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Crew KD, Anderson GL, Arnold KB, Stieb AP, Amenta JN, Collins N, Law CW, Pruthi S, Sandoval-Leon A, Bertoni D, Grosse Perdekamp MT, Colonna S, Krisher S, King T, Yee LD, Ballinger TJ, Braun-Inglis C, Mangino D, Wisinski KB, DeYoung CA, Ross M, Floyd J, Kaster A, Vander Walde L, Saphner T, Zarwan C, Lo S, Graham C, Conlin A, Yost K, Agnese D, Jernigan C, Hershman DL, Neuhouser ML, Arun B, Kukafka R. Making informed choices on incorporating chemoprevention into carE (MiCHOICE, SWOG 1904): Design and methods of a cluster randomized controlled trial. Contemp Clin Trials 2024; 142:107564. [PMID: 38704119 DOI: 10.1016/j.cct.2024.107564] [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: 12/12/2023] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy. METHODS/DESIGN We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation. RESULTS/DISCUSSION With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S. CLINICAL SETTINGS TRIAL REGISTRATION NCT04496739.
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Affiliation(s)
- K D Crew
- Columbia University Irving Medical Center, New York, NY, USA.
| | - G L Anderson
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - K B Arnold
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - A P Stieb
- Columbia University Irving Medical Center, New York, NY, USA
| | - J N Amenta
- Columbia University Irving Medical Center, New York, NY, USA
| | - N Collins
- Columbia University Irving Medical Center, New York, NY, USA
| | - C W Law
- Columbia University Irving Medical Center, New York, NY, USA
| | - S Pruthi
- Mayo Clinic, Rochester, MN, United States of America
| | - A Sandoval-Leon
- Miami Cancer Institute at Baptist Health South Florida, Miami, FL, USA
| | - D Bertoni
- Good Samaritan Hospital Corvallis, Corvallis, OR , USA
| | | | - S Colonna
- Huntsman Cancer Institute / University of Utah Medical Center, Salt Lake City, UT, USA
| | - S Krisher
- Holy Redeemer Hospital and Medical Center, Meadowbrook, PA, USA
| | - T King
- Dana-Farber Brigham Cancer Center, Brigham and Women's Hospital, Boston, MA, USA
| | - L D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - T J Ballinger
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - D Mangino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K B Wisinski
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | | | - M Ross
- Virginia Commonwealth University, Richmond, VA, USA
| | - J Floyd
- Cancer Care Specialists of Illinois, Heartland NCORP, Decatur, IL, USA
| | - A Kaster
- Sanford Roger Maris Cancer Center, Fargo, ND, United States of America
| | - L Vander Walde
- Baptist Memorial Health Care, Memphis, TN, United States of America
| | | | - C Zarwan
- Lahey Hospital & Medical Center, Burlington, MA, USA
| | - S Lo
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - C Graham
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA, USA
| | - A Conlin
- Providence Cancer Institute, Portland, OR, USA
| | - K Yost
- Cancer Research Consortium of West Michigan NCORP, Kalamazoo, MI, USA
| | - D Agnese
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - C Jernigan
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - D L Hershman
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - B Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Kukafka
- Columbia University Irving Medical Center, New York, NY, USA
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Sud S, Poellmann M, Garg V, King T, Casey DL, Wang AZ, Hong S, Weiner AA. Prospective Characterization of Circulating Tumor Cell Kinetics in Patients with Localized Lung Cancer Treated with Radiotherapy or Chemoradiotherapy with Definitive Intent. Int J Radiat Oncol Biol Phys 2023; 117:e60. [PMID: 37785811 DOI: 10.1016/j.ijrobp.2023.06.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize circulating tumor cell (CTC) kinetics in response to definitive therapy in patients with local or locoregional lung cancer and identify CTC kinetic profiles associated with favorable disease response versus progression. MATERIALS/METHODS In this single-institution prospective correlative biomarker study, we enrolled patients receiving definitive intent radiotherapy (RT) or chemoradiotherapy for non-metastatic lung cancer. Blood specimens were collected prior to RT (baseline), during RT and at follow up visits up to 24 months post RT. Subsequent lines of therapy were administered per standard of care. CTCs were captured and enumerated using a previously reported nanotechnology-based assay functionalized with aEpCAM, aHER-2, and aEGFR to facilitate biomimetic cell rolling and dendrimer-mediated multivalent binding. Disease status was assessed per RECIST 1.1 criteria. CTC kinetics and absolute values were analyzed to identify patterns associated with disease control versus progression. RESULTS We enrolled 24 patients with median follow up of 8 months corresponding to 114 CTC measurements. Seven patients (30%) had biopsy proven disease, while 17 (70%) were diagnosed based on clinical and radiographic features alone. Nineteen patients (79%) received stereotactic body radiation therapy. Median baseline CTC count was 12.6 CTCs/ml (range 0-290) and post RT decreased to median 4 CTCs/ml (0-42.7). For 95% of patients, a favorable kinetic profile (defined as stable CTC count, decreased CTC count or <24 CTCs/ml corresponding to the 80th percentile) during radiotherapy or at the time of first follow up corresponded to local control of the irradiated lesion. Five patients (20%) experienced disease progression within the follow up period. In the two patients with local progression of the irradiated lesion, the CTC count rose >10 fold prior to or at the time of radiographic detection of progression. In the three patients with systemic progression, CTC count rose 1.46-5.8-fold at the time of progression. Notably, four of the five patients with disease progression did not have initial biopsy confirmation of disease but did experience a CTC elevation at the time of progression. CONCLUSION Our data suggests CTCs may serve as a biomarker for response to therapy in patients being treated with RT with definitive intent for early stage or locally advanced lung cancer. This finding is of importance given important limitations in obtaining pathologic confirmation of disease in select patients and challenges distinguishing disease progression versus benign post radiotherapy radiographic changes. Further studies are needed to characterize the predictive and prognostic value of circulating biomarker levels and kinetics in lung cancer.
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Affiliation(s)
- S Sud
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M Poellmann
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI
| | - V Garg
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T King
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - D L Casey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A Z Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; UT Southwestern Department of Radiation Oncology, Dallas, TX
| | - S Hong
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Wun MK, Leister E, King T, Korman R, Malik R. Acute kidney injury in 18 cats after subcutaneous meloxicam and an update on non-steroidal anti-inflammatory drug usage in feline patients in Australia. Aust Vet J 2023; 101:90-98. [PMID: 36470590 DOI: 10.1111/avj.13222] [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: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a well-known but poorly documented adverse effect of non-steroidal anti-inflammatory drugs (NSAIDs) in cats. We aimed to describe instances of NSAID-associated AKI in cats and survey Australian veterinarians on NSAID use in acute settings. METHODS Medical records of cats that developed an AKI subsequent to the administration of meloxicam were obtained by searching the databases of seven practices in Queensland, as well as by contemporaneously contacting select veterinary colleagues of the authors in both general and specialist small animal practice. An online questionnaire was created for the survey, and the URL distributed to Australian practitioners. RESULTS A total of 18 cases were retrieved, all of which received injectable meloxicam. The indication(s) for its use and the dosage prescribed were within the manufacturer's recommendations for Australian veterinarians. The majority of cases (13/18 cats) received the label dose of 0.3 mg/kg subcutaneously (SC) on the day of the procedure. In 12/18 cats, the injection was given in association with general anaesthesia or sedation. Fourteen cats survived to hospital discharge. Of 187 survey respondees, 89% routinely administered NSAIDs for surgery-related analgesia, with 98% prescribing meloxicam and 84% of these giving it SC. Ninety percent of respondees routinely administered NSAIDs for non-surgical-related analgesia, with 99% prescribing meloxicam and 35% of those giving it SC. CONCLUSIONS AND RELEVANCE We strongly recommend that practitioners avoid prescribing meloxicam SC in cats. This recommendation is emphatic in situations where concurrent dehydration and/or hypotension are possible.
