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Maccallum F, Breen LJ, Phillips JL, Agar MR, Hosie A, Tieman J, DiGiacomo M, Luckett T, Philip J, Ivynian S, Chang S, Dadich A, Grossman CH, Gilmore I, Harlum J, Kinchin I, Glasgow N, Lobb EA. The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis. Psychol Med 2024; 54:1361-1372. [PMID: 38179660 DOI: 10.1017/s0033291723003227] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.
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Affiliation(s)
- F Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - L J Breen
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - J L Phillips
- Faculty of Health and Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - M R Agar
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Hosie
- School of Nursing & Midwifery, University of Notre Dame Australia and St Vincent's Health Network Sydney, Australia
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - M DiGiacomo
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - T Luckett
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Philip
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - S Ivynian
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - S Chang
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Dadich
- School of Business, Western Sydney University, Penrith, NSW, Australia
| | - C H Grossman
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | - I Gilmore
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Harlum
- District Palliative Care Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - I Kinchin
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - N Glasgow
- Australian National University College of Health and Medicine, Canberra, ACT, Australia
| | - E A Lobb
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
- Department of Palliative Care, Calvary Health Care, Kogarah, NSW, Australia
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Kayal M, Deepak P, Beniwal-Patel P, Raffals L, Dubinsky M, Chang S, Higgins PDR, Jiang Y, Cross RK, Long MD, Herfarth HH, Barnes EL. Changes in Therapy Are Not Associated With Increased Remission in Patients With Crohn's Disease of the Pouch. Am J Gastroenterol 2024:00000434-990000000-00942. [PMID: 37975591 DOI: 10.14309/ajg.0000000000002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is a paucity of data on the real-world effectiveness of therapies in patients with Crohn's disease of the pouch. METHODS This was a prospective multicenter study evaluating the primary outcome of remission at 12 months of therapy for Crohn's disease of the pouch. RESULTS One hundred thirty-four patients were enrolled. Among the 77 patients with symptoms at baseline, 35 (46.7%) achieved remission at 12 months. Of them, 12 (34.3%) changed therapy. There was no significant association between therapy patterns and remission status. DISCUSSION Approximately 50% with symptoms at enrollment achieved clinical remission at 12 months, most of whom did so without a change in therapy.
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Affiliation(s)
- Maia Kayal
- Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shannon Chang
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, New York, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yue Jiang
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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Beaty W, Katragadda A, Condos R, Dane B, Sarkar S, Shaffer E, Chang S. Pulmonary Crohn's Disease Masquerading as Lymphoma. ACG Case Rep J 2024; 11:e01247. [PMID: 38179265 PMCID: PMC10766257 DOI: 10.14309/crj.0000000000001247] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Although extraintestinal manifestations of inflammatory bowel disease (IBD) are common, pulmonary IBD is extremely rare. Owing to its nonspecific clinical, radiologic, and pathologic features, pulmonary IBD is difficult to diagnose and may mimic more concerning disease processes. We present a rare case of a patient with known Crohn's disease whose initial presentation was highly suspicious for malignancy before further investigation revealed pulmonary IBD.
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Affiliation(s)
- William Beaty
- New York University Grossman School of Medicine, New York, NY
| | - Anila Katragadda
- Kansas City University College of Osteopathic Medicine Kansas City, MO
| | - Rany Condos
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Bari Dane
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Suparna Sarkar
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Emily Shaffer
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Shannon Chang
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
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Chang S, Murphy M, Malter L. A Review of Available Medical Therapies to Treat Moderate-to-Severe Inflammatory Bowel Disease. Am J Gastroenterol 2024; 119:55-80. [PMID: 37615291 DOI: 10.14309/ajg.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
The treatment armamentarium for inflammatory bowel disease has expanded rapidly in the past several years with new biologic and small molecule-agents approved for moderate-to-severe ulcerative colitis and Crohn's disease. This has made treatment selection more challenging with limited but evolving guidance as to where to position each medication. In this review, we discuss the efficacy data for each agent approved in the United States by reviewing their phase 3 trial data and other comparative effectiveness studies. In addition, safety considerations and use in special populations are summarized with proposed algorithms for positioning therapies. The aim is to provide a synopsis of high-impact data and aid in outpatient treatment decision-making for patients with inflammatory bowel disease.
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Affiliation(s)
- Shannon Chang
- Division of Gastroenterology, Department of Medicine, New York University Langone Health, New York, New York, USA
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Fansiwala K, Rusher A, Shore B, Herfarth HH, Barnes E, Kochar B, Chang S. Oral vs Intravenous Discharge Antibiotic Regimens in the Management of Intra-abdominal Abscesses in Penetrating Crohn's Disease. Inflamm Bowel Dis 2023:izad299. [PMID: 38150318 DOI: 10.1093/ibd/izad299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Antibiotics are a cornerstone in management of intra-abdominal abscesses in Crohn's disease (CD). Yet, the optimal route of antibiotic administration is poorly studied. We aimed to compare surgical and nonsurgical readmission outcomes for patients hospitalized for intra-abdominal abscesses from CD discharged on oral (PO) or intravenous (IV) antibiotics. METHODS Data for patients with CD hospitalized for an intra-abdominal abscess were obtained from 3 institutions from January 2010 to December 2020. Baseline patient characteristics were obtained. Primary outcomes of interest included need for surgery and hospital readmission within 1 year from hospital discharge. We used multivariable logistic regression models and Cox regression analysis to adjust for abscess size, history of prior surgery, history of penetrating disease, and age. RESULTS We identified 99 patients discharged on antibiotics (PO = 74, IV = 25). Readmissions related to CD at 12 months were less likely in the IV group (40% vs 77% PO, P = .01), with the IV group demonstrating a decreased risk for nonsurgical readmissions over time (hazard ratio, 0.376; 95% confidence interval, 0.176-0.802). Requirement for surgery was similar between the groups. There were no differences in time to surgery between groups. CONCLUSIONS In this retrospective, multicenter cohort of CD patients with intra-abdominal abscess, surgical outcomes were similar between patients receiving PO vs IV antibiotics at discharge. Patients treated with IV antibiotics demonstrated a decreased risk for nonsurgical readmission. Further prospective trials are needed to better delineate optimal route of antibiotic administration in patients with penetrating CD.
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Affiliation(s)
- Kush Fansiwala
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alison Rusher
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Brandon Shore
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon Chang
- Inflammatory Bowel Disease Center, Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
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6
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Gong BW, Chang S, Zuo FF, Xie XJ, Wang SF, Wang YJ, Sun YY, Guan XC, Bai YX. [Automated cephalometric landmark identification and location based on convolutional neural network]. Zhonghua Kou Qiang Yi Xue Za Zhi 2023; 58:1249-1256. [PMID: 38061867 DOI: 10.3760/cma.j.cn112144-20230829-00118] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To develop an automated landmark location system applicable to the case of landmark missing. Methods: Four and eighty-one lateral cephalograms, which contained 240 males and 241 females, with an average age of (24.5±5.6) years, taken from January 2015 to January 2021 in the Department of Orthodontics, Capital Medical University School of Stomatology, and met the inclusion criteria were collected. Five postgraduate orthodontic students were the annotators to manually locate 61 possible landmarks in 481 lateral cephalograms. Two assistant professors in the department as reviewers performed calibration. Two professors as arbitrators, made final decision. Data sets were established (341 were used as training set, 40 as validation set, and 100 as test set). In this paper, an automatic landmarks identification and location model based on convolutional neural networks (CNN), CephaNET, was developed. The model was trained by feeding the original image into the feature extraction module and convolutional pose machine (CPM) module to locate landmarks with high accuracy using deep supervision. Training set was enhanced to 1 684 images by histogram equalization, cropping, and adjustment of brightness. The model was trained to compare the Gaussian heat maps output from the network with the set threshold to identify landmark missing cases. Test set of 100 lateral cephalograms was used to test the accuracy of the model. The evaluation criteria used were success detection rate of missing landmark, mean radial error (MRE) and success detection rate (SDR) in the range of 2.0, 2.5, 3.0, 3.5 and 4.0 mm. Results: The model identified and located 61 commonly used landmarks in 0.13 seconds on average. It had an average accuracy of 93.5% in identifying missing landmarks. The MRE of our testing set was (1.19±0.91) mm. SDR of 2.0, 2.5, 3.0, 3.5 and 4.0 mm were 85.4%, 90.2%, 93.5%, 95.4%, 97.0% respectively. Conclusions: The model proposed in this paper could adapt to the absence of landmark in lateral cephalograms and locate 61 commonly used landmarks with high accuracy to meet the requirements of different cephalometric analysis methods.
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Affiliation(s)
- B W Gong
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - S Chang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - F F Zuo
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - X J Xie
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - S F Wang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Y J Wang
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - Y Y Sun
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - X C Guan
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Y X Bai
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
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Barnes EL, Chang S. Shedding New Light on High-Risk Phenotypes for Pouchitis. Inflamm Bowel Dis 2023; 29:2003-2005. [PMID: 36869847 PMCID: PMC10697420 DOI: 10.1093/ibd/izad027] [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: 01/25/2023] [Indexed: 03/05/2023]
Abstract
Lay Summary
Identifying those patients at the greatest risk for pouchitis at the time of ileal pouch-anal anastomosis for ulcerative colitis remains a challenge. We discuss the importance of this topic by reviewing recent data regarding the impact of acute severe ulcerative colitis on risk of pouchitis and the implications for future clinical decisions and studies of risk stratification.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Shannon Chang
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, NY, USA
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Chang S, Hong S, Hudesman D, Remzi F, Sun K, Cao W, Kani HT, Axelrad J, Sarkar SA. Histologic Predictors of Clinical Outcomes and Healthcare Utilization in Patients With Ileal Pouch-Anal Anastomosis. Inflamm Bowel Dis 2023; 29:1769-1777. [PMID: 36702534 PMCID: PMC10628915 DOI: 10.1093/ibd/izac277] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The prognostic significance of histology in ileal pouch-anal anastomosis (IPAA) remains unclear. The aim of this study was to evaluate if histologic variables are predictive of IPAA clinical outcomes and healthcare utilization. METHODS This was a retrospective cohort study of patients with IPAA undergoing surveillance pouchoscopy at a tertiary care institution. Pouch body biopsies were reviewed by gastrointestinal pathologists, who were blinded to clinical outcomes, for histologic features of acute or chronic inflammation. Charts were reviewed for clinical outcomes including development of acute pouchitis, chronic pouchitis, biologic or small molecule initiation, hospitalizations, and surgery. Predictors of outcomes were analyzed using univariable and multivariable logistic and Cox regression. RESULTS A total of 167 patients undergoing surveillance pouchoscopy were included. Polymorphonuclear leukocytes (odds ratio [OR], 1.67), ulceration and erosion (OR, 2.44), chronic inflammation (OR, 1.97), and crypt distortion (OR, 1.89) were associated with future biologic or small molecule initiation for chronic pouchitis. Loss of goblet cells was associated with development of chronic pouchitis (OR, 4.65). Pyloric gland metaplasia was associated with hospitalizations (OR, 5.24). No histologic variables were predictive of development of acute pouchitis or surgery. In an exploratory subgroup analysis of new IPAA (<1 year), loss of goblet cells was associated with acute pouchitis (OR, 14.86) and chronic pouchitis (OR, 12.56). Pyloric gland metaplasia was again associated with hospitalizations (OR, 13.99). CONCLUSIONS Histologic findings may be predictive of IPAA outcomes. Pathologists should incorporate key histologic variables into pouchoscopy pathology reports. Clinicians may need to more closely monitor IPAA patients with significant histologic findings.
