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Cho MJ, Farhadi RV, Nash DW, Kaleeny J, Povoski SP, Chao AH. The current use of tissue expanders in breast reconstruction: device design, features, and technical considerations. Expert Rev Med Devices 2024; 21:27-35. [PMID: 38032224 DOI: 10.1080/17434440.2023.2288911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The use of tissue expanders (TE) in post-mastectomy breast reconstruction is a widely accepted practice, especially in patients desiring implant-based breast reconstruction. It has become the standard of care to perform a two-staged breast reconstruction using tissue expanders for the past 50 years due to its reliability, safety, cost-effectiveness, and versatility. Due to its popularity, there are numerous types and features of breast tissue expanders and various surgical approaches available for plastic surgeons. AREAS COVERED In this article, we will review the role of tissue expanders in breast reconstruction, the types and features of breast tissue expanders, and technical considerations. EXPERT OPINION The use of tissue expanders in breast reconstruction offers significant advantages of preserving the breast skin envelope and reestablishing the breast mound. With evolving approaches to breast reconstruction, tissue expander design, and application underwent several refinements and modifications. Due to these advances, studies on its long-term efficacy and safety profile typically fall behind and more studies with higher levels of evidence are needed to better evaluate the efficacy and safety profile of tissue expanders. With increased understanding, reconstructive surgeons can minimize complications and maximize reconstructive, aesthetic outcomes with high patient satisfaction.
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Affiliation(s)
- Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rana V Farhadi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David W Nash
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph Kaleeny
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Madison AA, Andridge R, Kantaras AH, Renna ME, Bennett JM, Alfano CM, Povoski SP, Agnese DM, Lustberg M, Wesolowski R, Carson WE, Williams NO, Reinbolt RE, Sardesai SD, Noonan AM, Stover DG, Cherian MA, Malarkey WB, Kiecolt-Glaser JK. Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship. Cancers (Basel) 2023; 15:4414. [PMID: 37686689 PMCID: PMC10487080 DOI: 10.3390/cancers15174414] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Biostatistics, The Ohio State University, Columbus, OH 43210, USA
| | - Anthony H Kantaras
- Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA
| | - Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Jeanette M Bennett
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC 28213, USA
| | | | - Stephen P Povoski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Doreen M Agnese
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Maryam Lustberg
- Center for Breast Cancer, Yale Cancer Center, Yale University, New Haven, CT 06519, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William E Carson
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Nicole O Williams
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Sagar D Sardesai
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Anne M Noonan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel G Stover
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Mathew A Cherian
- The Ohio State University Comprehensive Cancer Center, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Renna ME, Shrout MR, Madison AA, Lustberg M, Povoski SP, Agnese DM, Reinbolt RE, Wesolowski R, Williams NO, Ramaswamy B, Sardesai SD, Noonan AM, VanDeusen JB, Stover DG, Cherian M, Malarkey WB, Di Gregorio M, Kiecolt-Glaser JK. Distress Disorder Histories Relate to Greater Physical Symptoms Among Breast Cancer Patients and Survivors: Findings Across the Cancer Trajectory. Int J Behav Med 2023; 30:463-472. [PMID: 35831698 PMCID: PMC10278051 DOI: 10.1007/s12529-022-10115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychological disorders can substantially worsen physical symptoms associated with breast cancer diagnosis and treatment, reducing survivors' quality of life and increasing recurrence risk. Distress disorders may be particularly detrimental given their physical correlates. Across two studies, we examined the relationship between a distress disorder history and physical symptoms pre- and post-adjuvant treatment - two important periods of the cancer trajectory. METHODS Breast cancer patients awaiting adjuvant treatment (n = 147; mean age = 52.54) in study 1 and survivors 1-10 years post-treatment (n = 183; mean age = 56.11) in study 2 completed a diagnostic interview assessing lifetime presence of psychological disorders. They also rated their pain, fatigue, physical functioning, and self-rated health. Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. RESULTS Results from both studies indicated that a distress disorder history was associated with higher pain, fatigue, and sleep difficulties as well as lower self-rated health compared to those without such a history. CONCLUSIONS These findings suggest that breast cancer survivors with a distress disorder may be particularly at risk for more physical symptoms, poorer sleep, and worse self-rated health both prior to and following adjuvant treatment.
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Affiliation(s)
- Megan E Renna
- School of Psychology, University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS, 39406, USA.
| | | | | | | | | | - Doreen M Agnese
- The Ohio State University College of Medicine, Columbus, USA
| | | | | | | | | | | | - Anne M Noonan
- The Ohio State University College of Medicine, Columbus, USA
| | | | - Daniel G Stover
- The Ohio State University College of Medicine, Columbus, USA
| | - Mathew Cherian
- The Ohio State University College of Medicine, Columbus, USA
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Klonk I, Povoski SP, Tozbikian G, Hawley JR. Masson's tumor of the reconstructed breast. Radiol Case Rep 2023; 18:1748-1753. [PMID: 36915605 PMCID: PMC10006304 DOI: 10.1016/j.radcr.2023.01.081] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
Intravascular papillary endothelial hyperplasia (Masson's Tumor) is a rare benign endothelial vascular lesion that can mimic angiosarcoma if not properly recognized. It represents less than 2% of all vascular tumors, but has been seen in the postradiation setting, which also makes differentiating it from angiosarcoma crucial. It is classically characterized as a circumscribed, intravascular mass that is hypoechoic on ultrasound, and T1 isointense and T2 heterogenous on MRI with variable enhancement. Histologically, it demonstrates papillary architecture without significant atypia, and associated vascular thrombus. Although it typically occurs in the soft tissues of the trunk and neck, a very small percentage of cases have been found in the breast. The following case will involve a 64-year-old female with a Masson's tumor involving the capsule of her left breast implant, in the setting of previously treated ductal carcinoma in situ, which was surgically excised and irradiated over 20 years prior.
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Affiliation(s)
- Ian Klonk
- Department of Radiology, The Ohio State University Medical Center Columbus, 395 W 12th Ave # 4, Columbus, OH 43210 USA
| | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Jeffrey R Hawley
- Department of Radiology, Division of Breast Imaging, The Ohio State University Medical Center, Columbus OH, USA
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Madison AA, Filatov M, Andridge R, Haas G, Povoski SP, Agnese DM, Lustberg M, Reinbolt RE, Wesolowski R, Williams NO, Malarkey WB, Kiecolt-Glaser JK. A troubled heart: Mood disorder history longitudinally predicts faster cardiopulmonary aging in breast cancer survivorship. PLoS One 2023; 18:e0283849. [PMID: 37000800 PMCID: PMC10065250 DOI: 10.1371/journal.pone.0283849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Breast cancer survivors live longer due to more advanced cancer treatments; however, cardiovascular disease (CVD) is the leading non-cancer cause of death in breast cancer survivors. Previous studies have shown that depression is associated with an increased risk of CVD development. This study investigated whether depressive symptoms or mood disorder history, either independently or in combination with cardiotoxic treatments, predicted older cardiopulmonary age using a novel index-the Age Based on Exercise Stress Test (ABEST)-among breast cancer survivors. METHODS Breast cancer survivors (N = 80, ages 26-72, stage I-IIIA) were assessed an average of 53 days (SD = 26) post-surgery, but before adjuvant treatment, and again an average of 32 (SD = 6) months thereafter. At both visits, they reported depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D), completed the Structured Clinical Interview for DSM-V, and engaged in an exercise stress test to obtain ABEST scores. RESULTS Controlling for treatment type, age, education, trunk fat, antidepressant use, and time between visits, longitudinal analyses showed that breast cancer survivors with a mood disorder history had worsening ABEST scores over time, compared to their peers without this history (p = .046). Change in physical activity between Visits 1 and 2 did not mediate this relationship (95% CI: -0.16-0.51). Ancillary analyses provided some additional support for the primary finding, such that those with a mood disorder history trended toward greater decreases in Vo2max, although results were marginally non-significant (p = .095). There were no cross-sectional relationships between depressive symptoms or mood disorder history and ABEST scores (ps>.20). Treatment type did not modulate observed relationships (ps>.22). CONCLUSIONS Breast cancer survivors with a mood disorder history may experience faster cardiopulmonary aging compared to their peers without such a history, raising risk for CVD.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
| | - Marie Filatov
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Division of Biostatistics, The Ohio State University, Columbus, OH, United States of America
| | - Garrie Haas
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Stephen P Povoski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Doreen M Agnese
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Maryam Lustberg
- Center for Breast Cancer, Yale Cancer Center, New Haven, CT, United States of America
| | - Raquel E Reinbolt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Nicole O Williams
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Renna ME, Shrout MR, Madison AA, Alfano CM, Povoski SP, Lipari AM, Carson WE, Malarkey WB, Kiecolt-Glaser JK. Depression and anxiety in colorectal cancer patients: TIES TO PAIN, FATIGUE, AND INFLAMMATION. Psychooncology 2022; 31:1536-1544. [PMID: 35751505 DOI: 10.1002/pon.5986] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/04/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Colorectal cancer poses a significant threat to both psychological and physical health. This study examined relationships between anxiety and depressive symptoms with pain, fatigue, and inflammation among colorectal patients. METHODS Colorectal cancer patients (n = 88, stages 0-IV) completed a laboratory-based study visit before undergoing adjuvant cancer treatment. Patients completed questionnaires assessing depressive, anxiety, pain, and fatigue symptoms. A blood sample was also collected to measure c-reactive protein (CRP). Analyses controlled for age, sex, cancer stage, body mass index (BMI), and menopause status. RESULTS Multiple linear regression analyses showed colorectal patients with higher depressive and anxiety symptoms had greater pain, fatigue, and CRP (ps < .03). Approximately one-third of patients with clinically significant depressive (CESD > 16) and anxiety symptoms (BAI > 16) also had clinically-elevated levels of CRP ( > 3mg/L) (ps = .02). CONCLUSION These results extend findings from other cancer subgroups showing heightened symptom burden among patients with depression and anxiety. They also highlight the detrimental role that elevated anxiety and depressive symptoms may play in the physical and biological side effects associated with colorectal cancer. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - M Rosie Shrout
- Department of Human Development & Family Studies, Purdue University, Lafayette, IN, USA
| | - Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | - Stephen P Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adele M Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Shrout MR, Madison AA, Renna ME, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Malarkey WB, Bailey MT, Kiecolt-Glaser JK. The gut connection: Intestinal permeability as a pathway from breast cancer survivors' relationship satisfaction to inflammation across treatment. Brain Behav Immun 2022; 100:145-154. [PMID: 34808291 PMCID: PMC8769505 DOI: 10.1016/j.bbi.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Breast cancer survivors are prone to weakened gut barriers, allowing bacteria to migrate into the blood stream. Gut permeability fuels inflammation, which, among survivors, can elevate risk for comorbid disease development, cancer recurrence, and a poor quality of life; however, survivors' satisfying relationships can provide health benefits. This longitudinal study used a conceptual model addressing how intimate relationships is associated with health through changes in gut permeability and inflammation. METHOD Breast cancer survivors (n = 139, stages 0-IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women who had an abnormal breast cancer test followed by a benign diagnosis completed visits within a comparable timeframe (noncancer patient controls; n = 69). All women completed questionnaires assessing their relationship satisfaction and provided blood samples to assess two bacterial endotoxin biomarkers, lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14), as well as C-reactive protein (CRP) and interleukin 6 (IL-6). RESULTS Within-person multilevel mediation analyses showed that when a survivor's relationship satisfaction was higher than usual, her own LBP and LBP/sCD14 were lower, which was associated with lower than her own average CRP and IL-6 (95% CIs [-0.0104, -0.0002]). IL-6 was also higher when older survivors, but not younger survivors, experienced higher than usual intestinal permeability (p = .001). These effects of satisfying relationships held after accounting for cancer-related and behavioral factors. Post-hoc analyses showed LBP, sCD14, and LBP/sCD14 were associated with CRP for the cancer survivors, but only LBP and LBP/sCD14 were linked to CRP among the noncancer control patients. CONCLUSION The gut environment is a new promising candidate for understanding a relationship's long-term health impact, particularly among those with elevated health risks. Survivors may reap multiple physiological benefits from satisfying relationships.