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Affiliation(s)
- M K Wun
- Veterinary Specialist Services, Underwood, Australia
- Animal Referral Hospital Brisbane, Sinnamon Park, Australia
| | - E Leister
- Pet Intensive Care Unit, Underwood, Australia
| | - T King
- Veterinary Specialist Services, Underwood, Australia
| | - R Korman
- Veterinary Specialist Services, Underwood, Australia
| | - R Malik
- Centre for Veterinary Education, B22, The University of Sydney, Camperdown, Australia
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LaMontagne AD, Cox LL, Lockwood C, Mackinnon A, Hall N, Brimelow R, Le LKD, Mihalopoulos C, King T. Correction: Evaluation of a workplace suicide prevention program in the Australian manufacturing industry: protocol for a cluster-randomised trial of MATES in manufacturing. BMC Psychiatry 2023; 23:98. [PMID: 36755281 PMCID: PMC9909914 DOI: 10.1186/s12888-023-04590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- A. D. LaMontagne
- grid.1021.20000 0001 0526 7079Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - L. L. Cox
- Richmond Fellowship, Toowoomba, QLD Australia ,MATES in Construction (National), Brisbane, Australia
| | - C. Lockwood
- MATES in Construction (National), Brisbane, Australia
| | - A. Mackinnon
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia ,grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, Australia
| | - N. Hall
- grid.1029.a0000 0000 9939 5719Social Work & Communities, School of Social Sciences, Western Sydney University, Penrith, NSW Australia
| | - R. Brimelow
- MATES in Construction (National), Brisbane, Australia
| | - L. K.-D. Le
- grid.1002.30000 0004 1936 7857Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - C. Mihalopoulos
- grid.1002.30000 0004 1936 7857Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - T. King
- grid.1008.90000 0001 2179 088XCentre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, VIC Australia
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Freeman JN, Giroux C, King T, Maready M, Marbrey C, Pasha S, Davis J. Variations in the management and clinical outcomes for children with diabetic ketoacidosis based upon the site of initial presentation. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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6
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Rapson R, King T, Morris C, Jeffery R, Mellhuish J, Stephens C, Marsden J. Effect of different durations of using a standing frame on the rate of hip migration in children with moderate to severe cerebral palsy: a feasibility study for a randomised controlled trial. Physiotherapy 2022; 116:42-49. [DOI: 10.1016/j.physio.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 07/23/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Mertz C, Glowinski R, Cohen SH, Mertz S, Ye F, Hall MW, Peeples ME, King T, Wang H, Leber AL, Sanchez PJ, Ramilo O, Mejias A. SARS-CoV-2 RNAemia and clinical outcomes in children with COVID-19. J Infect Dis 2021; 225:208-213. [PMID: 34618885 DOI: 10.1093/infdis/jiab491] [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] [Received: 07/15/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
The burden of COVID-19 in children represents a fraction of cases worldwide, yet a subset of those infected are at risk for severe disease. We measured plasma SARS-CoV-2 RNA in a cohort of 103 children hospitalized with COVID-19 with diverse clinical manifestations. SARS-CoV-2 RNAemia was detected in 27 (26%) of these children, lasted for a median of 6 [2-9] days, and it was associated with higher rates of oxygen administration, admission to the intensive care unit, and longer hospitalization.
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Affiliation(s)
- C Mertz
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - R Glowinski
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - S H Cohen
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - S Mertz
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - F Ye
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - M W Hall
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - M E Peeples
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - T King
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA
| | - H Wang
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - A L Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - P J Sanchez
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital , and The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, Division of Neonatology, Columbus, OH, USA.,Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - O Ramilo
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - A Mejias
- Center for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
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Scovelle AJ, King T, Shields M, O'Neil A, Lallukka T, Hewitt B, Milner A. Do psychosocial job stressors differentially affect the sleep quality of men and women? A study using the HILDA Survey. Eur J Public Health 2021; 31:736-738. [PMID: 33963842 DOI: 10.1093/eurpub/ckab056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to investigate whether gender was an effect modifier of the relationship between three psychosocial job stressors and sleep quality, in a representative sample of 7280 employed Australians. We conducted linear regressions and effect measure modification analyses. Low job control, high job demands and low job security were associated with poorer sleep quality. There was evidence of effect modification of the relationship between job security and sleep quality by gender on the additive scale, indicating that the combined effect of being male and having low job security is greater than the summed interactive effect.
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Affiliation(s)
- A J Scovelle
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - T King
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - M Shields
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - A O'Neil
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - B Hewitt
- School of Social and Political Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - A Milner
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Sohawon R, Rizvi IG, Ravindra P, Pipe M, King T, Belal M. 877 The Transobturator Male Sling: Does It Stand the Test of Time? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.586] [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: 11/13/2022]
Abstract
Abstract
Introduction
The commonest cause of stress urinary incontinence in men is radical prostatectomy. We aimed to determine the efficacy, complication rate and need for salvage surgery in the medium-long term for male sling insertion.
Method
Retrospective review of all patients undergoing male sling insertion at one centre between 2009-2018. Data was collected on complications, patient satisfaction and need for further surgery. Preoperative severity was categorized as mild, moderate, or severe. We assessed ICIQ score, 24h-pad usage, patient satisfaction and identified risk factors for treatment success/failure.
Results
91 men had slings inserted (median age- 67.3). Three months success rates in mild, moderate and severe SUI groups were 96%, 86% and 80% respectively which dropped to 65%, 62% and 47% in the medium term. The rate of AUS implantation was 6%, 15% and 33% respectively. Complications included pain, infection, retention and OAB. Patient satisfaction at 5-years was 57%. Only factor predicting success or failure was pre-operative ICIQ-UI(SF) score.
Conclusions
Male sling success rates deteriorate over time. 15% will have an AUS. The risk of complications is low and transient. A pre-operative ICIQ-UI(SF) score of > 18 is a predictor of failure. Sling insertion remains a reasonable treatment option for male patients suffering with SUI.
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Affiliation(s)
- R Sohawon
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
| | - I G Rizvi
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
| | - P Ravindra
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
| | - M Pipe
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
| | - T King
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
| | - M Belal
- Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom
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King T. Omitting surgical staging of the axilla. Breast 2021. [DOI: 10.1016/s0960-9776(21)00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Singh M, Coulton A, King T, Salam A, Sharma M, Griffiths TW, Cohen SN. The British Association of Dermatologists' Undergraduate Curriculum Update 2021. Clin Exp Dermatol 2021; 46:710-714. [PMID: 33314241 DOI: 10.1111/ced.14534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/29/2022]
Abstract
The General Medical Council (GMC) plans to introduce a national Medical Licensing Assessment (MLA) in 2024 for all UK medical students as part of their primary medical qualification, with dermatology specified in its assessment blueprint. We present an Update to the British Association of Dermatologists' Undergraduate Curriculum, aligned both to the MLA Content Map and the GMC Outcomes for Graduates 2018.