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Affiliation(s)
- Shannon Chang
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA
| | - Simon Hong
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA
| | - David Hudesman
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA
| | - Feza Remzi
- Department of Colorectal Surgery, New York University Langone Health, New York, NY, USA
| | - Katherine Sun
- Department of Pathology, New York University Langone Health, New York, NY, USA; and
| | - Wenqing Cao
- Department of Pathology, New York University Langone Health, New York, NY, USA; and
| | - H Tarik Kani
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Jordan Axelrad
- Division of Gastroenterology, New York University Grossman School of Medicine, New York, NY, USA
| | - Suparna A Sarkar
- Department of Pathology, New York University Langone Health, New York, NY, USA; and
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Ghanem AI, Gilbert M, Lin CH, Khalil-Moawad R, Momin S, Chang S, Ali H, Siddiqui F. Treatment Tolerance and Toxicity in Elderly Oropharyngeal Cancer Patients and Implication on Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e584. [PMID: 37785770 DOI: 10.1016/j.ijrobp.2023.06.1926] [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) To investigate the tolerance level and toxicity for standard of care treatment for oropharyngeal cancer (OP) in elderly patients and their impact on outcomes. MATERIALS/METHODS Using our in-house head and neck cancer database, we looked for non-metastatic OP cases that received definitive treatment between 1/2009-6/2020. All patients received either definitive radiation therapy (RT) +/- concomitant systemic therapy (ST), or surgery followed by adjuvant RT or RT-ST. For the elderly (age at diagnosis ≥65 years) and young (<65 years) patients, we compared treatment package time (TPT) (time from surgery to RT conclusion) for adjuvant RT, total RT duration and unplanned RT interruptions. ST details and dose/protocol modifications were also compared. We evaluated worst grade of pain and mucositis, hospitalization for non-hydration causes and febrile neutropenia (FN) during RT. Feeding tube (FT) use and weight loss were compared. The independent effect of these indicators on locoregional (LRFS), distant (DRFS) recurrence free and overall (OS) survival was assessed using multivariate analyses (MVA). RESULTS A cohort of 326 patients was included: 36% elderly (n = 118) and 64% young (n = 208), with no differences in AJCC stage distribution (8th), treatment received and HPV status (HPV+ve: 73% vs 74.6%; p = 0.86). In 23.6 % who received adjuvant RT, median TPT was 86 (range 72-128) and 81 (65-137) days for elderly vs young (p = 0.27); whereas in the definitive RT cases 76.4%, total RT duration was 49 days for both age groups. Overall, prescribed RT course was not completed in 4% and unplanned RT interruptions occurred in 22.8% and both were non-significant between age groups. Among the 261 patients that received ST, elderly utilized more cetuximab (26 vs 12%; p = 0.007). For those who received cisplatin, 20% of elderly had cumulative dose <200 mg/m2 compared to 6% among the younger age group (p = 0.006); and cisplatin was changed to carboplatin or cetuximab in 18% vs 8% (p = 0.019). Delayed/cancelled cycles and dose reductions were similar. There were more hospitalizations (47% vs 27%; p<0.001) and a trend for more FN (9% vs 3%; p = 0.09) with older age, while worst pain and mucositis was similar. FTs were used more in elderly patients (64% vs 50%; p = 0.02), for a median of 97 vs 64 days (p = 0.31); of which 19.5% vs 11% (p = 0.28) were inserted before RT start. However, % weight loss was non-significant. On MVA, longer RT duration, FT use and hospitalizations predicted worse LRFS and DRFS; and they were prognostic for OS in addition to TPT >90 days (p<0.05 for all). Nevertheless, elderly vs young had non-significant 3-year LRFS (91% vs 90% and 67% vs 69%), DRFS (86% vs 90% and 79% vs 81%) & OS (85% vs 81% and 39% vs 52%) for HPV+ve and HPV-ve respectively (p>0.05). CONCLUSION Elderly patients with OP need more multi-disciplinary supportive care when receiving RT and concurrent ST. However, survival outcomes are equivalent to younger patients. Ongoing studies should enroll more elderly candidates and stratify endpoints with age.
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Affiliation(s)
- A I Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI; Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - M Gilbert
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - C H Lin
- Department of Public Health Sciences, Henry Ford Cancer Institute, Detroit, MI
| | - R Khalil-Moawad
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - S Momin
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - S Chang
- Department of Otolaryngology, Henry Ford Cancer Institute, Detroit, MI
| | - H Ali
- Department of Medical Oncology, Henry Ford Cancer Institute, Detroit, MI
| | - F Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI
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10
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Schrank BR, Gallagher CM, Nguyen L, Morris VK, Holliday E, Newman A, Merriman K, Sudol VM, Chiao EY, Hawk E, Koong AC, Chang S. Sexual Orientation and Gender Identity (SOGI) Data Collection: Opportunities to Advance Best Clinical Practices for LGBTQ+ Patients in Radiation Oncology. Int J Radiat Oncol Biol Phys 2023; 117:e56. [PMID: 37785716 DOI: 10.1016/j.ijrobp.2023.06.770] [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) A long-standing barrier to progress against health disparities is the lack of data regarding cancer risks, prevalence, treatment, and outcomes for sexual and gender minority (SGM) patients. Sexual orientation and gender identity (SOGI) data are not routinely collected by individual oncologists, cancer centers, or most non-federal hospital systems. Alarmingly high proportions of SGM patients report discrimination in healthcare or avoid routine care due to perceived lack of acceptance in the healthcare system. For these and other reasons, healthcare institutions must adopt practices that promote an inclusive environment for all patients including those self-identified from SGM groups. One strategy to achieve this aim is through SOGI data collection. The purpose of this study was to pilot new procedures and training for SOGI data collection, the aims of this project were to standardize the collection of SOGI data for all new patients referred to the Division of Radiation Oncology; promote clinical staff awareness of SGM health disparities and strategies for fostering an inclusive hospital environment; and to provide SGM patients and caregivers educational resources and support systems tailored to their needs. MATERIALS/METHODS We designed a Quality Improvement program for collecting SOGI data, which was approved by our institution's QIAB. Patient access specialists (PAS) were trained to collect SOGI data from newly registered patients and enter the data into the electronic health record. Radiation Oncology staff completed surveys before and after SOGI training to estimate its impact on the provision of patient care. A Fisher's exact test was utilized to evaluate associations between training and provider-reported outcomes. RESULTS Within a 3-week period starting in January 2023, two 1-hour interactive training sessions were offered to twenty-five PAS. Three 1-hour training sessions were offered to twenty-seven Radiation Oncology clinical staff. (1) Confidence for incorporating SOGI classifiers around patients improved from before training (52%, 13/25) to after training (100%, 17/17) among medical providers surveyed (odds ratio (OR) 32, 95% confidence interval (CI) 0.70-1493, p = 0.005). Use of SOGI data in clinical decision making increased from before training (9/25, 36%) to after training (100%, 17/17) among medical providers (OR 60.79, 95% CI 3.271-1130, p<0.0001). (2) A clinical pathway for SGM patients was developed to facilitate referral to our institution's SGM patient support group and distribution of patient education materials focused on sexual health. CONCLUSION Establishing standardized SOGI data collection can facilitate the provision of tailored resources and care that meets the needs of patients and staff in a large comprehensive cancer center. Specialized training for staff developed through this initiative helps foster an inclusive and welcoming environment that promotes the integration, visibility, and advancement of SGM cancer care at our institution.
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Affiliation(s)
- B R Schrank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C M Gallagher
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Nguyen
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - V K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Newman
- Department of Patient Safety, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Merriman
- Department of Tumor Registry, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - V M Sudol
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Y Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Hawk
- Department of Cancer Prevention & Pop Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - A C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Young S, Lee B, Smukalla S, Axelrad J, Chang S. Anorectal Manometry in Patients With Fecal Incontinence After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Cohort Study. Crohns Colitis 360 2023; 5:otad063. [PMID: 38077748 PMCID: PMC10708921 DOI: 10.1093/crocol/otad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 02/12/2024] Open
Abstract
Background Fecal incontinence commonly occurs in patients with ulcerative colitis and ileal pouch-anal anastomosis. There is a paucity of manometric data in pouch patients. We aimed to better define manometric parameters in pouch patients with fecal incontinence. Methods We compared clinical and manometric variables in ulcerative colitis patients with pouch and fecal incontinence to ulcerative colitis patients with pouch without fecal incontinence and to non-ulcerative colitis patients with fecal incontinence. Manometric data for the 3 cohorts were compared to established normative data. An independent-samples t-test was performed for continuous variables, and chi-square test was used for categorical variables. Logistic regression was performed to identify predictors of incontinence in pouch patients (P < .05). Results Among 26 pouch patients with fecal incontinence (73% female), 26 pouch patients without fecal incontinence (35% female), and 84 patients with fecal incontinence without ulcerative colitis (68% female), there were no differences in anorectal pressures between patients with fecal incontinence. Lower pressures were observed in pouch patients with fecal incontinence compared to those without fecal incontinence. Resting pressure was similar between pouch patients with fecal incontinence and healthy controls (60.9 ± 36.1 mmHg vs. 66.9 ± 3.2 mmHg, P = .40). Female sex (P = .019) and defecatory disorders (P = .033) each independently predicted fecal incontinence in pouch patients. Conclusions Pouch patients with fecal incontinence have lower anorectal pressures compared to pouch patients without incontinence, though have similar pressures to non-ulcerative colitis patients with fecal incontinence. Pouch patients with fecal incontinence have similar resting pressures as healthy controls. Distinct manometric normative values for pouch patients are needed.
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Affiliation(s)
- Sigrid Young
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Briton Lee
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Scott Smukalla
- Division of Gastroenterology, NYU Langone Health, New York, NY, USA
| | - Jordan Axelrad
- Division of Gastroenterology, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
| | - Shannon Chang
- Division of Gastroenterology, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
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12
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Kim ES, Rajan A, Chang K, Govindarajan S, Gulick C, English E, Rodriguez B, Bloomfield O, Nakada S, Beard C, O’Connor S, Mastroianni S, Downey E, Feigenbaum M, Tolentino C, Pace A, Khan M, Moon S, DiPrima J, Syed A, Lin F, Abukhadra Y, Bacon I, Beckerle J, Cho S, Donkor NE, Garberg L, Harrington A, Hoang M, Lawani N, Noori A, Park E, Parsons E, Oravitan P, Chen M, Molina C, Richmond C, Reddi A, Huang J, Shugrue C, Coviello R, Unver S, Indelicarto M, Islamovic E, McIlroy R, Yang A, Hamad M, Griffin E, Ahmed Z, Alla A, Fitzgerald P, Choi A, Das T, Cheng Y, Yu J, Roderiques T, Lee E, Liu L, Harper J, Wang J, Suhr C, Tan M, Luque J, Tam AR, Chen E, Triff M, Zimmermann L, Zhang E, Wood J, Clark K, Kpodonu N, Dey A, Ecker A, Chuang M, López RKS, Sun H, Wei Z, Stone H, Chi CYJ, Silvestri A, Orloff P, Nedumaran N, Zou A, Ünver L, Page O, Kim M, Chan TYT, Tulloch A, Hernandez A, Pillai A, Chen C, Chowdhury N, Huang L, Mudide A, Paik G, Wingate A, Quinn L, Conybere C, Baumgardt LL, Buckley R, Kolberg Z, Pattison R, Shazli AA, Ganske P, Sfragara L, Strub A, Collier B, Tamana H, Ravindran D, Howden J, Stewart M, Shimizu S, Braniff J, Fong M, Gutman L, Irvine D, Malholtra S, Medina J, Park J, Yin A, Abromavage H, Barrett B, Chen J, Cho R, Dilatush M, Gaw G, Gu C, Huang J, Kilby H, Markel E, McClure K, Phillips W, Polaski B, Roselli A, Saint-Cyr S, Shin E, Tatum K, Tumpunyawat T, Wetherill L, Ptaszynska S, Zeleznik M, Pesendorfer A, Nolan A, Tao J, Sammeta D, Nicholson L, Dinh GV, Foltz M, Vo A, Ross M, Tokarski A, Hariharan S, Wang E, Baziuk M, Tay A, Wong YHM, Floyd J, Cui A, Pierre K, Coppisetti N, Kutam M, Khurjekar D, Gadzi A, Gubbay B, Pedretti S, Belovich S, Yeung T, Fey M, Shaffer L, Li A, Beritela G, Huyghue K, Foster G, Durso-Finley G, Thierfelder Q, Kiernan H, Lenkowsky A, Thomas T, Cheng N, Chao O, L’Etoile-Goga P, King A, McKinley P, Read N, Milberg D, Lin L, Wong M, Gilman I, Brown S, Chen L, Kosai J, Verbinsky M, Belshaw-Hood A, Lee H, Zhou C, Lobo M, Tse A, Tran K, Lewis K, Sonawane P, Ngo J, Zuzga S, Chow L, Huynh V, Yang W, Lim S, Stites B, Chang S, Cruz-Balleza R, Pelta M, Kujawski S, Yuan C, Standen-Bloom E, Witt O, Anders K, Duane A, Huynh N, Lester B, Fung-Lee S, Fung M, Situ M, Canigiula P, Dijkgraaf M, Romero W, Baula SK, Wong K, Xu I, Martinez B, Nuygen R, Norris L, Nijensohn N, Altman N, Maajid E, Burkhardt O, Chanda J, Doscher C, Gopal A, Good A, Good J, Herrera N, Lanting L, Liem S, Marks A, McLaughlin E, Lee A, Mohr C, Patton E, Pyarali N, Oczon C, Richards D, Good N, Goss S, Khan A, Madonia R, Mitchell V, Sun N, Vranka T, Garcia D, Arroyo F, Morales E, Camey S, Cano G, Bernabe A, Arroyo J, Lopez Y, Gonzalez E, Zumba B, Garcia J, Vargas E, Trinidad A, Candelaria N, Valdez V, Campuzano F, Pereznegron E, Medrano J, Gutierrez J, Gutierrez E, Abrego ET, Gutierrez D, Ortiz C, Barnes A, Arms E, Mitchell L, Balanzá C, Bradford J, Detroy H, Ferguson D, Guillermo E, Manapragada A, Nanula D, Serna B, Singh K, Sramaty E, Wells B, Wiggins M, Dowling M, Schmadeke G, Cafferky S, Good S, Reese M, Fleig M, Gannett A, Cain C, Lee M, Oberto P, Rinehart J, Pan E, Mathis SA, Joiner J, Barr L, Evans CJ, Baena-Lopez A, Beatty A, Collette J, Smullen R, Suttie J, Chisholm T, Rotondo C, Lewis G, Turner V, Stark L, Fox E, Amirapu A, Park S, Lantz N, Rankin AE, Kim SK, Kockel L. Generation of LexA enhancer-trap lines in Drosophila by an international scholastic network. G3 (Bethesda) 2023; 13:jkad124. [PMID: 37279923 PMCID: PMC10468311 DOI: 10.1093/g3journal/jkad124] [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] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
Conditional gene regulation in Drosophila through binary expression systems like the LexA-LexAop system provides a superb tool for investigating gene and tissue function. To increase the availability of defined LexA enhancer trap insertions, we present molecular, genetic, and tissue expression studies of 301 novel Stan-X LexA enhancer traps derived from mobilization of the index SX4 line. This includes insertions into distinct loci on the X, II, and III chromosomes that were not previously associated with enhancer traps or targeted LexA constructs, an insertion into ptc, and seventeen insertions into natural transposons. A subset of enhancer traps was expressed in CNS neurons known to produce and secrete insulin, an essential regulator of growth, development, and metabolism. Fly lines described here were generated and characterized through studies by students and teachers in an international network of genetics classes at public, independent high schools, and universities serving a diversity of students, including those underrepresented in science. Thus, a unique partnership between secondary schools and university-based programs has produced and characterized novel resources in Drosophila, establishing instructional paradigms devoted to unscripted experimental science.