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Affiliation(s)
- M Rosie Shrout
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA; Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA.
| | - Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Megan E Renna
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Stephen P Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adele M Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Doreen M Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael T Bailey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH, USA; Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Oral and Gastrointestinal Microbiology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Hitchcock CL, Povoski SP, Mojzisik CM, Martin EW. Survival Advantage Following TAG-72 Antigen-Directed Cancer Surgery in Patients With Colorectal Carcinoma: Proposed Mechanisms of Action. Front Oncol 2021; 11:731350. [PMID: 34950576 PMCID: PMC8688248 DOI: 10.3389/fonc.2021.731350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/25/2021] [Indexed: 12/09/2022] Open
Abstract
Patients with colorectal carcinoma (CRC) continue to have variable clinical outcomes despite undergoing the same surgical procedure with curative intent and having the same pathologic and clinical stage. This problem suggests the need for better techniques to assess the extent of disease during surgery. We began to address this problem 35 years ago by injecting patients with either primary or recurrent CRC with 125I-labeled murine monoclonal antibodies against the tumor-associated glycoprotein-72 (TAG-72) and using a handheld gamma-detecting probe (HGDP) for intraoperative detection and removal of radioactive, i.e., TAG-72-positive, tissue. Data from these studies demonstrated a significant difference in overall survival data (p < 0.005 or better) when no TAG-72-positive tissue remained compared to when TAG-72-positive tissue remained at the completion of surgery. Recent publications indicate that aberrant glycosylation of mucins and their critical role in suppressing tumor-associated immune response help to explain the cellular mechanisms underlying our results. We propose that monoclonal antibodies to TAG-72 recognize and bind to antigenic epitopes on mucins that suppress the tumor-associated immune response in both the tumor and tumor-draining lymph nodes. Complete surgical removal of all TAG-72-positive tissue serves to reverse the escape phase of immunoediting, allowing a resetting of this response that leads to improved overall survival of the patients with either primary or recurrent CRC. Thus, the status of TAG-72 positivity after resection has a significant impact on patient survival.
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Affiliation(s)
- Charles L. Hitchcock
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephen P. Povoski
- Division of Surgical Oncology, Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Cathy M. Mojzisik
- Division of Surgical Oncology, Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Edward W. Martin
- Division of Surgical Oncology, Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, United States
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Reid VJ, Falk JS, Police AM, Ridgeway CA, Cadena LL, Povoski SP. Minimizing re-excision after breast conserving surgery - a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment. Expert Rev Med Devices 2021; 18:1057-1068. [PMID: 34657525 DOI: 10.1080/17434440.2021.1992273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION For early-stage breast cancer, breast-conserving surgery (BCS) plus radiation is standard-of-care. Nationwide, >20% of BCS patients require re-excision for positive margins, resulting in delayed adjuvant therapy, increased complications, emotional and financial stress for patients, and additional cost to the healthcare system. Although several methods may be employed to mitigate positive margins, no technique can fully address the need. MarginProbe® is an adjunctive tool for real-time intraoperative margin assessment and is shown to reduce positive margins by >50%. AREAS COVERED Discussion of the impact of re-excision following BCS, a review of currently available methods for intraoperative margin management, followed by a technology and literature review of the MarginProbe® Radiofrequency Spectroscopy System. EXPERT OPINION Re-excision significantly impacts patients, providers and payers. Limitations in the ability to assess margins at time of surgery warrant more advanced methods of residual disease detection. MarginProbe facilitates the most efficient pathway for breast cancer patients through the surgical phase of treatment. The device is well-suited for adoption as the healthcare focus shifts from volume to value and supports the three pillars of the US Department of Health and Human Services' 'Triple-Aim' strategy: improve population health, improve patient experience of care, and reduce per-capita costs.
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Affiliation(s)
- Vincent J Reid
- Director of Surgical Oncology, Medical Director, Hall-Perrine Cancer Center, Cedar Rapids, IA - Clinical Associate Professor of Surgery at the University of Iowa Hospitals and Clinics, USA
| | - Jeffrey S Falk
- Department of Surgery, Ascension St. John Hospital and Medical Center, Detroit, MI - Clinical Associate Professor of Surgery, Wayne State University College of Medicine, St. George's University College of Medicine, USA
| | - Alice M Police
- Director of Breast Surgery, Northwell Health, Western Region, New York, USA
| | - Calvin A Ridgeway
- Medical Director of Breast Care Center, Lovelace Women's Hospital, NM, USA
| | - Lisa L Cadena
- Director, Training and Medical Education, Dilon Technologies, Newport News, VA, USA
| | - Stephen P Povoski
- Professor of Surgery, Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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10
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Madison AA, Peng J, Shrout MR, Renna ME, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Malarkey WB, Kiecolt-Glaser JK. Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship. Psychoneuroendocrinology 2021; 131:105288. [PMID: 34090140 PMCID: PMC8405565 DOI: 10.1016/j.psyneuen.2021.105288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Black breast cancer survivors have greater morbidity and mortality than White survivors. However, evidence comparing Black survivors' psychological symptoms with their White counterparts has been mixed. Prior studies have not compared Black and White survivor's distress-related symptom trajectories from pre- to post-treatment - the goal of the current study. METHODS At three annual visits from shortly after diagnosis to 6 and 18 months post-treatment, 195 women (n = 163 White; n = 32 Black) reported their cancer-related distress (intrusive thoughts and avoidance), perceived stress, anxiety and depressive symptoms, fatigue, and pain. RESULTS Adjusting for age, educational attainment, income, treatment type, stage at diagnosis, and physical comorbidities, Black and White breast cancer survivors had different trajectories of cancer-related distress (p = .004), intrusive thoughts about cancer diagnosis and treatment (p = .002), perceived stress (p = .04), emotional fatigue (p = .01), and vigor (p = .02). Specifically, among White women, these distress-related symptoms improved from diagnosis to 6 months post-treatment (ps < 0.0001) and then remained stable between 6 and 18 months post-treatment, whereas Black women had persistently elevated distress - even 18 months after finishing treatment. Additionally, Black women reported more avoidance of cancer-related thoughts and emotions across visits (p = .047). Race was unrelated to the trajectories of anxiety and depressive symptoms, other fatigue subscales, or pain levels (ps > 0.08). CONCLUSION Longitudinal assessment of the same breast cancer survivors from diagnosis to early survivorship revealed that Black and White survivors had divergent trajectories of psychological distress symptoms that were not reliably evident at a single timepoint. Overall, White women reported less psychological distress from pre- to post-treatment, but Black women's distress remained high from diagnosis to 18 months post-treatment. If left untreated, Black women's high distress levels may contribute to their poorer health throughout survivorship.