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Affiliation(s)
- M Singh
- British Association of Dermatologists Education Board, London, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - A Coulton
- British Association of Dermatologists Education Board, London, UK.,Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - T King
- British Association of Dermatologists Education Board, London, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Salam
- British Association of Dermatologists Education Board, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Sharma
- British Association of Dermatologists Education Board, London, UK.,University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - T W Griffiths
- British Association of Dermatologists Education Board, London, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - S N Cohen
- British Association of Dermatologists Education Board, London, UK.,School of Medicine, University of Liverpool, Liverpool, UK
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Davidson C, Cao D, King T, Weiss ST, Wongvisavakorn S, Ratprasert N, Trakulsrichai S, Srisuma S. A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017. Am J Drug Alcohol Abuse 2020; 47:74-83. [PMID: 33232183 DOI: 10.1080/00952990.2020.1836185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Interest in the Southeast Asian natural remedy kratom has increased in Western countries recently, along with increasing concern over its potential toxic effects.Objective: To describe and compare demographics, common co-exposure substances, clinical effects, treatments, and medical outcomes of kratom "abuse" exposures in the United States (US) and Thailand.Methods: This is a retrospective analysis of kratom "abuse" exposures, defined as use when attempting to gain a psychotropic effect, reported to the National Poison Data System (NPDS) in the US and the Ramathibodi Poison Center (RPC) in Thailand from 2010 to 2017. Multivariate analysis identified risk factors for severe medical outcomes, defined as both ICU admissions and death.Results: Nine-hundred-twenty-eight cases were included (760 from NPDS and 168 from RPC). A greater proportion of cases involved co-exposures in Thailand (64.8% versus 37.4%; odds ratio [OR] = 3.10, 95% confidence interval [CI] = 2.15-4.47, p < .01). Both countries had a similar prevalence of opioid and benzodiazepine co-ingestions, but the US had more co-ingestions with other sedatives (4.6% versus 0%, OR = 0, 95% CI = 0-0.47, p < .01). Common clinical effects included tachycardia (30.4%), agitation/irritability (26.2%), and drowsiness/lethargy (21.1%). Six deaths occurred, including one single-substance exposure in the US, three multiple-substance exposures in the US, and two multiple-substance exposures in Thailand. Severe medical outcomes were reported more frequently in the US (OR = 18.82, 95% CI = 5.85-60.56, p < .01).Conclusions: Despite lower frequencies of co-ingestants overall, US kratom abuse exposures yielded greater clinical severity. This disparity may be attributable to differences in the products labeled "kratom," greater sedative co-exposures in the US, and/or differences in population genetics or use patterns.
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Affiliation(s)
- Christian Davidson
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dazhe Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Taylore King
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie T Weiss
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Sunun Wongvisavakorn
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthasiri Ratprasert
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satariya Trakulsrichai
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sahaphume Srisuma
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Johnston L, Mackay B, King T, Krockenberger MB, Malik R, Tebb A. Abdominal cryptococcosis in dogs and cats: 38 cases (2000-2018). J Small Anim Pract 2020; 62:19-27. [PMID: 33107069 DOI: 10.1111/jsap.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To report the clinical presentation, laboratory and imaging findings, treatment and outcome of abdominal cryptococcosis in dogs and cats in Australia. MATERIALS AND METHODS Canine and feline cases from Australia were retrospectively identified (2000 to 2018) via laboratory and referral centre searches for abdominal cryptococcosis diagnosed by cytology (needle aspirates) or histopathology (biopsy or necropsy) of abdominal organs/tissues. Signalment, presenting complaints, clinical signs, laboratory findings, medical imaging, latex cryptococcal antigen agglutination test (LCAT) titres, treatment and outcome data was collected. RESULTS Thirty-eight cases were included (35 dogs, three cats) in the study. Median age of presentation was 2 years for dogs and 6 years for cats. Common presenting complaints included vomiting (23/38), lethargy (19/38) and inappetence/anorexia (15/38). Abdominal ultrasound (25/38 cases) revealed mesenteric and intestinal lesions in most of the cases. On surgical exploration, seven cases had an intestinal lesion associated with an intussusception. Nineteen cases had a pre-treatment LCAT performed, with a median initial titre of 1:2048 (range 1:2 to 65,536). Twenty-four cases (23 dogs, one cat) received treatment, either medical, surgical or both. Median survival time for cases with combined medical and surgical treatment, surgical treatment alone or medical treatment alone was 730, 140 and 561 days, respectively. Eleven remain alive at the time of follow up. CLINICAL SIGNIFICANCE Abdominal cryptococcosis although rare should be a considered as a diagnostic possibility in an especially young dog presenting with gastro-intestinal signs. Older dogs can also present with this condition and should not be euthanised based on imaging alone due to the likenesses with neoplasia. With appropriate treatment and monitoring many dogs may have a prolonged survival period and some may be cured.
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Affiliation(s)
- L Johnston
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - B Mackay
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - T King
- Department of Internal Medicine, Veterinary Specialist Services, Carrara, 4211, Australia
| | - M B Krockenberger
- Sydney School of Veterinary Science, The University of Sydney, Sydney, 2006, Australia
| | - R Malik
- Centre for Veterinary Education, The University of Sydney, Sydney, 2006, Australia.,School of Animal and Veterinary Science, Charles Sturt University, Wagga Wagga, 2678, Australia
| | - A Tebb
- Western Australian Veterinary Emergency and Speciality, Success, 6164, Australia
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Goldfarb N, Lowes MA, Butt M, King T, Alavi A, Kirby JS. Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment. Br J Dermatol 2020; 184:905-912. [PMID: 32969027 DOI: 10.1111/bjd.19565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable. OBJECTIVES To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved. METHODS The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools. RESULTS The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters. CONCLUSIONS Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.