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Affiliation(s)
- Ella S Kim
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Arjun Rajan
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kathleen Chang
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | | | - Eva English
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | | | - Sarah O’Connor
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | | | - Emma Downey
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | | | | | - Abigail Pace
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Marina Khan
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Soyoun Moon
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Jordan DiPrima
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Amber Syed
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Flora Lin
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | | | | | | | - Sophia Cho
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | - Mai Hoang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Nosa Lawani
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Ayush Noori
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Euwie Park
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | | | | | - Adith Reddi
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Jason Huang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | - Selma Unver
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | - Alana Yang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Mahdi Hamad
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Zara Ahmed
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Asha Alla
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Audrey Choi
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Tanya Das
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Joshua Yu
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Ethan Lee
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | - Jason Wang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Chris Suhr
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Max Tan
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | - Emma Chen
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Max Triff
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Eric Zhang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Jackie Wood
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | - Nat Kpodonu
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Antar Dey
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | - Harry Sun
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Zijing Wei
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Henry Stone
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | | | | | - Leyla Ünver
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Oscair Page
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | - Minseo Kim
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | | | | | | | - Lina Huang
- Phillips Exeter Academy, Exeter, NH 03833, USA
| | | | | | | | - Lily Quinn
- Haileybury School, Hertford SG13 7NU, UK
| | | | | | | | | | | | | | - Pia Ganske
- Haileybury School, Hertford SG13 7NU, UK
| | | | | | | | | | | | | | | | | | - Julia Braniff
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Melanie Fong
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Lucy Gutman
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Danny Irvine
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Sahil Malholtra
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Jillian Medina
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - John Park
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Alicia Yin
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Breanna Barrett
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Jacqueline Chen
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Rachelle Cho
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Mac Dilatush
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Gabriel Gaw
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Caitlin Gu
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Jupiter Huang
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Houston Kilby
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Ethan Markel
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Katie McClure
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - William Phillips
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Benjamin Polaski
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Amelia Roselli
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Soleil Saint-Cyr
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Ellie Shin
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Kylan Tatum
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Tai Tumpunyawat
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Lucia Wetherill
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Sara Ptaszynska
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Maddie Zeleznik
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Anna Nolan
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Jeffrey Tao
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Divya Sammeta
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Laney Nicholson
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Giao Vu Dinh
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Merrin Foltz
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - An Vo
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Maggie Ross
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Andrew Tokarski
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Samika Hariharan
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Elaine Wang
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Martha Baziuk
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Ashley Tay
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Jax Floyd
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Aileen Cui
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Kieran Pierre
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Nikita Coppisetti
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Matthew Kutam
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Dhruv Khurjekar
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Anthony Gadzi
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Ben Gubbay
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Sophia Pedretti
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Sofiya Belovich
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Tiffany Yeung
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Mercy Fey
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Layla Shaffer
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Arthur Li
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Kyle Huyghue
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Greg Foster
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Quinn Thierfelder
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Holly Kiernan
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Andrew Lenkowsky
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Tesia Thomas
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Nicole Cheng
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Olivia Chao
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Pia L’Etoile-Goga
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Alexa King
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Paris McKinley
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Nicole Read
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - David Milberg
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Leila Lin
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Melinda Wong
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Io Gilman
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Samantha Brown
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Lila Chen
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Jordyn Kosai
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Mark Verbinsky
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | | | - Honon Lee
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Cathy Zhou
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Maya Lobo
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Asia Tse
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Kyle Tran
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Kira Lewis
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Pratmesh Sonawane
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Jonathan Ngo
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Sophia Zuzga
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Lillian Chow
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Vianne Huynh
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Wenyi Yang
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Samantha Lim
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Brandon Stites
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Shannon Chang
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | | | - Michaela Pelta
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Stella Kujawski
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Christopher Yuan
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | | | - Oliver Witt
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Karina Anders
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Audrey Duane
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Nancy Huynh
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Benjamin Lester
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Samantha Fung-Lee
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Melanie Fung
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Mandy Situ
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Paolo Canigiula
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Matijs Dijkgraaf
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Wilbert Romero
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | | | - Kimberly Wong
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Ivana Xu
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | | | - Reena Nuygen
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | - Lucy Norris
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | - Noah Nijensohn
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | - Naomi Altman
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | - Elise Maajid
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | | | | | | | - Alex Gopal
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | - Aaron Good
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | - Jonah Good
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | | | - Sophia Liem
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | - Anila Marks
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | - Audrey Lee
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | - Collin Mohr
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | - Emma Patton
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | | | | | - Nathan Good
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | - Adeeb Khan
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | | | - Natasha Sun
- Albuquerque Academy, Albuquerque, NM 87109, USA
| | | | | | | | | | | | | | | | | | | | | | - Bryan Zumba
- Pritzker College Prep, Chicago, IL 60639, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jake Bradford
- Loyola Marymount University, Los Angeles, CA 90045, USA
| | | | | | | | | | | | | | - Khushi Singh
- Loyola Marymount University, Los Angeles, CA 90045, USA
| | - Emily Sramaty
- Loyola Marymount University, Los Angeles, CA 90045, USA
| | - Brian Wells
- Loyola Marymount University, Los Angeles, CA 90045, USA
| | | | - Melissa Dowling
- Latin School of Chicago, 59 W North Blvd, Chicago, IL 60610, USA
| | | | | | | | | | | | | | - Cory Cain
- Pritzker College Prep, Chicago, IL 60639, USA
| | - Melody Lee
- Harvard-Westlake School, Los Angeles, CA 90077, USA
| | | | | | | | | | | | - Leslie Barr
- Westtown School, West Chester, PA 19382, USA
| | - Cory J Evans
- Loyola Marymount University, Los Angeles, CA 90045, USA
| | | | - Andrea Beatty
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | | | - Robert Smullen
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | - Jeanne Suttie
- Commack High School, 1 Scholar Ln, Commack, NY 11725, USA
| | | | | | | | | | | | - Elizabeth Fox
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | - Anjana Amirapu
- Lowell High School, 1101 Eucalyptus Dr, San Francisco, CA 94132, USA
| | - Sangbin Park
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nicole Lantz
- The Lawrenceville School, 2500 Main St, Lawrenceville, NJ 08648, USA
| | | | - Seung K Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lutz Kockel
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
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13
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Barnes EL, Beniwal-Patel P, Deepak P, Raffals L, Kayal M, Dubinsky M, Chang S, Higgins PDR, Barr JI, Anderson C, Cross RK, Long MD, Herfarth HH. Dietary Patterns Are Not Associated With Disease Activity Among Patients With Inflammatory Conditions of the Pouch in a Prospective Cohort. Crohns Colitis 360 2023; 5:otad039. [PMID: 37519405 PMCID: PMC10374273 DOI: 10.1093/crocol/otad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 08/01/2023] Open
Abstract
Background Evidence-based recommendations regarding the influence of diet on inflammatory conditions of the pouch after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) are limited. Methods We analyzed dietary patterns at enrollment in a prospective registry of patients with 1 of 4 inflammatory conditions of the pouch (acute pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic refractory pouchitis, and Crohn's disease of the pouch). We analyzed dietary intake by disease activity at enrollment and then compared dietary patterns among patients who remained in remission throughout the 12-month follow-up to those patients who experienced a disease relapse. We also compared dietary patterns among patients with inflammatory conditions of the pouch to the United States Department of Agriculture (USDA) recommended daily goals. Results Among 308 patients, there were no differences in dietary patterns among patients with 1 of the 4 disease states at enrollment. Additionally, among the 102 patients in remission at baseline, there were no significant differences noted among patients who went on to experience a disease flare in the 12 months after enrollment compared to those patients who remained in remission. However, patients with inflammatory conditions of the pouch demonstrated decreased intake of several food groups and macronutrients including dairy, fruits, vegetables, whole grains, and fiber when compared to USDA recommendations. Conclusions In a prospective cohort, we demonstrated no impact of dietary patterns on disease activity. The relative deficiencies in several food groups and macronutrients among patients after IPAA indicate the potential role of targeted nutritional counseling in this population.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Maia Kayal
- Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shannon Chang
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, NY, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer I Barr
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Chelsea Anderson
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
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Luo P, Hu W, Xu R, Wang Y, Li X, Jiang L, Chang S, Wu D, Li G, Dai Y. Enabling early detection of knee osteoarthritis using diffusion-relaxation correlation spectrum imaging. Clin Radiol 2023:S0009-9260(23)00224-6. [PMID: 37336674 DOI: 10.1016/j.crad.2023.05.013] [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: 03/20/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
AIM To present a technique that enables detection of early stage OA of the knee using diffusion-relaxation correlation spectrum imaging (DR-CSI). MATERIALS AND METHODS Fifty-five early osteoarthritis patients (OA, Kellgren-Lawrence [KL] score 1 to 2; mean age, 56.4 years) and 49 healthy volunteers (mean age, 56.7 years) were underwent magnetic resonance imaging (MRI) with T2-mapping and DR-CSI techniques. Maps of mean apparent diffusion coefficient (ADC), T2 relaxation time and volume fraction Vi for DR-CSI compartment i (A, B, C, D) sensitivity, specificity, and positive and negative likelihood ratio (PLR, NLR) were assessed to determine the diagnostic accuracy for detection of early-stage degeneration of knee articular cartilage. The structural abnormalities of articular cartilage were evaluated using modified Whole-Organ MR Imaging Scores (WORMS). RESULTS All intra- and interobserver agreements for DR-CSI compartment volume fractions and modified WORMS of cartilage were excellent. Early OA versus the controls had higher VC, lower VA and VB (p<0.001), but comparable VD (p>0.05). VA, VB and VC had a moderate association with WORMS. No significant correlation was identified between VD and WORMS. VC had better ability than VA,VB, VD, T2 and ADC to discriminate early OA patients from healthy controls (area under the curve, 0.898). Sensitivity, specificity, PLR, and NLR of VC with a cut-off value of 29.9% were 81.8% (95% confidence interval [CI], 69.1-90.9%), 95.9% (86-99.5%), 20.05% (5.13-78.34%), and 0.19% (0.11-0.33%). CONCLUSIONS DR-CSI compartment volume fractions may be sensitive indicators for detecting early-stage degeneration in knee articular cartilage.