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Affiliation(s)
- Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Psychology, The Ohio State University,Corresponding author: Annelise Madison, M.A., Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210,
| | - Juan Peng
- Center for Biostatistics, The Ohio State University
| | - M. Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
| | - Megan E. Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Comprehensive Cancer Center, The Ohio State University
| | | | | | | | | | | | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Internal Medicine, The Ohio State University College of Medicine
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine
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11
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Kerger A, Griffith B, Patel M, Hawley J, Povoski SP. The lateral arm device for mammographic breast procedures: overview of its uses, safety, and efficacy. Expert Rev Med Devices 2021; 18:413-420. [PMID: 33784927 DOI: 10.1080/17434440.2021.1908884] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Percutaneous image-guided biopsy is the procedure of choice for diagnosing suspicious abnormalities on breast imaging. Stereotactic, ultrasound, and magnetic resonance imaging are used for image-guided breast biopsies. Stereotactic guidance uses mammography to localize lesions and facilitate placement of a core biopsy needle. The first systems used a vertical-approach needle insertion. The lateral arm device, which is the most recent advancement in stereotactic biopsies and pre-surgical localization allows procedures to be performed using a needle insertion parallel to the compression plate.Areas covered: The lateral arm device was introduced to the market in 2007 and is the first device of its kind. In this article we review the mechanism of this device, the risks and benefits of the device and other the different other modalities utilized to biopsy and localize the breast. We summarize the current literature on this device along with our own experiences utilizing this device.Expert opinion: The lateral arm device has changed the face of stereotactic-guided breast biopsies and localizations by allowing a new approach to perform these procedures. It has improved care to patients by allowing us to get to areas previously not within the biopsy window, decreased biopsy time and increased patient throughput.
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Affiliation(s)
- Amy Kerger
- Division of Breast Imaging, Ohio State University Medical Center, College of Medicine, Department of Radiology, Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Brandy Griffith
- , Division of Womens Imaging, Department of Radiology, Ohio State University Medical Center, Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Mitva Patel
- Assistant Division Chief Breast Imaging, Ohio State University Medical Center, Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Jeffrey Hawley
- Department of Radiology, Ohio State University Medical Center, Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
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12
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Chao AH, Schulz SA, Povoski SP. The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery. Expert Rev Med Devices 2021; 18:367-374. [PMID: 33686906 DOI: 10.1080/17434440.2021.1900725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Lymphedema has traditionally been managed through noninvasive means with complete decongestive therapy. However, complete decongestive therapy is an intensive program that requires lifelong adherence by patients with lymphedema. More recently, reconstructive surgical procedures have shown promise in improving lymphedema by physiologically restoring lymphatic function. One of these types of procedures, lymphaticovenular anastomosis, relies on technological advances in imaging, particularly indocyanine green lymphangiography. AREAS COVERED This article reviews indocyanine green and near-infrared fluorescence imaging. In addition, this article discusses the application of this imaging to the preoperative, intraoperative, and postoperative assessment of the lymphatic system in the setting of lymphaticovenular anastomosis surgery. EXPERT OPINION Indocyanine green lymphangiography offers significant advantages over other types of imaging of the lymphatic system. In the future, it is hopeful that additional options for these imaging devices will become available which may increase their accessibility by centers interested in performing reconstructive lymphatic surgery, including in relation to cost. Finally, more studies with higher levels of evidence are needed to better define the long-term outcomes associated with lymphatic surgery including LVA. In this regard, practitioners should fully harness the information conferred by ICG lymphangiography as both a clinical and research tool.
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Affiliation(s)
- Albert H Chao
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Steven A Schulz
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, Ohio State University, Columbus, OH, USA
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13
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Poteet SJ, Schulz SA, Povoski SP, Chao AH. Negative pressure wound therapy: device design, indications, and the evidence supporting its use. Expert Rev Med Devices 2021; 18:151-160. [PMID: 33496626 DOI: 10.1080/17434440.2021.1882301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Negative pressure wound therapy (NPWT) has become a mainstay in the armamentarium for wound care. Since the initial commercial vacuum-assisted closure device became available in 1995, subsequent research has confirmed the positive physiological effects of negative pressure on wound healing. Traditionally, NPWT has been used to improve healing of open nonsurgical wounds by secondary intention. However, the clinical applications of NPWT have significantly broadened, and now also include use in open surgical wounds, closed surgical incisions, and skin graft surgery. In addition, devices have evolved and now include functionality and features such as instillation, antimicrobial sponges, and portability.Areas covered: This article reviews the history, background, and physiology underlying NPWT, as well as the most commonly used devices. In addition, an evidence-based discussion of the current clinical applications of NPWT is presented, with a focus on those with high levels of evidence.Expert opinion: Future directions for device development include modifications to increase ease of use by patients and to allow its use in a broader array of anatomic areas. Lastly, more research with high levels of evidence is needed to better define the outcomes associated with NPWT, including in relation to specific clinical applications and cost.
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Affiliation(s)
- Stephen J Poteet
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Steven A Schulz
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
| | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, Ohio State University, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic Surgery, Ohio State University, Columbus, OH, USA
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14
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Shrout MR, Renna ME, Madison AA, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Farrar WB, Carson WE, Kiecolt-Glaser JK. Breast cancer survivors' satisfying marriages predict better psychological and physical health: A longitudinal comparison of satisfied, dissatisfied, and unmarried women. Psychooncology 2021; 30:699-707. [PMID: 33340188 DOI: 10.1002/pon.5615] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Breast cancer survivors who experience psychological and physical symptoms after treatment have an increased risk for comorbid disease development, reduced quality of life, and premature mortality. Identifying factors that reduce or exacerbate their symptoms may enhance their long-term health and physical functioning. This study examined how survivors' marital status and marital satisfaction-key health determinants-impacted their psychological and physical health trajectories to understand when, and for whom, marriage offers health benefits. METHODS Breast cancer survivors (n = 209, stages 0-IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women completed questionnaires assessing their marital status and satisfaction when applicable, as well as their psychological (depressive symptoms, stress) and physical (fatigue, pain) health at each visit. RESULTS Married women-both those in satisfying and dissatisfying marriages-experienced improvements in their depressive symptoms, stress, and fatigue from pretreatment to 6- and 18-month posttreatment. Unmarried (i.e., single, divorced/separated, or widowed) women's depressive symptoms, stress, fatigue, and pain did not change over time, instead remaining elevated 6 and 18 months after treatment ended. Women in satisfying marriages also had fewer psychological and physical symptoms after treatment than those who were unmarried or in dissatisfying marriages. CONCLUSIONS Although marriage was associated with improved psychological and physical health, the gains were most notable when survivors' marriages were satisfying. Thus, the quality of survivors' marriages, rather than the marriage itself, provided the most benefits to their psychological and physical health.
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Affiliation(s)
- M Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Megan E Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | | | - Stephen P Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Adele M Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Doreen M Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - William B Farrar
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, Ohio, USA
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15
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Renna ME, Peng J, Shrout MR, Madison AA, Andridge R, Alfano CM, Povoski SP, Lipari AM, Malarkey WB, Kiecolt-Glaser JK. Childhood abuse histories predict steeper inflammatory trajectories across time. Brain Behav Immun 2021; 91:541-545. [PMID: 33166662 PMCID: PMC8063138 DOI: 10.1016/j.bbi.2020.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Center for Disease Control (CDC) recently named childhood abuse histories as a public health risk. Clear links between abuse histories and inflammation exist. However, it remains unknown how abuse histories impact inflammatory trajectories throughout adulthood. Accordingly, this study assessed inflammatory trajectories across three visits among healthy adults with and without abuse histories. METHOD In this secondary analysis of data from a longitudinal observational study of cancer survivors and noncancer controls, 157 noncancer controls (Mage = 55.8, range = 32-83) completed the Childhood Experiences Questionnaire (CTQ), providing data on physical, emotional, and sexual abuse prior to age 18. Cytokines interleukin-6 (IL-6), interleukin 1-beta (IL-1β), and tumor necrosis factor-alpha (TNF-α) were collected at the baseline visit and two follow-up visits approximately one (M months = 11.52, SD = 4.10) and two years (M months = 23.79, SD = 4.40) later. To represent inflammatory changes, cytokine data at each visit were combined into a composite z-score. Covariates in all analyses included age, biological sex, race, income, body mass index, menopause status, psychological diagnosis history, and medical comorbidities. RESULTS Compared to their nonabused peers, those who had experienced any type of abuse in childhood demonstrated steeper rises in inflammation across time. Inflammation rose more steeply for individuals with physical and emotional abuse histories compared to those without such histories. CONCLUSION Overall, these data suggest that childhood abuse histories may quicken age-related increases in inflammation, contributing to accelerated aging, morbidity, and early mortality. These findings provide mechanistic insight into why child abuse is a public health risk.
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Affiliation(s)
- Megan E. Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Corresponding author at: Institute of Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, 43210, United States. (M.E. Renna)
| | - Juan Peng
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - M. Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - Stephen P. Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adele M. Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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16
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Abstract
Objective: Percutaneous breast and axillary core biopsy followed by marker placement are integral parts of a breast imager's practice benefiting both patients and clinicians. Marker placement is the standard to facilitate future care. The purpose of this study is to characterize the safety and performance of MammoMARK, CorMARK, and HydroMARK biopsy markers by evaluating device-related adverse events, device deficiencies, and long-term safety.Methods: A retrospective review of three radiology practices identified patients who underwent image-guided breast or axillary biopsies followed by marker placement between 1 January 2012 and 1 January 2017. Medical records were reviewed with adverse events related to marker placement and use recorded.Results: 768 markers were placed with three (0.4%) events recorded. Two device deficiencies and one non-serious adverse event occurred in three patients. Device deficiency events involved user errors deploying the markers, one to inability to locate the marker on post-biopsy imaging, and the second to misplacement relative to biopsy target. One non-serious adverse event involved inability to locate/retain the marker in a surgically resected specimen. No serious adverse events were reported.Conclusion: Placement of breast biopsy markers is safe with minimal associated risks. Issues related to device malfunction, durability, reliability, safety, or performance were not reported.
