not simple. In the case of plant exploitation, this link can only be established by assessing site-based reference collections inclusive of both anthropogenic and natural residues as a necessary first step and comparative starting point. In this paper, we assess microbotanical remains from rock clasts sourced at the same quarry utilized by Oldowan hominins at Oldupai Gorge. We mapped this signal and analysed it quantitatively to classify its spatial distribution objectively, extracting proxies for taxonomic identification and further comparison with freestanding soils. In addition, we used blanks to manufacture pounding tools for blind, controlled replication of plant processing. We discovered that stone blanks are in fact environmental reservoirs in which plant remains are trapped by lithobionts, preserved as hardened accretions. Tool use, on the other hand, creates residue clusters; however, their spatial distribution can be discriminated from purely natural assemblages by the georeferencing of residues and statistical analysis of resulting patterns. To conclude, we provide a protocol for best practice and a workflow that has the advantage of overcoming environmental noise, reducing the risk of false positive, delivering a firm understanding of residues as polygenic mixtures, a reliable use of controls, and most importantly, a stronger link between microbotanical remains and stone tool use.
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Affiliation(s)
- Julio Mercader
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Institut Català de Paleoecologia Humana i Evolució Social (IPHES-CERCA), Zona Educacional 4, Campus Sescelades URV (Edifici W3), 43007, Tarragona, Spain. .,Department of Geoscience, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Department of Archaeology, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745, Jena, Germany.
| | - George Belev
- Saskatchewan Structural Sciences Centre, Rm. G81 Thorvaldson Building 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
| | - Pastory Bushozi
- Department of Archaeology and Heritage Studies, University of Dar Es Salaam, PO Box 35091, Dar Es Salaam, Tanzania
| | - Siobhán Clarke
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Julien Favreau
- Department of Anthropology, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Makarius Itambu
- Department of Archaeology, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745, Jena, Germany.,Department of Archaeology and Heritage Studies, University of Dar Es Salaam, PO Box 35091, Dar Es Salaam, Tanzania
| | - Zhu Jianfeng
- Saskatchewan Structural Sciences Centre, Rm. G81 Thorvaldson Building 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
| | - Samson Koromo
- Faculty of Arts and Social Sciences, University of Iringa, P.O Box 200, Iringa, Tanzania
| | - Fergus Larter
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Patrick Lee
- Department of Anthropology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Jason Maley
- Saskatchewan Structural Sciences Centre, Rm. G81 Thorvaldson Building 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
| | - Juan Luis Fernández-Marchena
- Institut Català de Paleoecologia Humana i Evolució Social (IPHES-CERCA), Zona Educacional 4, Campus Sescelades URV (Edifici W3), 43007, Tarragona, Spain.,Seminari d'Estudis i Recerques Prehistòriques, Secció de Prehistòria i Arqueologia, Departament d'Història i Arqueologia, Facultat de Geografia i Història, Universitat de Barcelona, c/Montalegre 6-8, 08001, Barcelona, Spain
| | - Abdallah Mohamed
- Department of Archaeology and Heritage Studies, University of Dar Es Salaam, PO Box 35091, Dar Es Salaam, Tanzania
| | - Aloyce Mwambwiga
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Natural History Museum, PO Box 2160, Arusha, Tanzania
| | - Benja Ngisaruni
- Ngorongoro Conservation Area Authority, Ngorongoro, P.O. Box 1, Arusha, Tanzania
| | - Meshack Kingi
- Ngorongoro Conservation Area Authority, Ngorongoro, P.O. Box 1, Arusha, Tanzania
| | - Lucas Olesilau
- Faculty of Arts and Social Sciences, University of Iringa, P.O Box 200, Iringa, Tanzania
| | - Robert Patalano
- Department of Archaeology, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745, Jena, Germany
| | - Antonella Pedergnana
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Ramaswami Sammynaiken
- Saskatchewan Structural Sciences Centre, Rm. G81 Thorvaldson Building 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
| | - Joakim Siljedal
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - María Soto
- Madrid Institute for Advanced Study (MIAS), Casa de Velázquez, Calle de Paul Guinard, 3, 28040, Madrid, Spain. .,Departamento de Prehistoria y Arqueología, Facultad de Filosofía y Letras, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain.
| | - Laura Tucker
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Dale Walde
- Department of Anthropology and Archaeology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Andreu Ollé
- Institut Català de Paleoecologia Humana i Evolució Social (IPHES-CERCA), Zona Educacional 4, Campus Sescelades URV (Edifici W3), 43007, Tarragona, Spain. .,Departament d'Història i Història de l'Art, Universitat Rovira i Virgili, Avinguda de Catalunya 35, 43002, Tarragona, Spain.