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Affiliation(s)
- P Luo
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - W Hu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - R Xu
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Y Wang
- Department of Gastroenterology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - X Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - L Jiang
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - S Chang
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - D Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronics Science, East China Normal University, Shanghai 200062, China
| | - G Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
| | - Y Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China.
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Chang S, Wang SF, Zuo FF, Wang F, Gong BW, Wang YJ, Xie XJ. [Automated diagnostic classification with lateral cephalograms based on deep learning network model]. Zhonghua Kou Qiang Yi Xue Za Zhi 2023; 58:549-555. [PMID: 37271999 DOI: 10.3760/cma.j.cn112144-20230305-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To establish a comprehensive diagnostic classification model of lateral cephalograms based on artificial intelligence (AI) to provide reference for orthodontic diagnosis. Methods: A total of 2 894 lateral cephalograms were collected in Department of Orthodontics, Capital Medical University School of Stomatology from January 2015 to December 2021 to construct a data set, including 1 351 males and 1 543 females with a mean age of (26.4± 7.4) years. Firstly, 2 orthodontists (with 5 and 8 years of orthodontic experience, respectively) performed manual annotation and calculated measurement for primary classification, and then 2 senior orthodontists (with more than 20 years of orthodontic experience) verified the 8 diagnostic classifications including skeletal and dental indices. The data were randomly divided into training, validation, and test sets in the ratio of 7∶2∶1. The open source DenseNet121 was used to construct the model. The performance of the model was evaluated by classification accuracy, precision rate, sensitivity, specificity and area under the curve (AUC). Visualization of model regions of interest through class activation heatmaps. Results: The automatic classification model of lateral cephalograms was successfully established. It took 0.012 s on average to make 8 diagnoses on a lateral cephalogram. The accuracy of 5 classifications was 80%-90%, including sagittal and vertical skeletal facial pattern, mandibular growth, inclination of upper incisors, and protrusion of lower incisors. The acuracy rate of 3 classifications was 70%-80%, including maxillary growth, inclination of lower incisors and protrusion of upper incisors. The average AUC of each classification was ≥0.90. The class activation heat map of successfully classified lateral cephalograms showed that the AI model activation regions were distributed in the relevant structural regions. Conclusions: In this study, an automatic classification model for lateral cephalograms was established based on the DenseNet121 to achieve rapid classification of eight commonly used clinical diagnostic items.
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Affiliation(s)
- S Chang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - S F Wang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - F F Zuo
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - F Wang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - B W Gong
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Y J Wang
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - X J Xie
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
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16
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Wang SF, Xie XJ, Zhang L, Chang S, Zuo FF, Wang YJ, Bai YX. [Research on multi-class orthodontic image recognition system based on deep learning network model]. Zhonghua Kou Qiang Yi Xue Za Zhi 2023; 58:563-570. [PMID: 37272001 DOI: 10.3760/cma.j.cn112144-20230305-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To develop a multi-classification orthodontic image recognition system using the SqueezeNet deep learning model for automatic classification of orthodontic image data. Methods: A total of 35 000 clinical orthodontic images were collected in the Department of Orthodontics, Capital Medical University School of Stomatology, from October to November 2020 and June to July 2021. The images were from 490 orthodontic patients with a male-to-female ratio of 49∶51 and the age range of 4 to 45 years. After data cleaning based on inclusion and exclusion criteria, the final image dataset included 17 453 face images (frontal, smiling, 90° right, 90° left, 45° right, and 45° left), 8 026 intraoral images [frontal occlusion, right occlusion, left occlusion, upper occlusal view (original and flipped), lower occlusal view (original and flipped) and coverage of occlusal relationship], 4 115 X-ray images [lateral skull X-ray from the left side, lateral skull X-ray from the right side, frontal skull X-ray, cone-beam CT (CBCT), and wrist bone X-ray] and 684 other non-orthodontic images. A labeling team composed of orthodontic doctoral students, associate professors, and professors used image labeling tools to classify the orthodontic images into 20 categories, including 6 face image categories, 8 intraoral image categories, 5 X-ray image categories, and other images. The data for each label were randomly divided into training, validation, and testing sets in an 8∶1∶1 ratio using the random function in the Python programming language. The improved SqueezeNet deep learning model was used for training, and 13 000 natural images from the ImageNet open-source dataset were used as additional non-orthodontic images for algorithm optimization of anomaly data processing. A multi-classification orthodontic image recognition system based on deep learning models was constructed. The accuracy of the orthodontic image classification was evaluated using precision, recall, F1 score, and confusion matrix based on the prediction results of the test set. The reliability of the model's image classification judgment logic was verified using the gradient-weighted class activation mapping (Grad-CAM) method to generate heat maps. Results: After data cleaning and labeling, a total of 30 278 orthodontic images were included in the dataset. The test set classification results showed that the precision, recall, and F1 scores of most classification labels were 100%, with only 5 misclassified images out of 3 047, resulting in a system accuracy of 99.84%(3 042/3 047). The precision of anomaly data processing was 100% (10 500/10 500). The heat map showed that the judgment basis of the SqueezeNet deep learning model in the image classification process was basically consistent with that of humans. Conclusions: This study developed a multi-classification orthodontic image recognition system for automatic classification of 20 types of orthodontic images based on the improved SqueezeNet deep learning model. The system exhibitted good accuracy in orthodontic image classification.
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Affiliation(s)
- S F Wang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - X J Xie
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - L Zhang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - S Chang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
| | - F F Zuo
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - Y J Wang
- LargeV Instrument Corp., Ltd, Beijing 100084, China
| | - Y X Bai
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing 100050, China
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Rudym D, Lewis T, LaMaina V, Lesko M, Natalini J, Fitzpatrick E, Stiefel A, Ohanian J, Geraci T, Chan J, Chang S, Angel L. Infectious Complications after Conversion to Belatacept in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1407] [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: 04/05/2023] Open
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18
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Li YX, Ma XX, Zhao CL, Chang S, Meng SW, Liu Y. The effect of microRNA-663b in the inhibition of interleukin-1-induced nucleus pulposus cell apoptosis and inflammatory response. J Physiol Pharmacol 2023; 74. [PMID: 37245236 DOI: 10.26402/jpp.2023.10.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/28/2023] [Indexed: 05/30/2023]
Abstract
The aim of this study was to explore the role and pathological mechanism of microRNA-663b in interleukin-1beta (IL-1β)-induced inflammation and apoptosis of nucleus pulposus cells. First, the best concentration and time to construct the nucleus pulposus cell inflammation model was screen out. Overexpression or inhibition of miR-663b expression was performed by adding microRNA-663b mimic or microRNA-663b inhibitor. 293T cells were transfected according to experimental requirements. The luciferase activity of each group was detected to analyze the targeted regulation of microRNA-663b on interleukin-1 receptor (IL1R1). Compared with the mimic negative control (NC) group, the expression of inflammatory factors in the microRNA-663b overexpression group was inhibited (P<0.05), and the expression of type 2 collagen and polysaccharide protein increased (P<0.05), and the apoptosis of nucleus pulposus cells was inhibited (P<0.01), and the number of TUNEL-positive cells decreased significantly (P<0.01), and the microRNA and protein expression of IL1R1, the ratio of P-P65/P65 and phospho-nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (P-IκBα)/nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (IκBα) protein expression were significantly decreased (P<0.05). The expression of inflammatory factors in the miR-663b inhibitor group was significantly higher than that in the inhibitor NC group (P<0.01), and the expression of type 2 collagen and polysaccharide protein was significantly decreased (P<0.01), and the number of apoptosis cells and TUNEL staining positive cells increased (p<0.01). The expression of IL1R1 gene and protein was significantly increased (P<0.01). The ratio of P-P65/P65 and P-IκBα/IκBα protein expression increased (P<0.05). IL1R1 is a downstream target gene of microRNA-663b. MicroRNA-663b may down-regulate the expression of IL1R1 at the transcriptional level by targeting IL1R1, inhibit the inflammatory response of nucleus pulposus cells, and slow down the degeneration of nucleus pulposus cells.
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Affiliation(s)
- Y-X Li
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - X-X Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - C-L Zhao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - S Chang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - S-W Meng
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Y Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China.
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19
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Li YX, Ma XX, Zhao CL, Chang S, Meng SW, Liu Y. The effect of microRNA-663b in the inhibition of interleukin-1-induced nucleus pulposus cell apoptosis and inflammatory response. J Physiol Pharmacol 2023; 74. [PMID: 37245236 DOI: 10.26402/jpp.2023.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/28/2023] [Indexed: 07/13/2023]
Abstract
The aim of this study was to explore the role and pathological mechanism of microRNA-663b in interleukin-1beta (IL-1β)-induced inflammation and apoptosis of nucleus pulposus cells. First, the best concentration and time to construct the nucleus pulposus cell inflammation model was screen out. Overexpression or inhibition of miR-663b expression was performed by adding microRNA-663b mimic or microRNA-663b inhibitor. 293T cells were transfected according to experimental requirements. The luciferase activity of each group was detected to analyze the targeted regulation of microRNA-663b on interleukin-1 receptor (IL1R1). Compared with the mimic negative control (NC) group, the expression of inflammatory factors in the microRNA-663b overexpression group was inhibited (P<0.05), and the expression of type 2 collagen and polysaccharide protein increased (P<0.05), and the apoptosis of nucleus pulposus cells was inhibited (P<0.01), and the number of TUNEL-positive cells decreased significantly (P<0.01), and the microRNA and protein expression of IL1R1, the ratio of P-P65/P65 and phospho-nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (P-IκBα)/nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (IκBα) protein expression were significantly decreased (P<0.05). The expression of inflammatory factors in the miR-663b inhibitor group was significantly higher than that in the inhibitor NC group (P<0.01), and the expression of type 2 collagen and polysaccharide protein was significantly decreased (P<0.01), and the number of apoptosis cells and TUNEL staining positive cells increased (p<0.01). The expression of IL1R1 gene and protein was significantly increased (P<0.01). The ratio of P-P65/P65 and P-IκBα/IκBα protein expression increased (P<0.05). IL1R1 is a downstream target gene of microRNA-663b. MicroRNA-663b may down-regulate the expression of IL1R1 at the transcriptional level by targeting IL1R1, inhibit the inflammatory response of nucleus pulposus cells, and slow down the degeneration of nucleus pulposus cells.
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Affiliation(s)
- Y-X Li
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - X-X Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - C-L Zhao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - S Chang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - S-W Meng
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Y Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China.
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Lan N, Smukalla STM, Chang S. Fecal Incontinence and Defecatory Disorders in Patients With Ileal Pouch-Anal Anastomosis. Gastroenterol Hepatol (N Y) 2023; 19:41-47. [PMID: 36865815 PMCID: PMC9972658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Functional anorectal disorders are common in patients with ileal pouch-anal anastomosis (IPAA) and often have a debilitating impact on quality of life. The diagnosis of functional anorectal disorders, including fecal incontinence (FI) and defecatory disorders, requires a combination of clinical symptoms and functional testing. Symptoms are generally underdiagnosed and underreported. Commonly utilized tests include anorectal manometry, balloon expulsion test, defecography, electromyography, and pouchoscopy. The treatment for FI begins with lifestyle modifications and medications. Sacral nerve stimulation and tibial nerve stimulation have been trialed on patients with IPAA and FI, resulting in improvement in symptoms. Biofeedback therapy has also been used in patients with FI but is more commonly utilized in defecatory disorders. Early diagnosis of functional anorectal disorders is important because a response to treatment may significantly improve a patient's quality of life. To date, there is limited literature describing the diagnosis and treatment of functional anorectal disorders in patients with IPAA. This article focuses on the clinical presentation, diagnosis, and treatment of FI and defecatory disorders in patients with IPAA.