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Affiliation(s)
- Sharon Smith
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Clayton R Taylor
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey R Hawley
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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17
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Madison AA, Andridge R, Padin AC, Wilson S, Bailey MT, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Malarkey WB, Kiecolt-Glaser JK. Endotoxemia coupled with heightened inflammation predicts future depressive symptoms. Psychoneuroendocrinology 2020; 122:104864. [PMID: 33166799 PMCID: PMC7721058 DOI: 10.1016/j.psyneuen.2020.104864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Cross-sectional data have linked gut barrier abnormalities and endotoxemia with depression, even among those without gastrointestinal symptoms. This study examined longitudinal associations between endotoxemia markers and depressive symptoms, as well as the role of inflammation in this relationship. DESIGN At three annual visits, 315 women (n=209 breast cancer survivors, n = 106 non-cancer patient controls, M=55 years old) completed the Center for Epidemiological Studies Depression questionnaire (CES-D) and provided blood samples to assess inflammatory markers - interleukin-6, tumor necrosis factor-alpha, and C-reactive protein - and endotoxemia markers - lipopolysaccharide-binding protein (LBP), soluble CD14 (sCD14), and their ratio. RESULTS Adjusting for key demographic variables, health behaviors, visit 1 depressive symptoms, and cancer status and treatment, women with higher visit 1 LBP and LBP/sCD14 had more depressive symptoms at the two subsequent annual visits. Illustrating the notable impact, a woman at the 75th percentile for LBP or LBP/sCD14 at visit 1 was 18 % more likely to report clinically significant depressive symptoms (CES-D ≥16) at follow-up than a woman in the lowest quartile. Cancer status and treatment type did not modulate this relationship. In contrast, visit 1 depressive symptoms did not predict endotoxemia at follow-up. A significant interaction between LBP/sCD14 and inflammatory burden suggested that visit 1 endotoxemia fueled depressive symptoms only in the context of elevated inflammation. CONCLUSION These results suggest that endotoxemia, combined with systemic inflammation, can drive depressive symptoms. These findings may implicate bacterial endotoxin translocation from the gut to the bloodstream in depression etiology. Interventions that reduce endotoxemia and inflammation may lessen the risk of depression.
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Affiliation(s)
- Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,Department of Psychology, The Ohio State University
| | - Rebecca Andridge
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,College of Public Health, The Ohio State University
| | - Avelina C. Padin
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,Department of Psychology, The Ohio State University
| | | | - Michael T. Bailey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,Department of Pediatrics, The Ohio State University College of Medicine,,Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | | | | | | | | | | | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,Department of Internal Medicine, The Ohio State University College of Medicine
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine
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18
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Renna ME, Shrout MR, Madison AA, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Kiecolt-Glaser JK. Within-person changes in cancer-related distress predict breast cancer survivors' inflammation across treatment. Psychoneuroendocrinology 2020; 121:104866. [PMID: 32947247 PMCID: PMC7572735 DOI: 10.1016/j.psyneuen.2020.104866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among breast cancer survivors, elevated inflammation has been linked to greater recurrence risk. Psychological processes, such as cancer-related distress, can pose threats to a survivor's longevity and wellbeing. Although distress can heighten inflammation, little is known about how fluctuations in distress during and after treatment impact a woman's own inflammation - the primary question of this study. METHODS Breast cancer survivors (n = 165, stages 0-III) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after. At each visit, women completed the Impact of Events Scale to assess cancer-related distress, and a blood sample was collected to measure proinflammatory cytokines IL-6, TNF-α, IL-1β, and IL-8. This longitudinal study related fluctuations in survivor's own cancer-related distress (i.e., within-person effects), as well as average effects of cancer-related distress between survivors (i.e., between-person effects) to inflammatory changes across visits. RESULTS Women had elevated inflammation at visits where they expressed more cancer-related distress than what was typical. In contrast, the average cancer-related distress was not associated with inflammation. CONCLUSION Larger increases in a women's cancer-related distress was linked with higher inflammation across visits. Comparing a survivor's own cancer-related distress to her average levels may prove useful in identifying links between distress and inflammation.
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Affiliation(s)
- Megan E. Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Corresponding author at: Institute of Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, 43210, United States. (M.E. Renna)
| | - M. Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | - Stephen P. Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adele M. Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Doreen M. Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William E. Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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19
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Suarez-Kelly LP, Pasley WH, Clayton EJ, Povoski SP, Carson WE, Rudolph R. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer 2019; 19:99. [PMID: 30674296 PMCID: PMC6345065 DOI: 10.1186/s12885-019-5293-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Background Seroma formation is the most common complication after mastectomy and places patients at risk of associated morbidities. Microporous polysaccharide hemospheres (MPH) consists of hydrophilic, plant based, polysaccharide particles and is currently used as an absorbable hemostatic agent. An animal model evaluating MPH and seroma formation after mastectomy with axillary lymph node dissection showed a significant decrease in seroma volume. Study aim was to evaluate topical MPH on the risk of post-mastectomy seroma formation as measured by total drain output and total drain days. Methods Prospective randomized single-blinded clinical trial of patients undergoing mastectomy for the treatment of breast cancer. MPH was applied to the surgical site in the study group and no application in the control group. Results Fifty patients were enrolled; eight were excluded due to missing data. Forty-two patients were evaluated, control (n = 21) vs. MPH (n = 21). No difference was identified between the two groups regarding demographics, tumor stage, total drain days, total drain output, number of clinic visits, or complication rates. On a subset analysis, body mass index (BMI) greater than 30 was identified as an independent risk factor for high drain output. Post hoc analyses of MPH controlling for BMI also revealed no statistical difference. Conclusions Unlike the data presented in an animal model, no difference was demonstrated in the duration and quantity of serosanguinous drainage related to the use of MPH in patients undergoing mastectomy for the treatment of breast cancer. BMI greater than 30 was identified as an independent risk factor for high drain output and this risk was not affected by MPH use. NCT03647930, retrospectively registered 08/2018.
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Affiliation(s)
- Lorena P Suarez-Kelly
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA. .,The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA.
| | - W Hampton Pasley
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Eric J Clayton
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Stephen P Povoski
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - William E Carson
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Ray Rudolph
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
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Povoski SP, Hatzaras IS, Mojzisik CM, Arnold MW, Hitchcock CL, Martin EW. Antigen-Directed Cancer Surgery for Primary Colorectal Cancer: 15-Year Survival Analysis: A Reply. Ann Surg Oncol 2017; 24:610-611. [PMID: 29086138 DOI: 10.1245/s10434-017-6201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA.
| | - Ioannis S Hatzaras
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA
| | - Cathy M Mojzisik
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA.,Department of Radiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Mark W Arnold
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA
| | - Charles L Hitchcock
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, USA
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21
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Garza R, Skoracki R, Hock K, Povoski SP. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer 2017; 17:468. [PMID: 28679373 PMCID: PMC5497342 DOI: 10.1186/s12885-017-3444-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
Secondary lymphedema of the upper and lower extremities related to prior oncologic therapies, including cancer surgeries, radiation therapy, and chemotherapy, is a major cause of long-term morbidity in cancer patients. For the upper extremities, it is most commonly associated with prior oncologic therapies for breast cancer, while for the lower extremities, it is most commonly associated with oncologic therapies for gynecologic cancers, urologic cancers, melanoma, and lymphoma. Both non-surgical and surgical management strategies have been developed and utilized, with the primary goal of all management strategies being volume reduction of the affected extremity, improvement in patient symptomology, and the reduction/elimination of resultant extremity-related morbidities, including recurrent infections. Surgical management strategies include: (i) ablative surgical methods (i.e., Charles procedure, suction-assisted lipectomy/liposuction) and (ii) physiologic surgical methods (i.e., lymphaticolymphatic bypass, lymphaticovenular anastomosis, vascularized lymph node transfer, vascularized omental flap transfer). While these surgical management strategies can result in dramatic improvement in extremity-related symptomology and improve quality of life for these cancer patients, many formidable challenges remain for successful management of secondary lymphedema. It is hopeful that ongoing clinical research efforts will ultimately lead to more complete and sustainable treatment strategies and perhaps a cure for secondary lymphedema and its devastating resultant morbidities.
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Affiliation(s)
- Ramon Garza
- PRMA Plastic Surgery, San Antonio, TX 78240 USA
| | - Roman Skoracki
- Department of Plastic Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Karen Hock
- Division of Oncology Rehabilitation Services, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Stephen P. Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
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22
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Alfano CM, Peng J, Andridge RR, Lindgren ME, Povoski SP, Lipari AM, Agnese DM, Farrar WB, Yee LD, Carson WE, Kiecolt-Glaser JK. Inflammatory Cytokines and Comorbidity Development in Breast Cancer Survivors Versus Noncancer Controls: Evidence for Accelerated Aging? J Clin Oncol 2016; 35:149-156. [PMID: 27893337 DOI: 10.1200/jco.2016.67.1883] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The sequelae of cancer treatment may increase systemic inflammation and create a phenotype at increased risk of functional decline and comorbidities, leading to premature mortality. Little is known about how this trajectory compares with natural aging among peers of the same age without cancer. This longitudinal study investigated proinflammatory cytokines and comorbidity development over time among breast cancer survivors and a noncancer control group. Methods Women (N = 315; 209 with breast cancer and 106 in the control group) were recruited at the time of their work-up for breast cancer; they completed the baseline questionnaire, interview, and blood draw (lipopolysaccharide-stimulated production of interleukin [IL] -6, tumor necrosis factor-α, and IL-1β). Measures were repeated 6 and 18 months after primary cancer treatment (cancer survivors) or within a comparable time frame (control group). Results There were no baseline differences in comorbidities or cytokines between survivors and the control group. Over time, breast cancer survivors had significantly higher tumor necrosis factor-α and IL-6 compared with the control group. Survivors treated with surgery, radiation, and chemotherapy accumulated a significantly greater burden of comorbid conditions and suffered greater pain associated with inflammation over time after cancer treatment than did the control group. Conclusion Survivors who had multimodal treatment had higher cytokines and comorbidities, suggestive of accelerated aging. Comorbidities were related to inflammation in this sample, which could increase the likelihood of premature mortality. Given that many comorbidities take years to develop, future research with extended follow-up beyond 18 months is necessary to examine the evidence of accelerated aging in cancer survivors and to determine the responsible mechanisms.