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Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - T King
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Kirby JS, Hereford B, Thorlacius L, Villumsen B, Ingram JR, Garg A, Butt M, Esmann S, King T, Tan J, Jemec GBE. Validation of global item for assessing impact on quality of life of patients with hidradenitis suppurativa. Br J Dermatol 2020; 184:681-687. [PMID: 32602129 DOI: 10.1111/bjd.19344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease. The HS core outcome set calls for a patient global assessment (PtGA). OBJECTIVES To assess the validity, reliability and responsiveness of a candidate single-item PtGA for HS-specific health-related quality of life (HRQoL). METHODS Cognitive debriefing interviews were conducted with patients with HS in Denmark and the USA. A cross-sectional observational study was done with adults with HS in the USA and Denmark. Candidate PtGA item, demographic items and multiple patient-reported scales - the Hidradenitis Suppurativa Quality of Life (HiSQOL), Dermatology Life Quality Index (DLQI) and numerical rating scale (NRS) for pain - were concurrently administered to evaluate convergent and known-groups validity. Scales with a single-item assessment of change were readministered 24-72 h later, to evaluate reliability and responsiveness. RESULTS After cognitive debriefing, the candidate PtGA for HS-specific HRQoL was finalized with five response levels. Convergent validity of the PtGA was supported by significant correlations with HiSQOL score [r = 0·79, 95% confidence interval (CI) 0·75-0·82] and DLQI (r = 0·78, 95% CI 0·74-0·82). The PtGA displayed known-groups validity with DLQI score bands based on significance of an anova (P < 0·001). Good test-retest reliability was supported by the intraclass correlation coefficient (0·82, 95% CI 0·78-0·85) for those who reported stable HS. Responsiveness was assessed by differences in PtGA score against a patient-reported assessment of change, which showed significant differences towards improvement. CONCLUSIONS The single-item PtGA exhibits reliability, validity and responsiveness in assessing HS-specific HRQoL in HS, making it a good provisional tool for HS clinical research.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - B Hereford
- Penn State College of Medicine, Hershey, PA, USA
| | - L Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - B Villumsen
- The Patients' Association HS Denmark, Copenhagen, Denmark
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - S Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - J Tan
- Department of Medicine, University of Western Ontario, Windsor, ON, Canada
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Rapson R, Marsden J, Jeffery R, Cox P, Morris C, King T. What is the effect of increased standing time in non-ambulant children with cerebral palsy? a feasibility study. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kirby J, Butt M, King T. A new way to measure the extent of patients’ hidradenitis suppurativa. Br J Dermatol 2020. [DOI: 10.1111/bjd.18909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Kirby J, Butt M, King T. 一种测量患者化脓性汗腺炎程度的新方法. Br J Dermatol 2020. [DOI: 10.1111/bjd.18928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daveson AJM, Popp A, Taavela J, Goldstein KE, Isola J, Truitt KE, Mäki M, Anderson RP, Adams A, Andrews J, Behrend C, Brown G, Chen Yi Mei S, Coates A, Daveson A, DiMarino A, Elliott D, Epstein R, Feyen B, Fogel R, Friedenberg K, Gearry R, Gerdis M, Goldstein M, Gupta V, Holmes R, Holtmann G, Idarraga S, James G, King T, Klein T, Kupfer S, Lebwohl B, Lowe J, Murray J, Newton E, Quinn D, Radin D, Ritter T, Stacey H, Strout C, Stubbs R, Thackwray S, Trivedi V, Tye‐Din J, Weber J, Wilson S. Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ygh2.380] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alina Popp
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu‐Rusescu" Bucharest Romania
| | - Juha Taavela
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- Department of Internal Medicine Central Finland Central Hospital Jyväskylä Finland
| | | | - Jorma Isola
- Laboratory of Cancer Biology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Jilab Inc. Tampere Finland
| | | | - Markku Mäki
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
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Milner A, Scovelle AJ, King T. Treatment-seeking differences for mental health problems in male- and non-male-dominated occupations: evidence from the HILDA cohort. Epidemiol Psychiatr Sci 2019; 28:630-637. [PMID: 30033889 PMCID: PMC6998979 DOI: 10.1017/s2045796018000367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a well-established gender divide among people who do and do not seek professional help from mental health professionals. Females are typically more likely to report, and seek help for, mental health problems. The current paper sought to examine the role of employment context on help-seeking for mental health issues. We hypothesised that men and women in male-dominated occupations would be less likely to seek help than those in non-male-dominated occupations. METHODS Data from the Household, Income and Labour Dynamics in Australia survey were used. Help-seeking, measured in 2013, was defined as whether a person reported attending a mental health professional in the 12 months prior to the survey. The exposure, male- and non-male-dominated occupations (measured in 2012), was defined using census data based on self-reported occupation. Analyses were stratified by gender and controlled for relevant confounders (measured in 2012), including mental health and prior help-seeking. We conducted multivariate logistic and propensity score analyses to improve exchangeability of those exposed and unexposed. RESULTS For males, being in a male-dominated occupation was independently associated with reduced likelihood of help-seeking (OR 0.66, 95% CI 0.46-0.95) in the adjusted model, although this result fell just out of significance in the propensity score analysis. There was no independent effect of being in a male-/non-male-dominated occupation for help-seeking among women. CONCLUSIONS Results suggest that male-dominated occupations may negatively influence help-seeking among males. There is a need for more research to understand this relationship and for workplace-based prevention initiatives.
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Affiliation(s)
- A. Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A. J. Scovelle
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - T. King
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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21
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Kirby JS, Butt M, King T. Severity and Area Score for Hidradenitis (SASH): a novel outcome measurement for hidradenitis suppurativa. Br J Dermatol 2019; 182:940-948. [PMID: 31233623 DOI: 10.1111/bjd.18244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a large impact on patients' health-related quality of life. However, reliable and consistent outcome measures to assess body surface area (BSA) of HS have not been established. OBJECTIVES To develop and assess the reliability and validity of a novel outcome instrument for assessment of HS BSA in a clinical trial setting. METHODS Qualitative interviews and focus groups were conducted from July to August 2015 and October 2017 to January 2018. Evaluation of the measurement was assessed during a single-day grading session with patients in April 2018. Participants, who included clinicians or patients, were recruited from academic medical centres in the U.S. mid-Atlantic region. RESULTS Concept elicitation included input from 10 providers, of which 60% (n = 6) were female, 80% (n = 8) dermatology specialists and 20% (n = 2) gynaecology specialists. Cognitive debriefing was conducted with 11 providers, of which 82% (n = 9) were dermatologists and 18% (n = 2) gynaecologists. The evaluation stage included 10 clinicians and 23 patients. The intraclass correlation coefficient (ICC) for inter-rater reliability was 0·60 [95% confidence interval (CI) 0·44-0·74]. The ICC for intrarater reliability was 0·98 (95% CI 0·94-1·00). Transformation of the BSA score resulted in an increase in inter-rater reliability to 0·75 (95% CI 0·62-0·85) or 0·76 (95% CI 0·62-0·85). Scores all demonstrated concurrent validity, with statistically significant correlations with extant scoring methods. CONCLUSIONS This novel scale is a reliable and valid HS outcome instrument and may capture a wide range of patients by assessing BSA. Future research is necessary to demonstrate its responsiveness. What's already known about this topic? The major HS disease activity scales rely on lesions counts and have moderate-to-good reliability. Body surface area (BSA) is one of the physical signs included in the Core Outcome Set for HS, but is not a part of existing HS disease activity scales. What does this study add? A novel disease severity scale, the Severity and Area Score for Hidradenitis (SASH), was developed and the psychometric properties assessed. There was high inter-rater reliability of 0·75 and 0·76 when BSA was scored on an ordinal scale, and an excellent intrarater reliability of 0·98. The SASH score also demonstrated convergent validity with extant instruments. What are the clinical implications of this work? The ability of clinicians to accurately assess disease status will be improved. Implementation of the SASH score will help guide and assess the effectiveness of appropriate treatment choice.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, U.S.A
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Metzger Filho O, Janiszewska M, Guo H, Yardley D, Mayer I, Spring L, Arteaga C, Wrabel E, DeMeo M, Freedman R, Tolaney S, Waks A, Bardia A, Parsons H, Partridge A, Mayer E, King T, Polyak K, Viale G, Winer E, Krop I. Abstract P1-15-01: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Metzger Filho O, Janiszewska M, Guo H, Yardley D, Mayer I, Spring L, Arteaga C, Wrabel E, DeMeo M, Freedman R, Tolaney S, Waks A, Bardia A, Parsons H, Partridge A, Mayer E, King T, Polyak K, Viale G, Winer E, Krop I. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-01.