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Affiliation(s)
- Nan Lan
- 1Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York
| | - Scot t M. Smukalla
- 2Division of Gastroenterology, New York University Grossman School of Medicine, New York, New York
| | - Shannon Chang
- 2Division of Gastroenterology, New York University Grossman School of Medicine, New York, New York
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Chen SL, Faye AS, Chang S. Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment. Curr Treat Options Gastroenterol 2022; 20:564-581. [PMID: 36844648 PMCID: PMC9957085 DOI: 10.1007/s11938-022-00405-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE OF REVIEW Ileal pouch-anal anastomosis (IPAA) has become the preferred surgical treatment for patients with medically refractive ulcerative colitis (UC). Previous studies have suggested that outcomes of this procedure may be worse in older patients; however, more recent reports have suggested that IPAA in select patients is safe, feasible, and results in good quality of life. In this review, we discuss the recent literature surrounding clinical considerations and treatment management of IPAA in older adults. RECENT FINDINGS IPAA complication rates and adverse events are similar in the older adult population, as compared to the younger adult patient population. Although fecal urgency and incontinence may be more common among older adults, chronological age alone is not a contraindication for IPAA surgery, as good quality of life can still be achieved. In this review, we will also discuss the development of pouchitis after IPAA, particularly among older adults, as the emergence of newer biologic drugs has shifted the treatment landscape. SUMMARY IPAA can be a safe and effective treatment modality for older adults with UC, with high self-reported patient satisfaction. Patient optimization and careful case selection are vital to achieving these outcomes, and specialized preoperative assessments and counseling can help facilitate the proper treatment.
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Affiliation(s)
- Sabrina L. Chen
- Department of Gastroenterology, New York University Grossman School of Medicine, 305 East 33rd Street, NY 10016 New York, USA
| | - Adam S. Faye
- Department of Gastroenterology, New York University Grossman School of Medicine, 305 East 33rd Street, NY 10016 New York, USA
| | - Shannon Chang
- Department of Gastroenterology, New York University Grossman School of Medicine, 305 East 33rd Street, NY 10016 New York, USA
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Chang S, Chen S, Chen J. 627 Macrophage-regulating Drug Healed a Diabetic foot Ulcer with Gangrene and Osteomyelitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hu S, Khoury P, Akuthota P, Baylis L, Chang S, Wechsler M, Bentley J. Efficacité du mépolizumab chez les patients atteints de GEPA en fonction de l’impact du traitement à l’inclusion, de la durée de la maladie et du statut réfractaire. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.338] [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: 12/12/2022]
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Mell L, Torres-Saavedra P, Wong S, Chang S, Kish J, Minn A, Jordan R, Liu T, Truong M, Winquist E, Wise-Draper T, Rodriguez C, Musaddiq A, Beadle B, Henson C, Narayan S, Spencer S, Harris J, Yom S. Radiotherapy with Durvalumab vs. Cetuximab in Patients with Locoregionally Advanced Head and Neck Cancer and a Contraindication to Cisplatin: Phase II Results of NRG-HN004. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.003] [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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Hong SJ, Zenger C, Pecoriello J, Pang A, Vallely M, Hudesman DP, Chang S, Axelrad JE. Ustekinumab and Vedolizumab Are Not Associated With Subsequent Cancer in IBD Patients with Prior Malignancy. Inflamm Bowel Dis 2022; 28:1826-1832. [PMID: 35262671 PMCID: PMC9713494 DOI: 10.1093/ibd/izac035] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little data regarding the risk of new or recurrent cancer in patients with inflammatory bowel disease (IBD) and a prior history of cancer who are exposed to ustekinumab or vedolizumab. We assessed the risk of subsequent cancer in patients exposed to these agents. METHODS We performed a retrospective cohort study of patients with IBD and a history of cancer at an academic medical center between January 2013 and December 2020. We collected data on demographics, IBD and cancer disease characteristics, and drug exposures. The primary exposure was immunosuppressive therapy after diagnosis of cancer. The primary outcome was interval development of new or recurrent cancer. RESULTS Of 390 patients with IBD and a previous history of cancer, 37 were exposed to vedolizumab, 14 ustekinumab, 41 antitumor necrosis factor (anti-TNF), and 31 immunomodulator; and 267 were not exposed to immunosuppression following cancer diagnosis. During a total median follow-up time of 52 months, 81 (20%) patients developed subsequent cancer: 6 (16%) were exposed to vedolizumab, 2 (14%) to ustekinumab, 3 (10%) to immunomodulators, 12 (29%) to anti-TNF, and 56 (21%) with no immunosuppression (P = .41). In a multivariable Cox model adjusting for age, IBD subtype, smoking, cancer recurrence risk, and cancer stage, there was no increase in subsequent cancer with vedolizumab (adjusted hazard ratio, 1.36; 95% CI, 0.27-7.01) or ustekinumab (adjusted hazard ratio, 0.96; 95% CI, 0.17-5.41). Patients with more than 1 biologic exposure also did not have an increased risk of subsequent cancer. CONCLUSIONS Exposure to ustekinumab or vedolizumab in patients with IBD and a prior history of cancer does not appear to be associated with an increased risk of subsequent new or recurrent cancer.
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Affiliation(s)
- Simon J Hong
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Cameron Zenger
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Jillian Pecoriello
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Alice Pang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Margaret Vallely
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - David P Hudesman
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Shannon Chang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Jordan E Axelrad
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
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Hong SJ, Bhattacharya S, Aboubakr A, Nadkarni D, Lech D, Ungaro RC, Agrawal M, Hirten RP, Greywoode R, Mone A, Chang S, Hudesman DP, Ullman T, Sultan K, Lukin DJ, Colombel JF, Axelrad JE. COVID-19 is not associated with worse long-term inflammatory bowel disease outcomes: a multicenter case-control study. Therap Adv Gastroenterol 2022; 15:17562848221132363. [PMID: 36348637 PMCID: PMC9637830 DOI: 10.1177/17562848221132363] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is not associated with worse coronavirus disease 2019 (COVID-19) outcomes. However, data are lacking regarding the long-term impact of severe acute respiratory syndrome coronavirus 2 infection on the disease course of IBD. OBJECTIVES We aimed to investigate the effect of COVID-19 on long-term outcomes of IBD. DESIGN We performed a multicenter case-control study of patients with IBD and COVID-19 between February 2020 and December 2020. METHODS Cases and controls were individuals with IBD with presence or absence, respectively, of COVID-19-related symptoms and confirmatory testing. The primary composite outcome was IBD-related hospitalization or surgery. RESULTS We identified 251 cases [ulcerative colitis (n = 111, 45%), Crohn's disease (n = 139, 55%)] and 251 controls, with a median follow-up of 394 days. The primary composite outcome of IBD-related hospitalization or surgery occurred in 29 (12%) cases versus 38 (15%) controls (p = 0.24) and on multivariate Cox regression, COVID-19 was not associated with increased risk of adverse IBD outcomes [adjusted hazard ratio (aHR): 0.84, 95% confidence interval [CI]: 0.44-1.42]. When stratified by infection severity, severe COVID-19 was associated with a numerically increased risk of adverse IBD outcomes (aHR: 2.43, 95% CI: 1.00-5.86), whereas mild-to-moderate COVID-19 was not (aHR: 0.68, 95% CI: 0.38-1.23). CONCLUSION In this case-control study, COVID-19 did not have a long-term impact on the disease course of IBD. However, severe COVID-19 was numerically associated with worse IBD outcomes, underscoring the continued importance of risk mitigation and prevention strategies for patients with IBD during the ongoing COVID-19 pandemic.
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Affiliation(s)
| | - Sumona Bhattacharya
- Inflammatory Bowel Disease Center, Division of
Gastroenterology, NYU Langone Health, New York, NY, USA
| | - Aiya Aboubakr
- Jill Roberts Center for Inflammatory Bowel
Disease, Division of Gastroenterology and Hepatology, Department of
Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Devika Nadkarni
- The Dr. Henry D. Janowitz Division of
Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Diana Lech
- Division of Gastroenterology, Northwell Health,
North Shore University Hospital and Long Island Jewish Medical Center, Great
Neck, NY, USA
| | - Ryan C. Ungaro
- The Dr. Henry D. Janowitz Division of
Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Manasi Agrawal
- The Dr. Henry D. Janowitz Division of
Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Robert P. Hirten
- The Dr. Henry D. Janowitz Division of
Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Ruby Greywoode
- Division of Gastroenterology, Montefiore
Medical Center, Bronx, NY, USA
| | - Anjali Mone
- Division of Gastroenterology, Northwell
Health, North Shore University Hospital and Long Island Jewish Medical
Center, Great Neck, NY, USA
| | - Shannon Chang
- Inflammatory Bowel Disease Center, Division of
Gastroenterology, NYU Langone Health, New York, NY, USA
| | - David P. Hudesman
- Inflammatory Bowel Disease Center, Division of
Gastroenterology, NYU Langone Health, New York, NY, USA
| | - Thomas Ullman
- Division of Gastroenterology, Montefiore
Medical Center, Bronx, NY, USA
| | - Keith Sultan
- Division of Gastroenterology, Northwell
Health, North Shore University Hospital and Long Island Jewish Medical
Center, Great Neck, NY, USA
| | - Dana J. Lukin
- Jill Roberts Center for Inflammatory Bowel
Disease, Division of Gastroenterology and Hepatology, Department of
Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jean-Frederic Colombel
- The Dr. Henry D. Janowitz Division of
Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY,
USA
| | - Jordan E. Axelrad
- Inflammatory Bowel Disease Center, Division of
Gastroenterology, NYU Langone Health, New York, NY, USA
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Kenyon L, Shields J, Porter A, Chen J, Chao L, Chang S, Kho K. Ice-Pop: Ice Packs for Post-Operative Pain, a Randomized Controlled Trial. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.083] [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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28
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Dane B, Qian K, Krieger R, Smereka P, Foster J, Huang C, Chang S, Kim S. Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years. Abdom Radiol (NY) 2022; 47:3424-3435. [PMID: 35916941 DOI: 10.1007/s00261-022-03624-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To retrospectively evaluate which key imaging features described by SAR-AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD. METHODS 52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index. RESULTS 19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568-0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar. CONCLUSION Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.