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Affiliation(s)
- Catherine M Alfano
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Juan Peng
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Rebecca R Andridge
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Monica E Lindgren
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Stephen P Povoski
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Adele M Lipari
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Doreen M Agnese
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - William B Farrar
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Lisa D Yee
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - William E Carson
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
| | - Janice K Kiecolt-Glaser
- Catherine M. Alfano, American Cancer Society, Washington, DC; Juan Peng, Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, Janice K. Kiecolt-Glaser, The Ohio State University College of Medicine; Rebecca R. Andridge, The Ohio State University College of Public Health; and Monica E. Lindgren, Stephen P. Povoski, Adele M. Lipari, Doreen M. Agnese, William B. Farrar, Lisa D. Yee, William E. Carson III, and Janice K. Kiecolt-Glaser, The Ohio State University, Columbus, OH
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Zhang Z, Pei J, Wang D, Gan Q, Ye J, Yue J, Wang B, Povoski SP, Martin EW, Hitchcock CL, Yilmaz A, Tweedle MF, Shao P, Xu RX. A Wearable Goggle Navigation System for Dual-Mode Optical and Ultrasound Localization of Suspicious Lesions: Validation Studies Using Tissue-Simulating Phantoms and an Ex Vivo Human Breast Tissue Model. PLoS One 2016; 11:e0157854. [PMID: 27367051 PMCID: PMC4930179 DOI: 10.1371/journal.pone.0157854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/02/2016] [Indexed: 12/02/2022] Open
Abstract
Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The development of intraoperative guidance systems for identifying all sites of disease and improving the likelihood of complete surgical resection is an area of active ongoing research, as this can lead to a decrease in the need of subsequent additional surgical procedures. We develop a wearable goggle navigation system for dual-mode optical and ultrasound imaging of suspicious lesions. The system consists of a light source module, a monochromatic CCD camera, an ultrasound system, a Google Glass, and a host computer. It is tested in tissue-simulating phantoms and an ex vivo human breast tissue model. Our experiments demonstrate that the surgical navigation system provides useful guidance for localization and core needle biopsy of simulated tumor within the tissue-simulating phantom, as well as a core needle biopsy and subsequent excision of Indocyanine Green (ICG)—fluorescing sentinel lymph nodes. Our experiments support the contention that this wearable goggle navigation system can be potentially very useful and fully integrated by the surgeon for optimizing many aspects of oncologic surgery. Further engineering optimization and additional in vivo clinical validation work is necessary before such a surgical navigation system can be fully realized in the everyday clinical setting.
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Affiliation(s)
- Zeshu Zhang
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jing Pei
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Dong Wang
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Qi Gan
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jian Ye
- School of Engineering Science, University of Science and Technology of China, Hefei, China
| | - Jian Yue
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Benzhong Wang
- Department of Surgery, Anhui Medical University, Hefei, China
| | - Stephen P. Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail: (SP); (PS); (RX)
| | - Edward W. Martin
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Charles L. Hitchcock
- Pathology Department, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Alper Yilmaz
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Michael F. Tweedle
- Radiology Department, Wright Center for Innovation, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Pengfei Shao
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- * E-mail: (SP); (PS); (RX)
| | - Ronald X. Xu
- School of Engineering Science, University of Science and Technology of China, Hefei, China
- College of Engineering, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail: (SP); (PS); (RX)
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Bluemel C, Matthies P, Herrmann K, Povoski SP. 3D scintigraphic imaging and navigation in radioguided surgery: freehand SPECT technology and its clinical applications. Expert Rev Med Devices 2016; 13:339-51. [PMID: 26878667 DOI: 10.1586/17434440.2016.1154456] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Freehand SPECT (fhSPECT) is a technology platform for providing 3-dimensional (3D) navigation for radioguided surgical procedures, such as sentinel lymph node (SLN) biopsy (SLNB). In addition to the information provided by conventional handheld gamma detection probes, fhSPECT allows for direct visualization of the distribution of radioactivity in any given region of interest, allowing for improved navigation to radioactive target lesions and providing accurate lesion depth measurements. Herein, we will review the currently available clinical data on the use of fhSPECT: (i) for SLNB of various malignancies, including difficult-to-detect SLNs, and (ii) for radioguided localization of solid tumors. Moreover, the combination of fhSPECT with other technologies (e.g., small field-of-view gamma cameras, and diagnostic ultrasound) is discussed. These technical advances have the potential to greatly expand the clinical application of radioguided surgery in the future.
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Affiliation(s)
- Christina Bluemel
- a Department of Nuclear Medicine , University Hospital Würzburg , Würzburg , Germany
| | - Philipp Matthies
- b Department of Informatics , Technische Universität München , Munich , Germany
| | - Ken Herrmann
- a Department of Nuclear Medicine , University Hospital Würzburg , Würzburg , Germany.,c Department of Molecular and Medical Pharmacology , David Geffen School of Medicine, University of California, Los Angeles (UCLA) , Los Angeles , CA , USA.,d Jonsson Comprehensive Cancer Center , University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Stephen P Povoski
- e Division of Surgical Oncology, Department of Surgery , The Ohio State University , Columbus , OH , USA.,f The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute , Columbus , OH , USA
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Povoski SP, Hall NC, Murrey DA, Wright CL, Martin EW. Feasibility of a multimodal (18)F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma. BMC Cancer 2015; 15:378. [PMID: 25953144 PMCID: PMC4426183 DOI: 10.1186/s12885-015-1381-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Background 18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma. Methods Thirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by 18F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with 18F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various 18F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT. Results Same-day 18F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of 18F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from 18F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from 18F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from 18F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified 18F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients. Conclusions A multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as 18F-FDG-avid lesions on diagnostic 18F-FDG PET/CT imaging.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Nathan C Hall
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. .,Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Douglas A Murrey
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Chadwick L Wright
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
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Hall NC, Nichols SD, Povoski SP, James IAO, Wright CL, Harris R, Schmidt CR, Muscarella P, Latchana N, Martin EW, Ellison EC. Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma: Proof of Concept. J Am Coll Surg 2015. [PMID: 26206636 DOI: 10.1016/j.jamcollsurg.2015.03.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 ((111)In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES. STUDY DESIGN Five patients (6 cases) with (111)In-pentetreotide-avid ZES were evaluated. Patients were injected with (111)In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize (111)In-pentetreotide-avid lesions, guide resection, assess specimens for (111)In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity. RESULTS Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of (111)In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The (111)In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery. CONCLUSIONS Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.
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Affiliation(s)
- Nathan C Hall
- Department of Radiology, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Shawnn D Nichols
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Stephen P Povoski
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Iyore A O James
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Chadwick L Wright
- Department of Radiology, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Randall Harris
- Division of Epidemiology, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Carl R Schmidt
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Peter Muscarella
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Nicholas Latchana
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Edward W Martin
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - E Christopher Ellison
- Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH
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Prakash S, Karnes MP, Sequin EK, West JD, Hitchcock CL, Nichols SD, Bloomston M, Abdel-Misih SR, Schmidt CR, Martin EW, Povoski SP, Subramaniam VV. Ex vivo electrical impedance measurements on excised hepatic tissue from human patients with metastatic colorectal cancer. Physiol Meas 2015; 36:315-28. [PMID: 25597963 DOI: 10.1088/0967-3334/36/2/315] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Point-wise ex vivo electrical impedance spectroscopy measurements were conducted on excised hepatic tissue from human patients with metastatic colorectal cancer using a linear four-electrode impedance probe. This study of 132 measurements from 10 colorectal cancer patients, the largest to date, reports that the equivalent electrical conductivity for tumor tissue is significantly higher than normal tissue (p < 0.01), ranging from 2-5 times greater over the measured frequency range of 100 Hz-1 MHz. Difference in tissue electrical permittivity is also found to be statistically significant across most frequencies. Furthermore, the complex impedance is also reported for both normal and tumor tissue. Consistent with trends for tissue electrical conductivity, normal tissue has a significantly higher impedance than tumor tissue (p < 0.01), as well as a higher net capacitive phase shift (33° for normal liver tissue in contrast to 10° for tumor tissue).
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Affiliation(s)
- S Prakash
- Department of Mechanical and Aerospace Engineering, The Ohio State University, 201 W. 19th Avenue, Columbus, OH 43210, USA
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Fagundes CP, Jaremka LM, Glaser R, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Yee LD, Carson WE, Farrar WB, Malarkey WB, Chen M, Kiecolt-Glaser JK. Attachment anxiety is related to Epstein-Barr virus latency. Brain Behav Immun 2014; 41:232-8. [PMID: 24945717 PMCID: PMC4304069 DOI: 10.1016/j.bbi.2014.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/03/2014] [Accepted: 04/05/2014] [Indexed: 12/22/2022] Open
Abstract
Attachment theory provides a framework for understanding individual differences in chronic interpersonal stress. Attachment anxiety, a type of relationship insecurity characterized by worry about rejection and abandonment, is a chronic interpersonal stressor. Stress impacts cellular immunity, including herpesvirus reactivation. We investigated whether attachment anxiety was related to the expression of a latent herpesvirus, Epstein-Barr virus (EBV), when individuals were being tested for breast or colon cancer and approximately 1 year later. Participants (N=183) completed a standard attachment questionnaire and provided blood to assess EBV viral capsid antigen (VCA) IgG antibody titers. Individuals with more attachment anxiety had higher EBV VCA IgG antibody titers than those with less attachment anxiety. The strength of the association between attachment anxiety and antibody titers was the same at both assessments. This study is the first to show an association between latent herpesvirus reactivation and attachment anxiety. Because elevated herpesvirus antibody titers reflect poorer cellular immune system control over the latent virus, these data suggest that high attachment anxiety is associated with cellular immune dysregulation.