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Saif N, Hristov H, Akiyoshi K, Niotis K, Ariza IE, Malviya N, Lee P, Melendez J, Sadek G, Hackett K, Rahman A, Meléndez-Cabrero J, Greer CE, Mosconi L, Krikorian R, Isaacson RS. Sex-Driven Differences in the Effectiveness of Individualized Clinical Management of Alzheimer's Disease Risk. J Prev Alzheimers Dis 2022; 9:731-742. [PMID: 36281678 DOI: 10.14283/jpad.2022.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Comparative Effectiveness Dementia and Alzheimer's Registry (CEDAR) trial demonstrated that individualized, multi-domain interventions improved cognition and reduced the risk of Alzheimer's disease (AD). As biological sex is a significant risk factor for AD, it is essential to explore the differential effectiveness of targeted clinical interventions in women vs. men. METHODS Patients were recruited from an Alzheimer's Prevention Clinic. Subjects with normal cognition, subjective cognitive decline, or asymptomatic preclinical AD were classified as "Prevention". Subjects with mild cognitive impairment due to AD or mild AD were classified as "Early Treatment." The primary outcome was the change from baseline to 18-months on the modified-Alzheimer's Prevention Cognitive Composite. Secondary outcomes included a cognitive aging composite, AD and cardiovascular (CV) risk scales, and serum biomarkers. Subjects who adhered to > 60% of recommendations in the CEDAR trial were included in this a priori sub-group analysis to examine whether individualized intervention effects were modified by sex (n=80). RESULTS In the Prevention group, both women (p=0.0205) and men (p=0.0044) demonstrated improvements in cognition with no sex differences (p=0.5244). In the Early Treatment group, there were also no significant sex differences in cognition (p=0.3299). In the Prevention group, women demonstrated greater improvements in the Multi-Ethnic Study of Atherosclerosis risk score (MESA-RS) than men (difference=1.5, p=0.0013). Women in the Early Treatment group demonstrated greater improvements in CV Risk Factors, Aging and Incidence of Dementia (CAIDE) risk score (difference=2.3, p=0.0067), and the MESA-RS (difference=4.1, p<0.001). CONCLUSIONS Individualized multi-domain interventions are equally effective at improving cognition in women and men. However, personally-tailored interventions led to greater improvements in calculated AD and CV risk, and CV blood biomarkers, in women compared to men. Future study in larger cohorts is necessary to further define sex differences in AD risk reduction in clinical practice.
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Affiliation(s)
- N Saif
- Richard S. Isaacson, MD, Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, 428 E 72nd Street, Suite 400, New York, NY, 10021, USA, Phone: 212-746-4624 Fax: 646-962-0236
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Balogun M, Millette D, Yip V, Chan SA, Lee P, Gamal N, Hashim N, Phillips D, Walsh M, Trehan P, Hanna-Bashara L, Abdullah A, Wernham A, Tso S. Phenotypic spectrum of serious cutaneous-only adverse event following immunization with COVID-19 vaccines: a multicentre case series and literature review. Clin Exp Dermatol 2021; 47:614-616. [PMID: 34748655 PMCID: PMC8653198 DOI: 10.1111/ced.15003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 01/26/2023]
Affiliation(s)
- M Balogun
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Millette
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - V Yip
- Department of Dermatology, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - S A Chan
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Lee
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Gamal
- Dermatology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - N Hashim
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - D Phillips
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - M Walsh
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - P Trehan
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - L Hanna-Bashara
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - A Abdullah
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - A Wernham
- Department of Dermatology, Walsall Healthcare NHS Foundation Trust, Walsall, UK
| | - S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
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46