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Affiliation(s)
- Bari Dane
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA.
| | - Kun Qian
- NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY, 10016, USA
| | - Rachel Krieger
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Paul Smereka
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Jonathan Foster
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Chenchan Huang
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Shannon Chang
- NYU Langone Health Department of Gastroenterology, 305 E 33rd Street, New York, NY, 10016, USA
| | - Sooah Kim
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
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29
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Dane B, Kernizan A, O'Donnell T, Petrocelli R, Rabbenou W, Bhattacharya S, Chang S, Megibow A. Crohn's disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation. Abdom Radiol (NY) 2022; 47:3406-3413. [PMID: 35833999 DOI: 10.1007/s00261-022-03605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare terminal ileum (TI) mucosal iodine density obtained at dual-energy CT enterography (DECTE) with conventional CT interpretation and endoscopy in patients with Crohn's disease (CD). MATERIALS AND METHODS Twenty-three CD patients (14 men; mean[SD] age:48.1[16.7] years) with endoscopy within 30 days of DECTE were retrospectively identified. An inflammatory bowel disease gastroenterologist reviewed endoscopic images. Two radiologists qualitatively assessed the presence of active TI inflammation. Mean iodine density normalized to the aorta (I%), mean absolute iodine density (I), and iodine density standard deviation (ISD) from the distal 2 cm ileum (TI) mucosa obtained using semiautomatic prototype software were compared with endoscopic assessment using Mann Whitney tests. The optimal threshold I% and I were determined from receiver operating curves (ROC). Sensitivity and specificity of conventional interpretation and determined iodine thresholds were compared using McNemar's test. Inter-reader agreement was assessed using kappa. A p < 0.05 indicated statistical significance. RESULTS Twelve (52.1%) patients had endoscopic active inflammation. I% was 37.9[13.3]% for patients with and 21.7[7.5]% for patients without endoscopic active inflammation (p = 0.001). The optimal ROC threshold 24.6% had 100% sensitivity and 81.8% specificity (AUC = 0.909, 95% CI 0.777-1). I was 2.44[0.73]mg/mL for patients with and 1.77[1.00]mg/mL for patients without active endoscopic inflammation (p = 0.0455). The optimal ROC threshold 1.78 mg/mL I had 91.7% sensitivity and 63.6% specificity (AUC = 0.75, 95% CI 0.532-0.968). ISD was similar for patients with and without endoscopic active inflammation (0.82[0.33]mg/mL and 0.77[0.28]mg/mL, respectively, p = 0.37). Conventional interpretation sensitivity and specificity (R1/R2) were 83.3%/91.7% and 72.7%/54.5%, respectively (all p > 0.05) with moderate inter-reader agreement (Κ = 0.542[95% CI 0.0202-0.088]). CONCLUSION Mean normalized iodine density is highly sensitive and specific for endoscopic active inflammation. DECTE could be considered as a surrogate to endoscopy in CD patients. Despite trends towards improved sensitivity and specificity compared with conventional interpretation, future larger studies are needed.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. .,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.
| | - Amelia Kernizan
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Thomas O'Donnell
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Robert Petrocelli
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Wendy Rabbenou
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Sumona Bhattacharya
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Shannon Chang
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
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Rodriguez Almaraz J, Guerra G, Wendt G, Chang S, Francis SS. P10.09.B Retroelement expression in glioma tumors exhibits subtype specific patterns. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There are ~3 million transposable elements in the human genome constituting about 42% of all basepairs. Retroelements (REs) are ~90% of the transposable elements present in the human genome. Active REs are considered highly mutagenic and have been implicated in multiple steps of cancer development and progression, as well as in neurologic diseases. RE activity has functional effects on the genome, including the maintenance of centromere and telomere integrity, and deleterious gene expression. Previous studies have shown that certain families of RE (HERVK, L1, Alu) are expressed in gliomas, however, their specific role as arbitrators of oncogenesis or promoters of the innate anti-tumor immune response remains uncertain. Moreover, it has been shown that a soluble form of PD-L1 (sPD-L1) that blocks its inhibitory activity is produced by exaptation of an intronic endogenous retroelement (LINE-2A) in the gene encoding PD-L1, highlighting the importance of REs as potential therapeutic targets. In this analysis we aim to identify the unique patterns of RE expression across major subtypes of glioma.
Material and Methods
We conducted a differential expression analysis of 49 RE families using RNA-seq data measured in glioma tumors from The Cancer Genome Atlas (TCGA). RE counts were produced using the software REDiscoverTE. Pairwise comparisons between glioma subtypes (defined by WHO2021) were done using in 625 tumor samples adjusting for age, sex and race.
Results
10 of the 49 considered RE families exhibited significantly different (false discovery rate, FDR, <0.05) expression in at least one glioma subtype. Alu(Fold change, FC=1.5), RNA(FC=11.3), PiggyBac(FC=1.6), rRNA(FC=5.23) and Dong-R4(FC=1.8) were overexpressed in IDH-wildtype glioblastoma while Gypsy(FC=0.4) and CRP1(FC=0.26) were decreased in expression. scRNA (FC=2.7) were overexpressed in IDH-mutant oligodendroglioma compared to glioblastoma while Dong-R4 (FC = 0.53) showed decreased expression. LTR (FC=2.02) and tRNA-Deu (FC=1.46), showed increased expression in IDH-wildtype diffuse astrocytomas compared to IDH-mutant, 1p/19q-codeleted oligodendrogliomas while Gypsy (FC =0.41) showed decreased expression.
Conclusion
We have shown that expression of certain RE families within gliomas have subtype-specific patterns. While it is well established that RE expression is dysregulated in cancer, our analysis is the first at exploring a wide range of retroelements in the context of glioma by subtype. Given the important role of REs in transcriptional control, genomic instability, chromosomal rearrangements, and oncogenic activation, the identification of individual families and specific REs in glioma holds an intrinsic value to potential biomarkers and immunotherapy targets.
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Affiliation(s)
| | - G Guerra
- University of California, San Francisco , San Francisco, CA , United States
| | - G Wendt
- University of California, San Francisco , San Francisco, CA , United States
| | - S Chang
- University of California, San Francisco , San Francisco, CA , United States
| | - S S Francis
- University of California, San Francisco , San Francisco, CA , United States
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31
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Kiran RP, Kochhar GS, Kariv R, Rex DK, Sugita A, Rubin DT, Navaneethan U, Hull TL, Ko HM, Liu X, Kachnic LA, Strong S, Iacucci M, Bemelman W, Fleshner P, Safyan RA, Kotze PG, D'Hoore A, Faiz O, Lo S, Ashburn JH, Spinelli A, Bernstein CN, Kane SV, Cross RK, Schairer J, McCormick JT, Farraye FA, Chang S, Scherl EJ, Schwartz DA, Bruining DH, Philpott J, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sandborn WJ, Silverberg MS, Pardi DS, Church JM, Shen B. Management of pouch neoplasia: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2022; 7:871-893. [PMID: 35798022 DOI: 10.1016/s2468-1253(22)00039-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Surveillance pouchoscopy is recommended for patients with restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis or familial adenomatous polyposis, with the surveillance interval depending on the risk of neoplasia. Neoplasia in patients with ileal pouches mainly have a glandular source and less often are of squamous cell origin. Various grades of neoplasia can occur in the prepouch ileum, pouch body, rectal cuff, anal transition zone, anus, or perianal skin. The main treatment modalities are endoscopic polypectomy, endoscopic ablation, endoscopic mucosal resection, endoscopic submucosal dissection, surgical local excision, surgical circumferential resection and re-anastomosis, and pouch excision. The choice of the treatment modality is determined by the grade, location, size, and features of neoplastic lesions, along with patients' risk of neoplasia and comorbidities, and local endoscopic and surgical expertise.
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Affiliation(s)
- Ravi P Kiran
- Division of Colorectal Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Akira Sugita
- Department of Clinical Research and Department of inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital Yokohama, Japan
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Udayakumar Navaneethan
- IBD Center and IBD Interventional Unit, Center for Interventional Endoscopy, Orlando Health, Orlando, FL, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Huaibin Mabel Ko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Xiuli Liu
- Department of Pathology and Immunology, Washington University, St Louis, MO, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Scott Strong
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust, University of Birmingham, UK
| | - Willem Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Philip Fleshner
- Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rachael A Safyan
- Division of Hematology and Oncology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Paulo G Kotze
- IBD Outpatients Clinic, Catholic University of Paraná, Curitiba, Brazil
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Belgium
| | - Omar Faiz
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow and Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simon Lo
- Pancreatic and Biliary Disease Program, Digestive Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jean H Ashburn
- Department of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Division Colon and Rectal Surgery, Rozzano, Milan, Italy
| | - Charles N Bernstein
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, MB, Canada
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Raymond K Cross
- Inflammatory Bowel Disease Program, University of Maryland School of Medicine, MD, USA
| | - Jason Schairer
- Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA
| | - James T McCormick
- Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Shannon Chang
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ellen J Scherl
- Jill Roberts Center for IBD, Gastroenterology and Hepatology, Weill Cornell Medicine and NewYork Presbyterian Hospital, New York, NY, USA
| | - David A Schwartz
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jessica Philpott
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Dino Tarabar
- IBD Clinical Center, University Hospital Center Dr Dragiša Mišović, Belgrade, Serbia
| | - Sandra El-Hachem
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - William J Sandborn
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mark S Silverberg
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, Toronto, ON, Canada
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - James M Church
- Division of Colorectal Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Bo Shen
- Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
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Chang S, Li SS, Lu QS, Jing ZP, Zhou J. [Research progress on risk factors for adverse events after thoracic endovascular aortic repair for Stanford type B aortic dissection]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:825-829. [PMID: 35982019 DOI: 10.3760/cma.j.cn112148-20220419-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- S Chang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - S S Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Q S Lu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Z P Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - J Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
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33
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Chang S, Zhou J, Lu QS, Jing ZP. [Exploration of endovascular repair of aortic disease]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:739-742. [PMID: 35982003 DOI: 10.3760/cma.j.cn112148-20220628-00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- S Chang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - J Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Q S Lu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Z P Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai 200433, China
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Dot G, Schouman T, Chang S, Rafflenbeul F, Kerbrat A, Rouch P, Gajny L. Automatic 3-Dimensional Cephalometric Landmarking via Deep Learning. J Dent Res 2022; 101:1380-1387. [PMID: 35982646 DOI: 10.1177/00220345221112333] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The increasing use of 3-dimensional (3D) imaging by orthodontists and maxillofacial surgeons to assess complex dentofacial deformities and plan orthognathic surgeries implies a critical need for 3D cephalometric analysis. Although promising methods were suggested to localize 3D landmarks automatically, concerns about robustness and generalizability restrain their clinical use. Consequently, highly trained operators remain needed to perform manual landmarking. In this retrospective diagnostic study, we aimed to train and evaluate a deep learning (DL) pipeline based on SpatialConfiguration-Net for automatic localization of 3D cephalometric landmarks on computed tomography (CT) scans. A retrospective sample of consecutive presurgical CT scans was randomly distributed between a training/validation set (n = 160) and a test set (n = 38). The reference data consisted of 33 landmarks, manually localized once by 1 operator(n = 178) or twice by 3 operators (n = 20, test set only). After inference on the test set, 1 CT scan showed "very low" confidence level predictions; we excluded it from the overall analysis but still assessed and discussed the corresponding results. The model performance was evaluated by comparing the predictions with the reference data; the outcome set included localization accuracy, cephalometric measurements, and comparison to manual landmarking reproducibility. On the hold-out test set, the mean localization error was 1.0 ± 1.3 mm, while success detection rates for 2.0, 2.5, and 3.0 mm were 90.4%, 93.6%, and 95.4%, respectively. Mean errors were -0.3 ± 1.3° and -0.1 ± 0.7 mm for angular and linear measurements, respectively. When compared to manual reproducibility, the measurements were within the Bland-Altman 95% limits of agreement for 91.9% and 71.8% of skeletal and dentoalveolar variables, respectively. To conclude, while our DL method still requires improvement, it provided highly accurate 3D landmark localization on a challenging test set, with a reliability for skeletal evaluation on par with what clinicians obtain.
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Affiliation(s)
- G Dot
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France.,Universite Paris Cite, AP-HP, Hopital Pitie Salpetriere, Service de Medecine Bucco-Dentaire, Paris, France
| | - T Schouman
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France.,Medecine Sorbonne Universite, AP-HP, Hopital Pitie-Salpetriere, Service de Chirurgie Maxillo-Faciale, Paris, France
| | - S Chang
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France
| | - F Rafflenbeul
- Department of Dentofacial Orthopedics, Faculty of Dental Surgery, Strasbourg University, Strasbourg, France
| | - A Kerbrat
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France
| | - P Rouch
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France
| | - L Gajny
- Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers Institute of Technology, Paris, France
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Axelrad JE, Li T, Bachour SP, Nakamura TI, Shah R, Sachs MC, Chang S, Hudesman DP, Holubar SD, Lightner AL, Barnes EL, Cohen BL, Rieder F, Esen E, Remzi F, Regueiro M, Click B. Early Initiation of Antitumor Necrosis Factor Therapy Reduces Postoperative Recurrence of Crohn's Disease Following Ileocecal Resection. Inflamm Bowel Dis 2022:6651946. [PMID: 35905032 PMCID: PMC10233395 DOI: 10.1093/ibd/izac158] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative recurrence (POR) of Crohn's disease (CD) is common after surgical resection. We aimed to compare biologic type and timing for preventing POR in adult CD patients after ileocecal resection (ICR). METHODS We performed a retrospective cohort study of CD patients who underwent an ICR at 2 medical centers. Recurrence was defined by endoscopy (≥ i2b Rutgeerts score) or radiography (active inflammation in neoterminal ileum) and stratified by type and timing of postoperative prophylactic biologic within 12 weeks following an ICR (none, tumor necrosis factor antagonists [anti-TNF], vedolizumab, and ustekinumab). RESULTS We identified 1037 patients with CD who underwent an ICR. Of 278 (26%) who received postoperative prophylaxis, 80% were placed on an anti-TNF agent (n = 223) followed by ustekinumab (n = 28, 10%) and vedolizumab (n = 27, 10%). Prophylaxis was initiated in 35% within 4 weeks following an ICR and in 65% within 4 to 12 weeks. After adjusting for factors associated with POR, compared with no biologic prophylaxis, the initiation of an anti-TNF agent within 4 weeks following an ICR was associated with a reduction in POR (adjusted hazard ratio, 0.61; 95% CI, 0.40-0.93). Prophylaxis after 4 weeks following an ICR or with vedolizumab or ustekinumab was not associated with a reduction in POR compared with those who did not receive prophylaxis. CONCLUSION Early initiation of an anti-TNF agent within 4 weeks following an ICR was associated with a reduction in POR. Vedolizumab or ustekinumab, at any time following surgery, was not associated with a reduction in POR, although sample size was limited.