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Affiliation(s)
- Christopher P. Fagundes
- Department of Health Disparities, University of Texas MD Anderson Cancer Center, United States, Corresponding author. Address: UT MD Anderson Cancer Center, Dept. of Health Disparities Research, Unit 1440, Rm. FCT 9.5016, PO Box 301402, Houston, TX 77230, United States. Tel.: +1 713 794 523. (C.P. Fagundes)
| | - Lisa M. Jaremka
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States
| | - Ronald Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States
| | - Catherine M. Alfano
- Office of Cancer Survivorship, National Cancer Institute, National Institute of Health, United States
| | - Stephen P. Povoski
- Department of Surgery, The Ohio State University College of Medicine, United States
| | - Adele M. Lipari
- Department of Radiology, The Ohio State University College of Medicine, United States
| | - Doreen M. Agnese
- Department of Surgery, The Ohio State University College of Medicine, United States
| | - Lisa D. Yee
- Department of Surgery, The Ohio State University College of Medicine, United States
| | - William E. Carson
- Department of Surgery, The Ohio State University College of Medicine, United States, Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University College of Medicine, United States
| | - William B. Farrar
- Department of Surgery, The Ohio State University College of Medicine, United States
| | - William B. Malarkey
- Department of Internal Medicine, The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States, Department of Molecular Virology, Immunology, and Medical Genetics, The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States, The Institute for Behavioral Medicine Research, Comprehensive Cancer Center, and Department of Psychiatry, The Ohio State University College of Medicine, United States
| | - Min Chen
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States
| | - Janice K. Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, United States, The Institute for Behavioral Medicine Research, Comprehensive Cancer Center, and Department of Psychiatry, The Ohio State University College of Medicine, United States
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Chapman GJ, Povoski SP, Hall NC, Murrey DA, Lee R, Martin EW. Comparison of two threshold detection criteria methodologies for determination of probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG-avid tissue sites during radioguided oncologic surgery. BMC Cancer 2014; 14:667. [PMID: 25218021 PMCID: PMC4171551 DOI: 10.1186/1471-2407-14-667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative in situ identification of 18F-FDG-avid tissue sites during radioguided oncologic surgery remains a significant challenge for surgeons. The purpose of our study was to evaluate the 1.5-to-1 ratiometric threshold criteria method versus the three-sigma statistical threshold criteria method for determination of gamma detection probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG-avid tissue sites in a manner that was independent of the specific type of gamma detection probe used. Methods From among 52 patients undergoing appropriate in situ evaluation of presumed abnormal 18F-FDG-avid tissue sites during 18F-FDG-directed surgery using 6 available gamma detection probe systems, a total of 401 intraoperative gamma detection probe measurement sets of in situ counts per second measurements were cumulatively taken. Results For the 401 intraoperative gamma detection probe measurement sets, probe positivity was successfully met by the 1.5-to-1 ratiometric threshold criteria method in 150/401 instances (37.4%) and by the three-sigma statistical threshold criteria method in 259/401 instances (64.6%) (P < 0.001). Likewise, the three-sigma statistical threshold criteria method detected true positive results at target-to-background ratios much lower than the 1.5-to-1 target-to-background ratio of the 1.5-to-1 ratiometric threshold criteria method. Conclusions The three-sigma statistical threshold criteria method was significantly better than the 1.5-to-1 ratiometric threshold criteria method for determination of gamma detection probe positivity for intraoperative in situ detection of presumed abnormal 18F-FDG-avid tissue sites during radioguided oncologic surgery. This finding may be extremely important for reshaping the ongoing and future research and development of gamma detection probe systems that are necessary for optimizing the in situ detection of radioisotopes of higher-energy gamma photon emissions used during radioguided oncologic surgery.
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Affiliation(s)
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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31
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Povoski SP, Murrey DA, Smith SM, Martin EW, Hall NC. 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single-institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues. BMC Cancer 2014; 14:453. [PMID: 24942656 PMCID: PMC4075626 DOI: 10.1186/1471-2407-14-453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/13/2014] [Indexed: 12/31/2022] Open
Abstract
Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a well-established imaging modality for a wide variety of solid malignancies. Currently, only limited data exists regarding the utility of PET/CT imaging at very extended injection-to-scan acquisition times. The current retrospective data analysis assessed the feasibility and quantification of diagnostic 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals. Methods 18F-FDG-avid lesions (not surgically manipulated or altered during 18F-FDG-directed surgery, and visualized both on preoperative and postoperative 18F-FDG PET/CT imaging) and corresponding background tissues were assessed for 18F-FDG accumulation on same-day preoperative and postoperative 18F-FDG PET/CT imaging. Multiple patient variables and 18F-FDG-avid lesion variables were examined. Results For the 32 18F-FDG-avid lesions making up the final 18F-FDG-avid lesion data set (from among 7 patients), the mean injection-to-scan times of the preoperative and postoperative 18F-FDG PET/CT scans were 73 (±3, 70-78) and 530 (±79, 413-739) minutes, respectively (P < 0.001). The preoperative and postoperative mean 18F-FDG-avid lesion SUVmax values were 7.7 (±4.0, 3.6-19.5) and 11.3 (±6.0, 4.1-29.2), respectively (P < 0.001). The preoperative and postoperative mean background SUVmax values were 2.3 (±0.6, 1.0-3.2) and 2.1 (±0.6, 1.0-3.3), respectively (P = 0.017). The preoperative and postoperative mean lesion-to-background SUVmax ratios were 3.7 (±2.3, 1.5-9.8) and 5.8 (±3.6, 1.6-16.2), respectively, (P < 0.001). Conclusions 18F-FDG PET/CT oncologic imaging can be successfully performed at extended injection-to-scan acquisition time intervals of up to approximately 5 half-lives for 18F-FDG while maintaining good/adequate diagnostic image quality. The resultant increase in the 18F-FDG-avid lesion SUVmax values, decreased background SUVmax values, and increased lesion-to-background SUVmax ratios seen from preoperative to postoperative 18F-FDG PET/CT imaging have great potential for allowing for the integrated, real-time use of 18F-FDG PET/CT imaging in conjunction with 18F-FDG-directed interventional radiology biopsy and ablation procedures and 18F-FDG-directed surgical procedures, as well as have far-reaching impact on potentially re-shaping future thinking regarding the “most optimal” injection-to-scan acquisition time interval for all routine diagnostic 18F-FDG PET/CT oncologic imaging.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Jaremka LM, Peng J, Bornstein R, Alfano CM, Andridge RR, Povoski SP, Lipari AM, Agnese DM, Farrar WB, Yee LD, Carson WE, Kiecolt-Glaser JK. Cognitive problems among breast cancer survivors: loneliness enhances risk. Psychooncology 2014; 23:1356-64. [PMID: 24729533 DOI: 10.1002/pon.3544] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 03/07/2014] [Accepted: 03/17/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer survivors often experience cognitive difficulties after treatment completion. Although chemotherapy enhances risk for cognitive problems, it is likely only one piece of a complex puzzle that explains survivors' cognitive functioning. Loneliness may be one psychosocial risk factor. The current studies included both subjective and objective cognitive measures and tested whether lonelier breast cancer survivors would have more concentration and memory complaints and experience more concentration difficulties than their less lonely counterparts. METHODS The relationship between loneliness and cognitive function was tested among three samples of breast cancer survivors. Study 1 was a sample of breast cancer survivors (n = 200) who reported their concentration and memory problems. Study 2a was a sample of breast cancer survivors (n = 185) and noncancer controls (n = 93) who reported their concentration and memory problems. Study 2b was a subsample of Study 2a breast cancer survivors (n = 22) and noncancer controls (n = 21) who completed a standardized neuropsychological test assessing concentration. RESULTS Studies 1 and 2a revealed that lonelier women reported more concentration and memory problems than less lonely women. Study 2b utilized a standardized neuropsychological continuous performance test and demonstrated that lonelier women experienced more concentration problems than their less lonely counterparts. CONCLUSIONS These studies demonstrated that loneliness is linked to concentration and memory complaints and the experience of concentration problems among breast cancer survivors. The results were also highly consistent across three samples of breast cancer survivors. These data suggest that loneliness may be a risk factor for cognitive difficulties among cancer survivors.