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Affiliation(s)
- O Metzger Filho
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - M Janiszewska
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - H Guo
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - D Yardley
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - I Mayer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - L Spring
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - C Arteaga
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Wrabel
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - M DeMeo
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - R Freedman
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - S Tolaney
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Waks
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Bardia
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - H Parsons
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Partridge
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Mayer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - T King
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - K Polyak
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - G Viale
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Winer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - I Krop
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
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Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Abstract GS6-01: Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Young women are more likely than older women to present with higher stage breast cancer (BC) and may benefit to a greater extent from downstaging with neoadjuvant systemic treatment (NST). Young age is also associated with greater likelihood of pathologic complete response (pCR). Using a large prospective cohort of young women with BC, we investigated response to neoadjuvant therapy, eligibility for breast conserving surgery (BCS) pre- and post-NST, and surgical treatment.
Methods
The Young Women's Breast Cancer Study (YWS) is a multi-center cohort of women diagnosed with BC at age ≤40, that enrolled 1302 patients from 2006 to 2016. Disease characteristics and treatment information were obtained through medical record and central pathology review. Surgical recommendation before and after NST, conversion from BCS borderline/ineligible to BCS eligible, surgery, documented reasons for choosing mastectomy (MTX) among BCS eligible women, and final pathologic response were independently reviewed.
Results
Among 1302 women enrolled in YWS, 801 (62%) presented with unilateral stage I-III breast cancer and 317(40%) received NST. Median age was 36 years old (22-40). Pre-NST, 85/317 (27%) were BCS eligible, 49 (15%) were borderline, and 169 (53%) were not eligible (16 inflammatory breast cancer (IBC), 88 large tumor size /cosmetic, 48 diffuse calcifications, and 83 multicentricity). Among the 218 patients who were BCS ineligible/borderline pre-NST, 82 (38%) became eligible for BCS after NST. 4 patients who were BCS eligible pre-NST became ineligible. Of all patients eligible for BCS post-NST (n=163), 80 (49%) attempted BCS, 74 (93%) of whom were successful, and 83 (51%) chose MTX. Reasons for choosing MTX included: patient preference (38/83 (46%)), BRCA or TP53 mutation (31 (37%)), family history (3 (4%)), unknown (11 (13%)). On final pathology, 75 (24%) patients had pCR. Among patients who achieved a pCR, 48 (64%) underwent MTX, fewer than half (21/48 (44%)) were for anatomic indications (IBC, large tumor at diagnosis, diffuse calcifications, multicentric disease).
Conclusion
While NST doubled the proportion of young women eligible for BCS, nearly half chose MTX regardless of response to NST, mostly for personal preference or high-risk preventative reasons. These data highlight that surgical decision making among young women with breast cancer is often driven by factors beyond extent of disease and clinical response to therapy.
Table 1.Clinical-pathologic characteristicsCharacteristicsNumber%Pre NST surgical recommendation BCS eligible8526.8Borderline4915.5BCS ineligible16953.3Unknown144.4Clinical Response Complete20263.7Partial9229.0Stable30.9Progressing72.2Unknown134.1Pathologic Response pCR (No invasive or DCIS)7524No pCR24276Post NST Surgical recommendation BCS eligible16351.4BCS ineligible14445.4Unknown103.2Attempted surgery BCS8025.2MTX23674.1Unknown20.6Final Surgery BCS7423.3MTX24176unknown20.6
Citation Format: Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-01.
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Affiliation(s)
- HJ Kim
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Dominici
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Rosenberg
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - LM Pak
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - PD Poorvu
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - K Ruddy
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - R Tamimi
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Schapira
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Come
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - V Borges
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - E Warner
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - H Vardeh
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Collins
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - T King
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - A Partridge
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
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Abstract
Erythromelalgia is a condition characterized by episodic pain, erythema and temperature of the extremities, which is relieved by cooling and aggravated by warming. It is useful to review this topic in light of recent discoveries of the genetic mutations that now define primary erythromelalgia, as opposed to secondary erythromelalgia, which is often associated with underlying medical disorders.
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Affiliation(s)
- N Mann
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - T King
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
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26
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Radosa J, Radosa MP, Hamza A, Zoltan T, Solomayer EF, King T, Morrow M. Risikofaktoren für das triple negative Mammakarzinom im Vergleich zu anderen Mammakarzinomsubtypen: Ergebnisse einer monozentrischen Kohortenstudie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Radosa
- Universität des Saarlandes, Frauenklinik, Homburg Saar, Deutschland
| | - MP Radosa
- Diakonie Klinik Kassel, Gynäkologie, Kassel, Deutschland
| | - A Hamza
- Universität des Saarlandes, Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Homburg Saar, Deutschland
| | - T Zoltan
- Diakonie Klinik Kassel, Gynäkologie, Kassel, Deutschland
| | - EF Solomayer
- Universität des Saarlandes, Frauenklinik, Homburg Saar, Deutschland
| | - T King
- Memorial Sloan Kettering Cancer Center, Breast Surgery Department, New York, Vereinigte Staaten von Amerika
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, Breast Surgery Department, New York, Vereinigte Staaten von Amerika
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27
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Fowler P, King T, Lee M, Erasmus J. Retrospective study of eligibility for orthognathic surgery using the Index of Orthognathic Functional Treatment Need (IOFTN). Br J Oral Maxillofac Surg 2018; 56:416-420. [PMID: 29678373 DOI: 10.1016/j.bjoms.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/31/2017] [Accepted: 03/26/2018] [Indexed: 11/19/2022]
Abstract
To assess the functional needs of orthognathic patients who had been accepted for treatment by Christchurch Hospital, New Zealand, we made a retrospective assessment of 80 consecutive patients using the Index of Orthognathic Functional Treatment Need (IOFTN). Eligibility was based on the Severity and Outcome Index (SOI) score of ≤3 derived from seven lateral cephalometric measurements (three skeletal, three dental, and one soft tissue), which made allowances for asymmetrical or reported important functional issues. The IOFTN grades 4 or 5 indicated "great" or "very great" need for treatment, and we also used a self-reported oral health-related quality of life (QoL) questionnaire (OHIP-14). Sixty-eight patients were considered eligible using the SOI, and 71 when the IOFTN was used. Eight who were eligible using the SOI would not have been eligible using the IOFTN while 11 who were not considered eligible using the SOI scored ≥4 using the IOFTN. However, when it was compared with the SOI, the IOFTN tended to underscore those patients who were Class III/skeletal 3 with reverse overjets of <3mm and with no reported functional difficulties, while it tended to overscore Class II/skeletal 2 patients with overjets ≥6mm. We found no association found between the OHIP-14 and the SOI or the IOFTN. Further investigations are required to clarify functional difficulties that are applicable to the IOFTN grading, and to find out the most appropriate self-reported, oral-health-related QoL measure(s) to complement the use of the IOFTN.
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Affiliation(s)
- P Fowler
- Christchurch Hospital Dental Service, Canterbury District Health Board, 2 Riccarton Ave, Christchurch Central, Christchurch 8011, New Zealand.
| | - T King
- Dental School, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - M Lee
- Community Dental Services, Canterbury District Health Board, Hillmorton Hospital, Sylvan Street, Christchurch 8024, New Zealand.
| | - J Erasmus
- Department of Oral and Maxillofacial Surgery, Canterbury District Health Board, 2 Riccarton Ave, Christchurch, New Zealand.