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Hsieh S, Ng L, Cao M, Lee P. Comparison of In-Room Biplane Radiography and Tomosynthesis in Simulation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Li V, Wang Z, Yu V, Dams R, Philipson R, Lee P, Kishan A, Lee A, Qi X. Multivariate Model for Predicting Overall Survival in Malignant Pleural Mesothelioma After Adjuvant Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Inamdar AA, Loo A, Mikhail N, Lee P. An Aggressive Presentation of Mantle Cell Lymphoma With Unique Molecular Features. Cureus 2021; 13:e17598. [PMID: 34646650 PMCID: PMC8483434 DOI: 10.7759/cureus.17598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Mantle cell lymphoma (MCL) is an aggressive non-Hodgkin lymphoma (NHL) with a dismal prognosis. The pathogenesis of MCL is complex and involves molecular alterations in various genes and pathways including the regulatory elements of the cell cycle machinery and senescence, DNA damage response pathways, and cell survival signals. Currently, Mantle Cell Lymphoma International Prognostic Index (MIPI) score and proliferative gene markers. TP53 and CDKN2A alterations are being used for the prognosis of MCL patients. The molecular profiling performed with various expression studies has paved the way for the identification of novel molecular targets and novel biomarkers not only aid in the diagnosis and prognosis of MCL but also predict the clinical outcome and prognosis. Our patient is a 74-year-old male who came for urinary complaints and routine blood work and revealed leukocytosis and lymphocytosis with abdominal and pelvic lymphadenopathies. Further work-up confirmed the diagnosis of MCL involving peripheral blood, bone marrow, and colon. In our patient, due to aggressive presentation, next generation sequencing was performed to understand the genetic aberrations relevant for MCL. In addition to known markers, we identified genetic mutations in FAT1, IKZF3, and TRAF2. which have never been reported in MCL and could be pathogenic for the aggressive presentation of our patient and thus could be further investigated with in vitro and animal models.
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Affiliation(s)
| | - Abraham Loo
- Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA
| | - Nagy Mikhail
- Pathology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, USA
| | - Patrick Lee
- Hematology Oncology, Monmouth Medical Center, Long Branch, USA
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49
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Li K, Wentzell JJB, Liu Q, Leithead A, Moussa SG, Wheeler MJ, Han C, Lee P, Li SM, Liggio J. Evolution of Atmospheric Total Organic Carbon from Petrochemical Mixtures. Environ Sci Technol 2021; 55:12841-12851. [PMID: 34525806 DOI: 10.1021/acs.est.1c02620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reactive organic compounds play a central role in the formation of ozone and secondary organic aerosols. The ability to accurately predict their fate, in part, relies upon quantitative knowledge of the chemical and physical parameters associated with the total organic carbon (TOC), which includes both precursors and oxidation products that evolve in the atmosphere over short to long time scales. However, such knowledge, obtained via limited carbon closure experiments, has not been attained for complex anthropogenic emissions. Here we present the first comprehensive characterization of TOC in the atmospheric oxidation of organic vapors from light and heavy oil mixtures associated with oil sand operations. Despite the complexity of the investigated oil mixtures, we are able to achieve carbon closure (83-116%) within the uncertainties (±20%), with the degree of the closure being dependent upon the vapor composition and NOx levels. In contrast to biogenic precursors (e.g., α-pinene), the photochemical time scale required for a largely complete oxidation and evolution of chemical parameters is very long for the petrochemical vapors (i.e., ∼7-10 days vs ∼1 day), likely due to the lower initial precursor reactivity. This suggests that petrochemical emissions and their impacts are likely to extend further spatially than biogenic emissions, and retain more of their complex composition and reactivity for many days. The results of this work provide key parameters to regional models for further improving the representation of the chemical evolution of petrochemical emissions.
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Affiliation(s)
- Kun Li
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
- Laboratory of Atmospheric Chemistry, Paul Scherrer Institute, Villigen 5232, Switzerland
| | - Jeremy J B Wentzell
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Qifan Liu
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Amy Leithead
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Samar G Moussa
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Michael J Wheeler
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Chong Han
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Patrick Lee
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
| | - Shao-Meng Li
- College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China
| | - John Liggio
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, Ontario M3H 5T4, Canada
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50
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Smeltzer M, Spigel D, Shiller M, Lee P, Feller-Kopman D, Spira A, West H, Martin N, Stiles B, Plotkin E, Kim J, Lucas L, Boehmer L. P53.06 A Multi-Phase Quality Initiative to Improve Processes of Care for Non-small Cell Lung Cancer (NSCLC) in US Community Cancer Centers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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