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Affiliation(s)
- Jordan E Axelrad
- Divison of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Terry Li
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Salam P Bachour
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Takahiro I Nakamura
- Divison of Gastroenterology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Ravi Shah
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Michael C Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Shannon Chang
- Divison of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - David P Hudesman
- Divison of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Edward L Barnes
- Divison of Gastroenterology, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Esen
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Feza Remzi
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
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Barnes EL, Deepak P, Beniwal-Patel P, Raffals L, Kayal M, Dubinsky M, Chang S, Higgins PDR, Barr JI, Galanko J, Jiang Y, Cross RK, Long MD, Herfarth HH. Treatment Patterns and Standardized Outcome Assessments Among Patients With Inflammatory Conditions of the Pouch in a Prospective Multicenter Registry. Crohn's & Colitis 360 2022; 4:otac030. [PMID: 36082341 PMCID: PMC9446900 DOI: 10.1093/crocol/otac030] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Much of our understanding about the natural history of pouch-related disorders has been generated from selected populations. We designed a geographically diverse, prospective registry to study the disease course among patients with 1 of 4 inflammatory conditions of the pouch. The primary objectives in this study were to demonstrate the feasibility of a prospective pouch registry and to evaluate the predominant treatment patterns for pouch-related disorders.
Methods
We used standardized diagnostic criteria to prospectively enroll patients with acute pouchitis, chronic antibiotic-dependent pouchitis (CADP), chronic antibiotic refractory pouchitis (CARP), or Crohn’s disease (CD) of the pouch. We obtained detailed clinical and demographic data at the time of enrollment, along with patient-reported outcome (PRO) measures.
Results
We enrolled 318 patients (10% acute pouchitis, 27% CADP, 12% CARP, and 51% CD of the pouch). Among all patients, 55% were on a biologic or small molecule therapy. Patients with CD of the pouch were more likely to use several classes of therapy (P < .001). Among patients with active disease at the time of enrollment, 23% with CARP and 40% with CD of the pouch were in clinical remission at 6 months after enrollment.
Conclusions
In a population where most patients had refractory inflammatory conditions of the pouch, we established a framework to evaluate PROs and clinical effectiveness. This infrastructure will be valuable for long-term studies of real-world effectiveness for pouch-related disorders.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina , Chapel Hill, North Carolina , USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis , St. Louis, Missouri , USA
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin , Milwaukee, Wisconsin , USA
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic , Rochester, Minnesota , USA
| | - Maia Kayal
- Division of Gastroenterology, The Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Marla Dubinsky
- Division of Pediatric Gastroenterology, The Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Shannon Chang
- Division of Gastroenterology and Hepatology, NYU Langone Health , New York, New York , USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, University of Michigan , Ann Arbor, Michigan , USA
| | - Jennifer I Barr
- Center for Gastrointestinal Biology and Disease, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Joseph Galanko
- Center for Gastrointestinal Biology and Disease, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Yue Jiang
- Trinity College of Arts and Sciences, Duke University , Durham, North Carolina , USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine , Baltimore, Maryland , USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina , Chapel Hill, North Carolina , USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina , Chapel Hill, North Carolina , USA
- Center for Gastrointestinal Biology and Disease, University of North Carolina , Chapel Hill, North Carolina , USA
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Luo P, Hu W, Jiang L, Chang S, Wu D, Li G, Dai Y. Evaluation of articular cartilage in knee osteoarthritis using hybrid multidimensional MRI. Clin Radiol 2022; 77:e518-e525. [DOI: 10.1016/j.crad.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
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Shields J, Kenyon L, Porter A, Chen J, Chao L, Chang S, Kho K. Ice-pop: ice packs for postoperative pain, a randomized controlled trial. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shen B, Kochhar GS, Rubin DT, Kane SV, Navaneethan U, Bernstein CN, Cross RK, Sugita A, Schairer J, Kiran RP, Fleshner P, McCormick JT, D'Hoore A, Shah SA, Farraye FA, Kariv R, Liu X, Rosh J, Chang S, Scherl E, Schwartz DA, Kotze PG, Bruining DH, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, Picoraro JA, Vermeire S, Sandborn WJ, Silverberg MS, Pardi DS. Treatment of pouchitis, Crohn's disease, cuffitis, and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2022; 7:69-95. [PMID: 34774224 DOI: 10.1016/s2468-1253(21)00214-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
Pouchitis, Crohn's disease of the pouch, cuffitis, polyps, and extraintestinal manifestations of inflammatory bowel disease are common inflammatory disorders of the ileal pouch. Acute pouchitis is treated with oral antibiotics and chronic pouchitis often requires anti-inflammatory therapy, including the use of biologics. Aetiological factors for secondary pouchitis should be evaluated and managed accordingly. Crohn's disease of the pouch is usually treated with biologics and its stricturing and fistulising complications can be treated with endoscopy or surgery. The underlying cause of cuffitis determines treatment strategies. Endoscopic polypectomy is recommended for large, symptomatic inflammatory polyps and polyps in the cuff. The management principles of extraintestinal manifestations of inflammatory bowel disease in patients with pouches are similar to those in patients without pouches.
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Affiliation(s)
- Bo Shen
- Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA.
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Udayakumar Navaneethan
- Center for IBD and Interventional IBD Unit, Digestive Health Institute, Orlando Health, Orlando, FL, USA
| | - Charles N Bernstein
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Raymond K Cross
- Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Maryland, MD, USA
| | - Akira Sugita
- Department of Clinical Research and Department of inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital, Yokohama, Japan
| | - Jason Schairer
- Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA
| | - Ravi P Kiran
- Division of Colorectal Surgery, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA
| | - Philip Fleshner
- Division of Colorectal Surgery, University of California-Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - James T McCormick
- Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Samir A Shah
- Alpert Medical School of Brown University and Miriam Hospital, Gastroenterology Associates, Providence, RI, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainsville, FL, USA
| | - Joel Rosh
- Department of Pediatric Gastroenterology, Goryeb Children's Hospital/Atlantic Health, Morristown, NJ, USA
| | - Shannon Chang
- Division of Gastroenterology, New York University Langone Health, New York, NY, USA
| | - Ellen Scherl
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, NewYork Presbytarian Hospital, New York, NY, USA
| | - David A Schwartz
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jessica Philpott
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Bincy Abraham
- Houston Methodist and Weill Cornell Medical College, Houston, TX, USA
| | - Jonathan Segal
- Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge, UK
| | - Rocio Sedano
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Maia Kayal
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA
| | - Dino Tarabar
- IBD Clinical Center, University Hospital Center Dr Dragiša Mišović, Belgrade, Serbia
| | - Sandra El-Hachem
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Priya Sehgal
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, NY, USA
| | - Joseph A Picoraro
- Department of Pediatrics, Columbia University Irving Medical Center-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - William J Sandborn
- Department of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Mark S Silverberg
- Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Lukin D, Faleck D, Xu R, Zhang Y, Weiss A, Aniwan S, Kadire S, Tran G, Rahal M, Winters A, Chablaney S, Koliani-Pace JL, Meserve J, Campbell JP, Kochhar G, Bohm M, Varma S, Fischer M, Boland B, Singh S, Hirten R, Ungaro R, Lasch K, Shmidt E, Jairath V, Hudesman D, Chang S, Swaminath A, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Comparative Safety and Effectiveness of Vedolizumab to Tumor Necrosis Factor Antagonist Therapy for Ulcerative Colitis. Clin Gastroenterol Hepatol 2022; 20:126-135. [PMID: 33039584 PMCID: PMC8026779 DOI: 10.1016/j.cgh.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 06/03/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We aimed to compare safety and effectiveness of vedolizumab to tumor necrosis factor (TNF)-antagonist therapy in ulcerative colitis in routine practice. METHODS A multicenter, retrospective, observational cohort study (May 2014 to December 2017) of ulcerative colitis patients treated with vedolizumab or TNF-antagonist therapy. Propensity score weighted comparisons for development of serious adverse events and achievement of clinical remission, steroid-free clinical remission, and steroid-free deep remission. A priori determined subgroup comparisons in TNF-antagonist-naïve and -exposed patients, and for vedolizumab against infliximab and subcutaneous TNF-antagonists separately. RESULTS A total of 722 (454 vedolizumab, 268 TNF antagonist) patients were included. Vedolizumab-treated patients were more likely to achieve clinical remission (hazard ratio [HR], 1.651; 95% confidence interval [CI], 1.229-2.217), steroid-free clinical remission (HR, 1.828; 95% CI, 1.135-2.944), and steroid-free deep remission (HR, 2.819; 95% CI, 1.496-5.310) than those treated with TNF antagonists. Results were consistent across subgroup analyses in TNF-antagonist-naïve and -exposed patients, and for vedolizumab vs infliximab and vs subcutaneous TNF-antagonist agents separately. Overall, there were no statistically significant differences in the risk of serious adverse events (HR, 0.899; 95% CI, 0.502-1.612) or serious infections (HR, 1.235; 95% CI, 0.608-2.511) between vedolizumab-treated and TNF-antagonist-treated patients. However, in TNF-antagonist-naïve patients, vedolizumab was less likely to be associated with serious adverse events than TNF antagonists (HR, 0.192; 95% CI, 0.049-0.754). CONCLUSIONS Treatment of ulcerative colitis with vedolizumab is associated with higher rates of remission than treatment with TNF-antagonist therapy in routine practice, and lower rates of serious adverse events in TNF-antagonist-naïve patients.
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Affiliation(s)
- Dana Lukin
- Montefiore Medical Center, New York, New York
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronghui Xu
- University of California, San Diego, La Jolla, California
| | - Yiran Zhang
- University of California, San Diego, La Jolla, California
| | - Aaron Weiss
- Montefiore Medical Center, New York, New York
| | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California
| | | | | | | | | | | | - Brigid Boland
- University of California, San Diego, La Jolla, California
| | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Lasch
- Takeda Pharmaceuticals, Lexington, Massachusetts
| | | | - Vipul Jairath
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
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Tappy E, Pan E, Chang S, Wang A, Diksha V, Brown S, Florian-Rodriguez M. Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dane B, Qian K, Gauvin S, Ji H, Karajgikar J, Kim N, Chang S, Chandarana H, Kim S. Inter-reader agreement of the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus reporting for key phenotypes at MR enterography in adults with Crohn disease: impact of radiologist experience. Abdom Radiol (NY) 2021; 46:5095-5104. [PMID: 34324038 DOI: 10.1007/s00261-021-03229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist experience on inter-reader agreement of CD phenotypes. METHODS Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level. RESULTS All readers had almost-perfect inter-reader agreement (κ > 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (κ: 0.80-0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (κ 0.68 versus 0.96, p = 0.018) and for strictures on follow-up than initial MRE (κ 0.76 versus 1.0, p = 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (κ: 0.55 versus 0.92, p = 0.008). CONCLUSION There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.