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28
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Kavanagh A, Priest N, Emerson E, Milner A, King T. Gender, parental education, and experiences of bullying victimization by Australian adolescents with and without a disability. Child Care Health Dev 2018; 44:332-341. [PMID: 29341204 DOI: 10.1111/cch.12545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study sought to compare the prevalence of bullying victimization between adolescents with and without a disability and between adolescents with and without borderline intellectual functioning or intellectual disability (BIF/ID). We also sought to assess whether the relationships between either disability or BIF/ID and bullying victimization vary by gender and parental education. METHODS The sample included 3,956 12- to 13-year-old adolescents who participated in Wave 5 of the Longitudinal Study of Australian Children. Three indicators of bullying were used: physical bullying victimization, social bullying victimization, and "any bullying victimization." We used Poisson regression to obtain the prevalence risk ratios (PRR) of bullying by disability status adjusting for potential confounders. RESULTS In adjusted models, we found evidence that social bullying victimization was more prevalent among adolescents with a disability than those without a disability (PRR 1.29, 95% confidence interval [CI] 1.06-1.42) and between adolescents with BIF/ID than those without (PRR 1.24, 95% CI 1.07-1.44). Adolescents with BIF/ID were also more likely to experience "any bullying victimization"(PRR 1.10, 95% CI 1.00-1.22). Having a disability and living in a family with low parental education were associated with an elevated risk of social bullying victimization BIF/ID. CONCLUSIONS Adolescents with disabilities and BIF/ID are at elevated risk of social bullying victimization. School-based antibullying initiatives should concentrate on enhancing the inclusion of adolescents with disabilities, with an emphasis on adolescents from disadvantaged backgrounds.
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Affiliation(s)
- A Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - N Priest
- Centre for Social Research and Methods, Australian National University, Canberra, Australia
| | - E Emerson
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW, Australia.,Centre for Disability Research, Lancaster University, Lancaster, UK
| | - A Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - T King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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29
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Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Abstract P3-04-01: Molecular determinants of post-mastectomy breast cancer recurrence. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-04-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
The management of breast cancer (BC) patients who undergo mastectomy in the setting of 1-3 positive lymph nodes has been controversial. This retrospective Translational Breast Cancer Research Consortium study evaluated the molecular aberrations associated with locoregional recurrence (LRR) or distant metastasis (DM) compared to controls in an effort to identify molecular predictors associated with recurrence.
Methods/Materials
We identified 115 HER2 negative, therapy naïve, T 1-3 and N 0-1 BC patients treated with mastectomy and no post mastectomy radiation therapy from 1997 to present with available FFPE tissue blocks. The cohort included 32 patients with LRR, 34 with DM, and 49 controls (without recurrence) who were matched for stage, grade, hormone receptor status, age ≤ or > 50, chemotherapy receipt, and margin status. Matched primary and recurrent LRR samples were available for 3 patients. Hybrid capture next generation sequencing (NGS) of 142 cancer related genes and RNAseq were performed to identify DNA/RNA alterations associated with LRR or DM. The frequency of common alterations on NGS was compared with Fisher's exact test. Expression of each gene from mRNA-Seq was treated as an explanatory variable. Immunohistochemistry (IHC) was performed for PTEN, Ki-67 and cleaved caspase 3 (CC3). PTEN loss and percentage of Ki-67 and CC3 positive cells were compared between groups with Fisher's exact test and nonparametric methods, respectively.
Results
RNAseq was performed on 115 patients; there was no difference in RNA expression levels between the groups. DNA analysis was performed on 57 patients (17 LRR, 15 DM and 25 controls), NF1 mutation rate was significantly elevated in both the LRR (24%) and DM (27%) samples compared to controls 0%; (p=0.0070). The mitogen activated protein kinase (MAPK) pathway was significantly mutated in both LRR (47%) and DM (40%) samples compared to the controls 0%; (p<0.0001). There was no significant difference in the rate of alterations of the PI3K/Akt/mTOR pathway among the three groups. Of three patients with matched primary vs LRR samples, one had concordant mutations. The second patient had additional mutations in the LRR, including gain of a NF1 mutation. The third patient had complete discordance of mutations identified in primary and LRR and had gain of HER2 amplification, suggestive of a new primary. There was no significant association between the groups and the loss of PTEN expression or CC3 expression. There was a significant difference between Ki 67 positive cells in patients with LRR (mean 29%), DM (mean 26%) versus controls (mean 14%, p= 0.0011). HR+ patients were significantly more likely to have a positive PTEN, lower Ki-67 and lower CC3 expression, p=0.0004, p<0.0001, and p<0.0001 respectively.
Conclusions
In this matched cohort analysis, mutations in the MAPK pathway, specifically NF1, were associated with both LRR and DM, suggesting that alterations in this pathway are associated with a more aggressive tumor phenotype. However, there were no molecular features that discriminated between those likely to recur locally alone versus distantly. Further study is needed to validate these findings, and to determine whether targeting alterations in this pathway could decrease the risk of recurrence.
Citation Format: Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Molecular determinants of post-mastectomy breast cancer recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-01.
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Affiliation(s)
- KS Keene
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - T King
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - ES Hwang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - B Peng
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - K McGuire
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Tapia
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - H Zhang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - S Bae
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Nakhlis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - N Klauber-Demore
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - I Meszoely
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - MS Sabel
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - SC Willey
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - KA Eterovic
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Hudis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Wolff
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - J De Los Santos
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Thompson
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - GB Mills
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Meric-Bernstam
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
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30
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Overmoyer B, Regan M, Polyak K, Brock J, Van Poznak C, King T, Haddad T, Stearns V, Hwang S, Winer E. Abstract OT3-05-01: TBCRC 039: Phase II study of combination ruxolitinib (INCB018424) with preoperative chemotherapy for triple negative inflammatory breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Stage III triple negative(TN) inflammatory breast cancer(IBC) is associated with a poor prognosis evidenced by a 15 month(mo) median disease free survival(DFS) and overall survival(OS) of 34 mo. The substantial incidence of developing distant metastasis may be due to the prevalence of cancer cells with stem cell-like features (e.g. CD44+/CD24-) in TNIBC. The transcriptional pathway JAK2/STAT3 is associated with the survival of CD44+/CD24- cells, and preclinical data demonstrates overexpression of activated STAT3(pSTAT3) in > 95% of TNIBC. Preclinical studies have shown that ruxolitinib (Incyte®Corporation), an approved JAK1/JAK2 inhibitor, suppresses pSTAT3 in IBC patient derived xenograft models, and when combined with paclitaxel, results in a synergistic reduction in tumor weight. Given the lack of a known therapeutic target in TNIBC, this preoperative proof of principle study exploits the survival mechanism of CD44+/CD24- stem cells prevalent in this disease, by combining ruxolitinib(Rux) with paclitaxel(T) followed by doxorubicin/cyclophosphamide(AC).
Methods: Up to 64 pts with newly diagnosed stage III TNIBC (cT4d, any N, M0) are eligible if they have adequate organ function and are willing to undergo 2 research biopsies(rbx) of the affected breast. Following baseline rbx, pts are randomized to a 7 day(d) run-in phase of Rux vs Rux(15 mg bid) + T(80mg/m2/wkx1). A 2nd rbx is obtained after the run-in phase. Pts randomized to RuxT continue to receive a total of Tx12 wks+Rux. Pts randomized to Rux alone, are re-randomized to receive Tx12 wks+Rux vs Tx12wks alone. Following T, all pts receive AC (A-60mg/m2,C-600mg/m2) every 14d x 4. Pts proceed to modified radical mastectomy (MRM) followed by chest wall/regional lymph nodes radiation therapy.