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Affiliation(s)
- Lisa M Jaremka
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
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Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, Agnese DM, Farrar WB, Yee LD, Carson WE, Malarkey WB, Kiecolt-Glaser JK. Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology 2014; 42:38-44. [PMID: 24636499 PMCID: PMC3970938 DOI: 10.1016/j.psyneuen.2013.12.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/27/2013] [Accepted: 12/24/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Pain and depressive symptoms are commonly experienced by cancer survivors. Lower social support is linked to a variety of negative mental and physical health outcomes among survivors. Immune dysregulation may be one mechanism linking low social support to the development of pain and depressive symptoms over time. Accordingly, the goal of the present study was to examine the relationships among survivors' social support, pain, depressive symptoms, and inflammation. METHODS Breast cancer survivors (N=164, stages 0-IIIA) completed two study visits, one before any cancer treatment and the other 6 months after the completion of surgery, radiation, or chemotherapy, whichever came last. Women completed self-report questionnaires assessing social support, pain, and depressive symptoms, and provided a blood sample at both visits. RESULTS Survivors with lower social support prior to treatment experienced higher levels of pain and depressive symptoms over time than their more socially supported counterparts. Furthermore, women with lower pretreatment social support had higher levels of IL-6 over time, and these elevations in IL-6 predicted marginally larger increases in depressive symptoms. CONCLUSIONS The results of this study suggest that social support at the time of diagnosis predicts the post-treatment development of pain, depressive symptoms, and inflammation. Consequently, early interventions targeting survivors' social networks could improve quality of life during survivorship.
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Affiliation(s)
- Spenser Hughes
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Lisa M. Jaremka
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | | | - Ronald Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Stephen P. Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Adele M. Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Doreen M. Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - William B. Farrar
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Lisa D. Yee
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - William E. Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Department of Psychology, The Ohio State University, Columbus, OH 43210 USA,Department of Psychiatry, The Ohio State University College of Medicine, Columbus, OH 43210 USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH 43210 USA
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Povoski SP, Jimenez RE, Wang WP. Use of an Intraoperative Ultrasonography-Guided Localization and Tissue Fixation Device Demonstrates Less Margin Positivity During Breast-Conserving Surgery for Invasive Breast Cancer Than Standard Preoperative Needle-Wire Localization: A Retrospective Comparative Analysis in a Consecutively Treated Case Series. Clin Breast Cancer 2014; 14:46-52. [DOI: 10.1016/j.clbc.2013.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/31/2013] [Accepted: 09/04/2013] [Indexed: 11/15/2022]
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35
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Hall NC, Povoski SP, Zhang J, Knopp MV, Martin EW. Use of intraoperative nuclear medicine imaging technology: strategy for improved patient management. Expert Rev Med Devices 2014; 10:149-52. [DOI: 10.1586/erd.13.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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Povoski SP, Hatzaras IS, Mojzisik CM, Martin EW. Oncologic theranostics: recognition of this concept in antigen-directed cancer therapy for colorectal cancer with anti-TAG-72 monoclonal antibodies. Expert Rev Mol Diagn 2014; 11:667-70. [DOI: 10.1586/erm.11.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Povoski SP, Hall NC. Recognizing the role of surgical oncology and cancer imaging in the multidisciplinary approach to cancer: an important area of future scholarly growth for BMC Cancer. BMC Cancer 2013; 13:355. [PMID: 23879552 PMCID: PMC3724699 DOI: 10.1186/1471-2407-13-355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022] Open
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Kocak E, Nagel TW, Hulsen JH, Carruthers KH, Povoski SP, Salgado CJ, Chao AH. Biologic matrices in oncologic breast reconstruction after mastectomy. Expert Rev Med Devices 2013; 11:65-75. [DOI: 10.1586/17434440.2014.864087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Povoski SP, Davis PD, Colcher D, Martin EW. Single molecular weight discrete PEG compounds: emerging roles in molecular diagnostics, imaging and therapeutics. Expert Rev Mol Diagn 2013; 13:315-9. [PMID: 23638813 DOI: 10.1586/erm.13.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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40
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Ding H, Carlton MM, Povoski SP, Milum K, Kumar K, Kothandaraman S, Hinkle GH, Colcher D, Brody R, Davis PD, Pokora A, Phelps M, Martin EW, Tweedle MF. Site specific discrete PEGylation of (124)I-labeled mCC49 Fab' fragments improves tumor MicroPET/CT imaging in mice. Bioconjug Chem 2013; 24:1945-54. [PMID: 24175669 DOI: 10.1021/bc400375f] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The tumor-associated glycoprotein-72 (TAG-72) antigen is highly overexpressed in various human adenocarcinomas and anti-TAG-72 monoclonal antibodies, and fragments are therefore useful as pharmaceutical targeting vectors. In this study, we investigated the effects of site-specific PEGylation with MW 2-4 kDa discrete, branched PEGylation reagents on mCC49 Fab' (MW 50 kDa) via in vitro TAG72 binding, and in vivo blood clearance kinetics, biodistribution, and mouse tumor microPET/CT imaging. mCC49Fab' (Fab'-NEM) was conjugated at a hinge region cysteine with maleimide-dPEG 12-(dPEG24COOH)3 acid (Mal-dPEG-A), maleimide-dPEG12-(dPEG12COOH)3 acid (Mal-dPEG-B), or maleimide-dPEG12-(m-dPEG24)3 (Mal-dPEG-C), and then radiolabeled with iodine-124 ((124)I) in vitro radioligand binding assays and in vivo studies used TAG-72 expressing LS174T human colon carcinoma cells and xenograft mouse tumors. Conjugation of mCC49Fab' with Mal-dPEG-A (Fab'-A) reduced the binding affinity of the non PEGylated Fab' by 30%; however, in vivo, Fab'-A significantly lengthened the blood retention vs Fab'-NEM (47.5 vs 28.1%/ID at 1 h, 25.1 vs 8.4%/ID at 5 h, p < 0.01), showed excellent tumor to background, better microPET/CT images due to higher tumor accumulation, and increased tumor concentration in excised tissues at 72 h by 130% (5.09 ± 0.83 vs 3.83 ± 1.50%ID/g, p < 0.05). Despite the strong similarity of the three PEGylation reagents, PEGylation with Mal-dPEG-B or -C reduced the in vitro binding affinity of Fab'-NEM by 70%, blood retention, microPET/CT imaging tumor signal intensity, and residual 72 h tumor concentration by 49% (3.83 ± 1.50 vs 1.97 ± 0.29%ID/g, p < 0.05) and 63% (3.83 ± 1.50 vs 1.42 ± 0.35%ID/g, p < 0.05), respectively. We conclude that remarkably subtle changes in the structure of the PEGylation reagent can create significantly altered biologic behavior. Further study is warranted of conjugates of the triple branched, negatively charged Mal-dPEG-A.
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Affiliation(s)
- Haiming Ding
- Department of Radiology, The Wright Center for Innovation in Biomedical Imaging, ‡Department of Surgery, and ⊥Department of Pharmacology, The Ohio State University , Columbus, Ohio 43210, United States
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41
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Chen Z, Butke R, Miller B, Hitchcock CL, Allen HC, Povoski SP, Martin EW, Coe JV. Infrared metrics for fixation-free liver tumor detection. J Phys Chem B 2013; 117:12442-50. [PMID: 24053455 DOI: 10.1021/jp4073087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infrared (IR) spectroscopic imaging of human liver tissue slices has been used to identify and characterize liver tumors. Liver tissue, containing a liver metastasis of breast origin (mucinous carcinoma), was surgically removed from a consenting patient and frozen without formalin fixation or dehydration procedures, so that lipids and water remained in the tissues. A set of IR metrics (ratios of various IR peaks) was determined for tumors in fixation-free liver tissues. K-means cluster analysis was used to tell tumor from nontumor. In this case, there was a large reduction in lipid content upon going from nontumor to tumor tissue, and a well-resolved IR spectrum of nontumor liver lipid was obtained and analyzed. These IR metrics may someday guide work on IR spectroscopic diagnostics on patients in the operating room. This work also suggests utility for these methods beyond the identification of liver tumors, perhaps in the study of liver lipids.
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Affiliation(s)
- Zhaomin Chen
- Department of Chemistry and Biochemistry, The Ohio State University , 100 West 18th Avenue, Columbus , Ohio 43210-1173, United States
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Tiwari P, Coriddi M, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol 2013; 11:237. [PMID: 24053624 PMCID: PMC3852359 DOI: 10.1186/1477-7819-11-237] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/05/2013] [Indexed: 11/24/2022] Open
Abstract
Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation.
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Affiliation(s)
- Pankaj Tiwari
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Michelle Coriddi
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Mrózek E, Povoski SP, Shapiro CL. The challenges of individualized care for older patients with localized breast cancer. Expert Rev Anticancer Ther 2013; 13:963-73. [PMID: 23984898 DOI: 10.1586/14737140.2013.820568] [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: 11/08/2022]
Abstract
Individualized care is achieved when the appropriate screening and/or evaluative tests are used, the treatment plan is driven by evidence-based data and the patient's functional ability, physical and mental health, preference and social situation are incorporated into treatment decisions. Breast cancer is a disease of aging; yet, the management of breast cancer in older women in most cases lacks evidence from prospective randomized clinical trials (i.e., level 1 evidence) to support treatment recommendations. Older women are underrepresented in therapeutic clinical studies, even though studies show that selected fit older women enrolled on clinical trials derive similar benefits as younger women. Very few studies have focused on the distribution and biological behavior of different molecular subtypes of breast cancer in older women making it difficult to conclude whether old age adds extra biological complexity. A comprehensive geriatric assessment that includes a multidimensional process designed to assess functional ability, physical health, cognitive and mental health, social issues and environmental situation of elderly person should be an integral part of individualized care for older patients with breast cancer. However, incorporation of this tool into standard oncology practice is very slow despite the expected steep increase in older individuals with cancer projected over the next 25 years. All of the factors mentioned above hinder progress in delivering individualized care to older patients with breast cancer. This article provides an overview on progress and challenges of individualized and personalized health care in older women with breast cancer.
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Affiliation(s)
- Ewa Mrózek
- Division of Medical Oncology, The Wexner Medical Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.