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Oppenheimer J, Abott C, Chang S, Chupp G, Crawford J, Mannino D, Win P. D010 CAPTAIN STUDY: EFFECTS OF BASELINE IGE LEVELS ON TRIPLE THERAPY RESPONSE IN INADEQUATELY CONTROLLED ASTHMA. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.048] [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: 10/19/2022]
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Legg-St. Pierre C, Desprez I, Chang S, Machin K, Ambros B. Comparison of time until hemoglobin desaturation between preoxygenated and non-preoxygenated hens (Gallus domesticus) following isoflurane mask induction of anesthesia and rocuronium-induced apnea. Vet Anaesth Analg 2021. [DOI: 10.1016/j.vaa.2021.09.018] [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: 10/19/2022]
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Hong S, Zaki TA, Main M, Hine AM, Chang S, Hudesman D, Axelrad JE. Comparative Evaluation of Conventional Stool Testing and Multiplex Molecular Panel in Outpatients With Relapse of Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1634-1640. [PMID: 33386740 PMCID: PMC9115373 DOI: 10.1093/ibd/izaa336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Differentiating between enteric infection and relapse of inflammatory bowel disease (IBD) is a common clinical challenge. Few studies have evaluated the impact of multiplex gastrointestinal polymerase chain reaction (GI PCR) pathogen panels on clinical practice compared to stool culture. Our aim was to compare the impact of PCR stool testing to conventional stool testing in outpatients presenting with relapse of IBD. METHODS In a retrospective cohort study of outpatients with IBD presenting to NYU Langone Health with flare from September 2015 to April 2019, we compared patients who underwent stool testing with GI PCR to age-, sex-, and IBD-subtype-matched patients who underwent culture and ova and parasite exam (conventional testing). The primary outcome was IBD therapy escalation after testing. Secondary outcomes included rates of posttesting endoscopy, abdominal radiography, antibiotics, and IBD-related emergency department visits, hospitalizations, and abdominal surgeries. RESULTS We identified 134 patients who underwent GI PCR matched to 134 patients who underwent conventional testing. Pathogens were more frequently identified on GI PCR (26 vs 5%; P < 0.01). We found that GI PCR was associated with less escalation in IBD therapy (16 vs 29%; P < 0.01) and fewer posttest endoscopies (10% vs 18%; P = 0.04), with no differences in IBD outcomes. On multivariate analysis, testing with GI PCR was associated with an odds ratio of 0.26 (95% confidence interval, 0.08-0.84; P = 0.02) for escalation of IBD therapies. CONCLUSIONS Testing with GI PCR was associated with higher rates of pathogen detection and lower rates of IBD therapy escalation and endoscopy in the outpatient setting. These changes in management were not associated with a difference in IBD outcomes.
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Affiliation(s)
- Soonwook Hong
- Department of Medicine, NYU Langone Health, New York, New York, New York, USA
- Address correspondence to: Soonwook Hong, MD, Department of Medicine, NYU Langone Health, 555 First Ave., New York, NY 10016, USA ()
| | - Timothy A Zaki
- Department of Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Main
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley M Hine
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Shannon Chang
- Department of Gastroenterology, NYU Langone Health , New York, New York, USA
| | - David Hudesman
- Department of Gastroenterology, NYU Langone Health , New York, New York, USA
| | - Jordan E Axelrad
- Department of Gastroenterology, NYU Langone Health , New York, New York, USA
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Shen B, Kochhar GS, Kariv R, Liu X, Navaneethan U, Rubin DT, Cross RK, Sugita A, D'Hoore A, Schairer J, Farraye FA, Kiran RP, Fleshner P, Rosh J, Shah SA, Chang S, Scherl E, Pardi DS, Schwartz DA, Kotze PG, Bruining DH, Kane SV, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, McCormick JT, Picoraro JA, Silverberg MS, Bernstein CN, Sandborn WJ, Vermeire S. Diagnosis and classification of ileal pouch disorders: consensus guidelines from the International Ileal Pouch Consortium. Lancet Gastroenterol Hepatol 2021; 6:826-849. [PMID: 34416186 DOI: 10.1016/s2468-1253(21)00101-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Restorative proctocolectomy with ileal pouch-anal anastomosis is an option for most patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the construction of an ileal pouch substantially improves patients' health-related quality of life, the surgery is, directly or indirectly, associated with various structural, inflammatory, and functional adverse sequelae. Furthermore, the surgical procedure does not completely abolish the risk for neoplasia. Patients with ileal pouches often present with extraintestinal, systemic inflammatory conditions. The International Ileal Pouch Consortium was established to create this consensus document on the diagnosis and classification of ileal pouch disorders using available evidence and the panellists' expertise. In a given individual, the condition of the pouch can change over time. Therefore, close monitoring of the activity and progression of the disease is essential to make accurate modifications in the diagnosis and classification in a timely manner.
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Affiliation(s)
- Bo Shen
- Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA.
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Xiuli Liu
- Department of Pathology and Immunology, Washington University, MO, USA
| | - Udayakumar Navaneethan
- IBD Center and IBD Interventional Unit, Center for Interventional Endoscopy, Orlando Health, Orlando, FL, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Raymond K Cross
- Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akira Sugita
- Department of Clinical Research and Department of Inflammatory Bowel Disease, Yokohama Municipal Citizens Hospital Yokohama, Japan
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Belgium
| | - Jason Schairer
- Department of Gastroenterology, Henry Ford Health System, Detroit, MI, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ravi P Kiran
- Division of Colorectal Surgery, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA
| | - Philip Fleshner
- Division of Colorectal Surgery, University of California-Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Joel Rosh
- Department of Pediatric Gastroenterology, Goryeb Children's Hospital-Atlantic Health, Morristown, NJ, USA
| | - Samir A Shah
- Alpert Medical School of Brown University and Miriam Hospital, Gastroenterology Associates, Providence, RI, USA
| | - Shannon Chang
- Division of Gastroenterology, New York University Langone Health, New York, NY, USA
| | - Ellen Scherl
- New York Presbyterian Hospital, Jill Roberts Center for IBD, Weill Cornell Medicine, Gastroenterology and Hepatology, New York, NY, USA
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David A Schwartz
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paulo G Kotze
- IBD Outpatients Clinic, Catholic University of Paraná, Curitiba, Brazil
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jessica Philpott
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Bincy Abraham
- Houston Methodist and Weill Cornell Medical College, Houston, TX, USA
| | - Jonathan Segal
- Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge, UK
| | - Rocio Sedano
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Maia Kayal
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA
| | - Dino Tarabar
- IBD Clinical Center, University Hospital Center Dr Dragiša Mišović, Belgrade, Serbia
| | - Sandra El-Hachem
- Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
| | - Priya Sehgal
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New-York Presbyterian Hospital, NY, USA
| | - James T McCormick
- Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Joseph A Picoraro
- Department of Pediatrics, Columbia University Irving Medical Center-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Mark S Silverberg
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, Toronto, ON, Canada
| | - Charles N Bernstein
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - William J Sandborn
- Department of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Séverine Vermeire
- Department of Gastroenterology, University hospitals Leuven, Leuven, Belgium
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Dane B, Sarkar S, Nazarian M, Galitzer H, O'Donnell T, Remzi F, Chang S, Megibow A. Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis. Radiology 2021; 301:144-151. [PMID: 34342502 DOI: 10.1148/radiol.2021204405] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Dual-energy CT enterography (DECTE) has been shown to be useful in characterizing Crohn disease activity compared with clinical markers of inflammation but, to the knowledge of the authors, comparison has not been made with histopathologic specimens. Purpose To compare mucosal iodine density obtained at DECTE from Crohn disease-affected bowel with histopathologic specimens from surgically resected ileocolectomy bowel segments or terminal ileum colonoscopic biopsies in the same patients. Materials and Methods This was a retrospective study. Bowel segments in adults with Crohn disease who underwent DECTE from January 2017 to April 2019 within 90 days of ileocolectomy or colonoscopy were retrospectively evaluated with prototype software allowing the semiautomatic determination of inner hyperdense bowel wall (mucosal) mean iodine density, normalized to the aorta. Mean normalized iodine density and clinical activity indexes (Crohn Disease Activity Index [CDAI] and Harvey-Bradshaw Index [HBI]) were compared with histologic active inflammation grades by using two-tailed t tests. Receiver operating characteristic curves were generated for mean normalized iodine density, CDAI, and HBI to determine sensitivity, specificity, and accuracy. A P value less than .05 was considered to indicate statistical significance. Results The following 16 patients were evaluated (mean age, 41 years ± 14 [standard deviation]): 10 patients (five men, five women; mean age, 41 years ± 15) with 19 surgical resection specimens and six patients with terminal ileum colonoscopic mucosal biopsies (four men, two women; mean age, 43 years ± 14). Mean normalized iodine density was 16.5% ± 5.7 for bowel segments with no active inflammation (n = 8) and 34.7% ± 9.7 for segments with any active inflammation (n = 17; P < .001). A 20% mean normalized iodine density threshold had sensitivity, specificity, and accuracy of 17 of 17 (100%; 95% CI: 80.5, 100), six of eight (75%; 95% CI: 35, 97), and 23 of 25 (92%; 95% CI: 74, 99), respectively, for active inflammation. Clinical indexes were similar for patients with and without active inflammation at histopathologic analysis (CDAI score, 261 vs 251, respectively [P = .77]; HBI score, 7.8 vs 6.4, respectively [P = .36]). Conclusion Iodine density from dual-energy CT enterography may be used as a radiologic marker of Crohn disease activity as correlated with histopathologic analysis. © RSNA, 2021 See also the editorial by Ohliger in this issue.
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Affiliation(s)
- Bari Dane
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Suparna Sarkar
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Matthew Nazarian
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Hayley Galitzer
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Thomas O'Donnell
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Feza Remzi
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Shannon Chang
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Alec Megibow
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
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Ding X, Chang S, Liu G, Zhao L, Zheng W, Qin A, Di Y, Li X. PO-1842 Introduce a new rotational robust optimized Spot-scanning Proton Arc (SPArc) framework. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Esen E, Kirat HT, Erkan A, Aytac E, Esterow J, Kani HT, Grieco MJ, Chang S, Remzi FH. Indications, functional and quality of life outcomes of new pouch creation during re-do ileal pouch anal anastomosis: A comparative study with existing pouch salvage. Surgery 2021; 171:287-292. [PMID: 34272046 DOI: 10.1016/j.surg.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Salvage of the existing ileal pouch is favored during re-do ileal pouch anal anastomosis if the pouch is not damaged after pelvic dissection and there are no other mechanical reasons that may necessitate construction of a new pouch. Excision of the existing pouch may be associated with some concerns for short-bowel syndrome and poor functional outcomes. This study aimed to report indications and compare functional and quality of life outcomes of new pouch creation versus salvage of the existing pouch during re-do ileal pouch anal anastomosis. METHODS Patients who underwent re-do ileal pouch anal anastomosis between September 2016 and June 2020 were included. The reasons for pouch excision and new pouch creation were reported. Perioperative, functional outcomes and quality of life were compared between patients who had creation of a new pouch versus salvage of existing pouch. RESULTS A total of 105 patients with re-do ileal pouch anal anastomosis (new pouch, n = 63) were included. Most common indications for a new pouch creation were chronic pelvic infection that compromised the integrity and viability of the existing pouch (n = 32) and small pouch (n = 21). No patient developed short-bowel syndrome. The number of bowel movements, daily restrictions and Cleveland Global Quality of Life score scores were similar between 2 groups. Day-time seepage, day-time and night-time pad usage were more common after new pouch creation. Two-year pouch survival rates were comparable (new pouch: 92% versus existing pouch: 85%, P = .31). CONCLUSION New pouch creation can be safely performed at the time of re-do ileal pouch anal anastomosis. It provides acceptable functional and quality of life outcomes if existing pouch salvage is not feasible.
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Affiliation(s)
- Eren Esen
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/ErenEsenMD
| | - Hasan T Kirat
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/TarikKiratMD
| | - Arman Erkan
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/ArmanErkanMD
| | - Erman Aytac
- Department of Surgery, Acibadem Mehmet Ali Aydinlar School of Medicine, Istanbul, Turkey. https://twitter.com/DrErmanAytac
| | - Joanna Esterow
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/IjoannaG
| | - H Tarik Kani
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Michael J Grieco
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/MichaelJGrieco
| | - Shannon Chang
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY. https://twitter.com/shannonchang
| | - Feza H Remzi
- Inflammatory Bowel Disease Center, NYU Langone Health, NYU Grossman School of Medicine, New York, NY.
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50
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Peyser A, Abittan B, Chang S, Noyes N. DOES TRIGGER CHOICE AFFECT EMBRYONIC MOSAICISM? Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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