Correlatives: To assess the effect of JAK inhibition with Rux on pSTAT3 and STAT3 related gene expression, molecular and genomic markers (e.g. RNA-seq, ChIPseq, FISH) will be determined in each rbx and residual tumor at MRM. The relative frequency and topology of CD44+/CD24- cell population and pSTAT3 expression by IHC will also be assessed in these tumor specimens. IL-6 and CRP plasma concentrations will be measured at baseline, prior to T and AC and prior to MRM.
Statistics: The primary endpoint is change in markers of JAK/STAT inhibition. If the proportion of rbx exhibit a biologic response to Rux alone (i.e. change from pSTAT3 expression to pSTAT3 negative) is <10%, then Rux alone is minimally effective on JAK inhibition vs alternative hypothesis that Rux inhibits JAK if the proportion of biologic response is ≥33%. If ≥5/25 rbx treated with Rux alone have a biologic response then the hypothesis that biologic response is ≤10% is rejected with an error rate of 0.098 (target 0.10). If ≤4/25 rbx have a biologic response then the hypothesis that biologic response is ≥33% is rejected with an error rate of 0.05 (target 0.10). Biologic response of rbx with Rux alone will also be compared with the proportion of biologic response to RuxT (33% vs. 66% based upon presumed synergy with RuxT). Secondary endpoints are clinical: pathologic complete response in breast/lymph nodes, Residual Cancer Burden, DFS and OS. Clinical Trial Information: NCT02876302.
Citation Format: Overmoyer B, Regan M, Polyak K, Brock J, Van Poznak C, King T, Haddad T, Stearns V, Hwang S, Winer E. TBCRC 039: Phase II study of combination ruxolitinib (INCB018424) with preoperative chemotherapy for triple negative inflammatory breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-01.
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Affiliation(s)
- B Overmoyer
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - M Regan
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - K Polyak
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - J Brock
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - C Van Poznak
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - T King
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - T Haddad
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - V Stearns
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - S Hwang
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - E Winer
- Dana Farber Cancer Institute, Boston, MA; Brigham and Womens Hospital, Boston, MA; University of Michigan, Ann Arbor, MI; Duke University Medical Center, Durham, NC; Mayo Clinic Cancer Center, Rochester, MN; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Choi J, Golshan M, Hu J, Gagnon HC, Densantis S, Barry B, King T. Abstract P3-08-07: Margins in breast conserving surgery after neoadjuvant therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The margin consensus guideline for patients undergoing primary breast conserving surgery (BCS) and whole breast radiotherapy defines a negative margin as no tumor on ink and concludes that wider margins do not improve local recurrence (LR) rates. There are few studies examining BCS margin width after neoadjuvant chemotherapy (NAC).We sought to determine the impact of margin width on LR and survival rates after NAC and BCS. Methods: Institutional database were reviewed to identify patients with stage I-III breast cancer treated with NAC and BCS from 2002-2014. Patients with inflammatory breast cancer were excluded. Chart review was performed to collect detailed patient and treatment factors. Margins widths were collected as reported and grouped as: positive (ink on tumor), close (<2mm), and negative (>2mm), for the purposes of this analysis. Cox regression was used to determine the relationship between margin width and local recurrence, disease free survival (DFS) and overall survival (OS). Result: 395 patients underwent NAC followed by BCS during the study period. The result was same as below.
results Patients, n (%)Age at diagnosis (yrs)51 [22;79]Initial tumor size (cm)3.0 [0.6;11.0]Clinical node status - negative207 (52.4%)- positive188 (47.6%)subtype - HR-/Her2-148 (37.5%)- HR-/Her2+48 (12.2%)- HR+/Her2-124 (31.4%)- HR+/Her2+72 (18.2%)- unclassified3 ( 0.8%)pCR* status - pCR97 (24.6%)- non pCR295 (74.7%)- unclassified3 ( 0.8%)Final margin state - no residual tumor in breast108 (27.3%)- positive8 ( 2.0%)- close (≤2)99 (25.1%)- negative (>2)180 (45.6%)*pCR was defined as no invasive or in situ disease in breast and no tumor in axillary node
Median patient age was 51 yrs (range 22-79); median tumor size at presentation was 3.0 cm (range 0.6-11.0) and 188 (47.6%) patients (pts) presented with clinically node positive disease. Breast cancer subtypes included 148 (37.5%) pts with HR-/Her2-, 48 (12.2%) pts with HR-/Her2+, 124 (31.4%) pts with HR+/Her2- and 72 (18.2%) pts with HR+/Her2+, disease. Among all patients the pCR rate, defined as no invasive or in situ disease, in the breast was 27.3% (108/395) and the pCR rate in the breast and axillary nodes was 24.6% (97/395). Final margin status included 8 (2.0%) pts with positive margins, 99 (25.1%) with close <2mm and 180 (45.6%) with negative (>2mm) margins. Among the patients with “positive margins”; all were noted to be posterior or anterior and the surgeon noted that re-excision was not possible. At a median follow-up of 53.0 months the LR rate was 2.8% and DFS was 87.4%. On cox regression, HR positive subtype (p=0.048), pCR (p=0.035), and pathologic negative node (p<0.001) were correlated with favorable DFS and pathologic negative node (p<0.001) was correlated with favorable OS. There was no difference in LR rate, DFS or OS between 'close/positive margin' and '>2mm margin groups. Conclusion: In this cohort of patients treated with NAC followed by BCS, LR rates were very low and there was no difference in DFS between patients with margins < 2mm or > 2mm. Further studies are needed to confirm the effect of margin width in the NAC setting.
Citation Format: Choi J, Golshan M, Hu J, Gagnon HC, Densantis S, Barry B, King T. Margins in breast conserving surgery after neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-07.
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Affiliation(s)
- J Choi
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - M Golshan
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - J Hu
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - HC Gagnon
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - S Densantis
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - B Barry
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
| | - T King
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Dana Farber Cancer Institue, Boston, MA
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Affiliation(s)
- T King
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
| | - R Rabindranathnambi
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
| | - G S Van Schalkwyk
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
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Fabresse N, Eddleston M, Thompson A, Astier A, Gregson R, King T, Clutton E, Baud F, Alvarez JC. Étude de l’efficacité d’un antidote de type Fab dans les intoxications à la colchicine chez le cochon nain Göttingen utilisé comme modèle de l’intoxication humaine. Toxicologie Analytique et Clinique 2017. [DOI: 10.1016/j.toxac.2017.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Siegel B, King T, MacDonald T, Phan H. 0922 PILOT DATA: SLEEP DYSFUNCTION IN SURVIVORS OF CEREBELLAR TUMORS TREATED WITH AND WITHOUT RADIATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yang H, Watach A, Varrasse M, King T, Sawyer AM. 0483 CLINICAL TRIAL ENROLLMENT ENRICHMENT IN RESOURCE-CONSTRAINED RESEARCH ENVIRONMENTS: MULTIVARIABLE APNEA PREDICTION INDEX (MAP) IN SCIP-PA TRIAL. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Frazier-Bowers S, Guo D, Cavender A, Xue L, Evans B, King T, Milewicz D, D'Souza R. A Novel Mutation in Human PAX9 Causes Molar Oligodontia. J Dent Res 2017. [DOI: 10.1177/0810129] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Experimental and animal studies, as well as genetic mutations in man, have indicated that the development of dentition is under the control of several genes. So far, mutations in MSX1 and PAX9 have been associated with dominantly inherited forms of human tooth agenesis that mainly involve posterior teeth. We identified a large kindred with several individuals affected with molar oligodontia that was transmitted as an isolated autosomal-dominant trait. Two-point linkage analysis using DNA from the family and polymorphic marker D14S288 in chromosome 14q12 produced a maximum lod score of 2.29 at Θ = 0.1. Direct sequencing of exons 2 to 4 of PAX9revealed a cytosine insertion mutation at nucleotide 793, leading to a premature termination of translation at aa 315. Our results support the conclusion that molar oligodontia is due to allelic heterogeneity in PAX9, and these data further corroborate the role of PAX9 as an important regulator of molar development.