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Abstract
The use of microvascular anastomoses to allow transfer of viable tissue is a fundamental technique of reconstructive surgery, and is used to treat a broad spectrum of clinical problems. The primary threat to this type of reconstructive surgery is anastomotic vascular thrombosis, which can lead to complete loss of tissue with potentially devastating consequences. Monitoring of tissue perfusion postoperatively is critical, since early recognition of vascular compromise and prompt surgical intervention is correlated with the ability for tissue salvage. Traditionally, physical examination was the primary means of monitoring, but possesses several limitations. Medical devices introduced for the purposes of flap monitoring address many of these deficiencies, and have greatly enhanced this critical aspect of the reconstructive surgery process.
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Affiliation(s)
- Albert H Chao
- Department of Plastic Surgery, The Ohio State University, Columbus, OH 43212, USA
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Jaremka LM, Andridge RR, Fagundes CP, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Arnold MW, Farrar WB, Yee LD, Carson WE, Bekaii-Saab T, Martin EW, Schmidt CR, Kiecolt-Glaser JK. Pain, depression, and fatigue: loneliness as a longitudinal risk factor. Health Psychol 2013; 33:948-57. [PMID: 23957903 DOI: 10.1037/a0034012] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pain, depression, and fatigue function as a symptom cluster and thus may share common risk factors. Interpersonal relationships clearly influence health, suggesting that loneliness may promote the development of the pain, depression, and fatigue symptom cluster. We hypothesized that loneliness would be related to concurrent symptom cluster levels and increases in symptom cluster levels over time. METHOD We utilized two observational studies with distinct longitudinal samples. Study 1 was a sample of cancer survivors and benign controls (N = 115) assessed annually for 2 years. Study 2 was a sample of older adults caring for a spouse with dementia (caregivers) and non-caregiver controls (N = 229) assessed annually for 4 years. Participants completed annual measures assessing loneliness, pain, depression, and fatigue. RESULTS Across both samples, lonelier participants experienced more concurrent pain, depression, and fatigue and larger increases in symptom cluster levels from one year to the next than less lonely participants. Sleep quality did not mediate the results in either study. All analyses were adjusted for relevant demographic and health variables. CONCLUSIONS Two longitudinal studies with different populations demonstrated that loneliness was a risk factor for the development of the pain, depression, and fatigue symptom cluster over time. The current research helps identify people most at risk for pain, depression, and fatigue, and lays the groundwork for research about their diagnosis and treatment. These data also highlight the health risks of loneliness; pain, depression, and fatigue often accompany serious illness and place people at risk for poor health and mortality.
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Wallace AM, Han LK, Povoski SP, Deck K, Schneebaum S, Hall NC, Hoh CK, Limmer KK, Krontiras H, Frazier TG, Cox C, Avisar E, Faries M, King DW, Christman L, Vera DR. Comparative evaluation of [(99m)tc]tilmanocept for sentinel lymph node mapping in breast cancer patients: results of two phase 3 trials. Ann Surg Oncol 2013; 20:2590-9. [PMID: 23504141 PMCID: PMC3705144 DOI: 10.1245/s10434-013-2887-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [(99m)Tc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance. METHODS A total of 13 centers contributed 148 patients with breast cancer. Each patient received [(99m)Tc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [(99m)Tc]tilmanocept. RESULTS A total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [(99m)Tc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [(99m)Tc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [(99m)Tc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [(99m)Tc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [(99m)Tc]tilmanocept. CONCLUSION [(99m)Tc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [(99m)Tc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.
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Affiliation(s)
- Anne M Wallace
- Divisions of Surgical Oncology and Plastic Surgery, UCSD Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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Povoski SP, Chapman GJ, Murrey DA, Lee R, Martin EW, Hall NC. Intraoperative detection of ¹⁸F-FDG-avid tissue sites using the increased probe counting efficiency of the K-alpha probe design and variance-based statistical analysis with the three-sigma criteria. BMC Cancer 2013; 13:98. [PMID: 23496877 PMCID: PMC3599348 DOI: 10.1186/1471-2407-13-98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative detection of (18)F-FDG-avid tissue sites during 18F-FDG-directed surgery can be very challenging when utilizing gamma detection probes that rely on a fixed target-to-background (T/B) ratio (ratiometric threshold) for determination of probe positivity. The purpose of our study was to evaluate the counting efficiency and the success rate of in situ intraoperative detection of (18)F-FDG-avid tissue sites (using the three-sigma statistical threshold criteria method and the ratiometric threshold criteria method) for three different gamma detection probe systems. METHODS Of 58 patients undergoing (18)F-FDG-directed surgery for known or suspected malignancy using gamma detection probes, we identified nine (18)F-FDG-avid tissue sites (from amongst seven patients) that were seen on same-day preoperative diagnostic PET/CT imaging, and for which each (18)F-FDG-avid tissue site underwent attempted in situ intraoperative detection concurrently using three gamma detection probe systems (K-alpha probe, and two commercially-available PET-probe systems), and then were subsequently surgical excised. RESULTS The mean relative probe counting efficiency ratio was 6.9 (± 4.4, range 2.2-15.4) for the K-alpha probe, as compared to 1.5 (± 0.3, range 1.0-2.1) and 1.0 (± 0, range 1.0-1.0), respectively, for two commercially-available PET-probe systems (P < 0.001). Successful in situ intraoperative detection of 18F-FDG-avid tissue sites was more frequently accomplished with each of the three gamma detection probes tested by using the three-sigma statistical threshold criteria method than by using the ratiometric threshold criteria method, specifically with the three-sigma statistical threshold criteria method being significantly better than the ratiometric threshold criteria method for determining probe positivity for the K-alpha probe (P = 0.05). CONCLUSIONS Our results suggest that the improved probe counting efficiency of the K-alpha probe design used in conjunction with the three-sigma statistical threshold criteria method can allow for improved detection of 18F-FDG-avid tissue sites when a low in situ T/B ratio is encountered.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus 43210, OH, USA.
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Kocak E, Carruthers KH, Knopp MV, Carkaci S, Martin EW, Povoski SP. Image-guided technologies to facilitate the dissection of microsurgical autologous tissue-free flaps. Expert Rev Med Devices 2012; 9:547-9. [PMID: 23249148 DOI: 10.1586/erd.12.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lindgren ME, Fagundes CP, Alfano CM, Povoski SP, Agnese DM, Arnold MW, Farrar WB, Yee LD, Carson WE, Schmidt CR, Kiecolt-Glaser JK. Beta-blockers may reduce intrusive thoughts in newly diagnosed cancer patients. Psychooncology 2012; 22:1889-94. [PMID: 23255459 DOI: 10.1002/pon.3233] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/30/2012] [Accepted: 11/07/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A cancer diagnosis provokes significant levels of emotional distress, with intrusive thoughts being the most common manifestation among breast cancer survivors. Cancer-related intrusive thoughts can take the form of emotional memories, flashbacks, nightmares, and intrusive images. Emotional arousal after a severe life stressor prolongs adrenergic activation, which in turn may increase risk for post-traumatic symptomatology. However, antihypertensive beta-blockers block adrenergic activation and are known to reduce traumatic memories and related psychological distress. Thus, the current study examined the association between beta-blocker use and the severity of cancer-related intrusive thoughts and related symptoms following a cancer diagnosis. METHODS The 174 breast and 36 female colorectal cancer patients who had recently undergone diagnostic screening or biopsy included 39 beta-blocker users and 171 non-users. Prior to any cancer treatment including surgery, participants completed questionnaires that included the Impact of Events Scale and the Center for Epidemiological Studies Depression Scale. Analyses controlled for age, education, cancer stage, cancer type, days since diagnosis, marital status, depression, and comorbidities. RESULTS Although the high rates of cancer-related distress in this sample were similar to those of other studies with recently diagnosed patients, beta-blocker users endorsed 32% fewer cancer-related intrusive thoughts than non-users. CONCLUSIONS Recently diagnosed cancer patients using beta-blockers reported less cancer-related psychological distress. These results suggest that beta-blocker use may benefit cancer patients' psychological adjustment following diagnosis, and provide a promising direction for future investigations on the pharmacological benefits of beta-blockers for cancer-related distress.
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Affiliation(s)
- Monica E Lindgren
- Institute for Behavioral Medicine Research, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Povoski SP, Hall NC, Murrey DA, Sharp DS, Hitchcock CL, Mojzisik CM, Bahnson EE, Knopp MV, Martin EW, Bahnson RR. Multimodal imaging and detection strategy with 124 I-labeled chimeric monoclonal antibody cG250 for accurate localization and confirmation of extent of disease during laparoscopic and open surgical resection of clear cell renal cell carcinoma. Surg Innov 2012; 20:59-69. [PMID: 22455975 PMCID: PMC3758170 DOI: 10.1177/1553350612438416] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Renal cell carcinoma (RCC) accounts for approximately 85% to 90% of all primary kidney
malignancies, with clear cell RCC (ccRCC) constituting approximately 70% to 85% of all
RCCs. This study describes an innovative multimodal imaging and detection strategy that
uses 124I-labeled chimeric monoclonal antibody G250 (124I-cG250) for
accurate preoperative and intraoperative localization and confirmation of extent of
disease for both laparoscopic and open surgical resection of ccRCC. Two cases presented
herein highlight how this technology can potentially guide complete surgical resection and
confirm complete removal of all diseased tissues. This innovative 124I-cG250
(ie, 124I-girentuximab) multimodal imaging and detection approach, which would
be clinically very useful to urologic surgeons, urologic medical oncologists, nuclear
medicine physicians, radiologists, and pathologists who are involved in the care of ccRCC
patients, holds great potential for improving the diagnostic accuracy, operative planning
and approach, verification of disease resection, and monitoring for evidence of disease
recurrence in ccRCC patients.
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Affiliation(s)
- Stephen P Povoski
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH 43210, USA.
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