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Affiliation(s)
- S.A. Frazier-Bowers
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - D.C. Guo
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - A. Cavender
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - L. Xue
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - B. Evans
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - T. King
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - D. Milewicz
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
| | - R.N. D'Souza
- Department of Orthodontics, Dental Branch, Suite 371, and
- Department of Internal Medicine, Medical School, University of Texas Health Science Center, 6516 M.D. Anderson Blvd., Houston, Texas 77030
- Specialists in Orthodontics, 817 9th Street, Rapid City, SD 57701
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Nones C, Claudino R, Ferreira L, Dos Reis R, King T, Chichorro J. Descending facilitatory pain pathways mediate ongoing pain and tactile hypersensitivity in a rat model of trigeminal neuropathic pain. Neurosci Lett 2017; 644:18-23. [DOI: 10.1016/j.neulet.2017.02.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/18/2017] [Indexed: 11/24/2022]
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King T, Carr RA, Sharma M. A painful leg ulcer. Clin Exp Dermatol 2016; 42:106-108. [PMID: 27917526 DOI: 10.1111/ced.12963] [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] [Accepted: 02/14/2016] [Indexed: 12/01/2022]
Affiliation(s)
- T King
- Department of Dermatology, Derby Teaching Hospitals, Derby, UK
| | - R A Carr
- Department of Histopathology, South Warwickshire NHS Trust, Warwickshire, UK
| | - M Sharma
- Department of Dermatology, Derby Teaching Hospitals, Derby, UK
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McVeety J, King T, Tasse H, Dorschner D. ISQUA16-2526GOVERNANCE STANDARDS FOR ABORIGINAL HEALTH SERVICES - A COLLABORATIVE JOURNEY. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rasco BC, Wolińska-Cichocka M, Fijałkowska A, Rykaczewski KP, Karny M, Grzywacz RK, Goetz KC, Gross CJ, Stracener DW, Zganjar EF, Batchelder JC, Blackmon JC, Brewer NT, Go S, Heffron B, King T, Matta JT, Miernik K, Nesaraja CD, Paulauskas SV, Rajabali MM, Wang EH, Winger JA, Xiao Y, Zachary CJ. Decays of the Three Top Contributors to the Reactor ν[over ¯]_{e} High-Energy Spectrum, ^{92}Rb, ^{96gs}Y, and ^{142}Cs, Studied with Total Absorption Spectroscopy. Phys Rev Lett 2016; 117:092501. [PMID: 27610847 DOI: 10.1103/physrevlett.117.092501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Indexed: 06/06/2023]
Abstract
We report total absorption spectroscopy measurements of ^{92}Rb, ^{96gs}Y, and ^{142}Cs β decays, which are the most important contributors to the high energy ν[over ¯]_{e} spectral shape in nuclear reactors. These three β decays contribute 43% of the ν[over ¯]_{e} flux near 5.5 MeV emitted by nuclear reactors. This ν[over ¯]_{e} energy is particularly interesting due to spectral features recently observed in several experiments including the Daya Bay, Double Chooz, and RENO Collaborations. Measurements were conducted at Oak Ridge National Laboratory by means of proton-induced fission of ^{238}U with on-line mass separation of fission fragments and the Modular Total Absorption Spectrometer. We observe a β-decay pattern that is similar to recent measurements of ^{92}Rb, with a ground-state to ground-state β feeding of 91(3)%. We verify the ^{96gs}Y ground-state to ground-state β feeding of 95.5(20)%. Our measurements substantially modify the β-decay feedings of ^{142}Cs, reducing the β feeding to ^{142}Ba states below 2 MeV by 32% when compared with the latest evaluations. Our results increase the discrepancy between the observed and the expected reactor ν[over ¯]_{e} flux between 5 and 7 MeV, the maximum excess increases from ∼10% to ∼12%.
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Affiliation(s)
- B C Rasco
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - M Wolińska-Cichocka
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Heavy Ion Laboratory, University of Warsaw, PL-02-093 Warsaw, Poland
| | - A Fijałkowska
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
- Faculty of Physics, University of Warsaw, PL-02-093 Warsaw, Poland
| | - K P Rykaczewski
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Karny
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Faculty of Physics, University of Warsaw, PL-02-093 Warsaw, Poland
| | - R K Grzywacz
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - K C Goetz
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
- CIRE Bredesen Center, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - C J Gross
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D W Stracener
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - E F Zganjar
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803 USA
| | - J C Batchelder
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Nuclear Engineering, University of California, Berkeley, Berkeley California 94720, USA
| | - J C Blackmon
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803 USA
| | - N T Brewer
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - S Go
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - B Heffron
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - T King
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - J T Matta
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - K Miernik
- JINPA, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Faculty of Physics, University of Warsaw, PL-02-093 Warsaw, Poland
| | - C D Nesaraja
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S V Paulauskas
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - M M Rajabali
- Department of Physics, Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - E H Wang
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - J A Winger
- Department of Physics and Astronomy, Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - Y Xiao
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37966, USA
| | - C J Zachary
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee 37235, USA
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Abstract
Objectives: To prospectively study the profile of restless leg syndrome (RLS) in patients presenting to a phlebology practice. Methods: The study uses prospective questionnaire and clinical observation study. In all, 174 consecutive patients and 174 matched controls were evaluated in detail. The diagnosis of restless legs syndrome (RLS) was established by the International RLS study group (IRLSSG) criteria. Detailed clinical, systemic and Duplex ultrasound evaluations were done to establish the presence of chronic venous disorders (CVD) (reflux > 0.5s on augmentation manoeuvers and revised clinical, aetiological, anatomical and pathological [CEAP] criteria). Results: Of the 174 consecutive subjects studied (22M: 152F), 63 (36%) had evidence of RLS compared with only 34 of 174 of the controls (19%, P <0.05). Sixty-two (98%) of these RLS-positive study subjects were subsequently diagnosed with CVD. In comparison, 31 (91%) of the RLS-positive control subjects ( n = 34) were found to have CVD. This prevalence of CVD was comparable with RLS-positive study subjects, but was significantly higher than the prevalence in CVD in RLS-negative controls ( P <0.01). Only three (9%) of the controls had RLS without CVD. RLS-positive subjects were typically women above the age of 40 years ( P <0.01 vs. men, P <0.01 vs. below 40 years). A significant difference in clinical presentation in the study subjects was the high prevalence of leg cramps in the RLS-positive subjects ( P <0.01). None of the patients with RLS in this series gave history of anaemia, chronic renal failure or an established psychiatric or neurological disease as found pathognomic for RLS by others. Conclusions: RLS appears to be a common overlapping clinical syndrome in patients with CVD. Prospective blinded therapeutic trials are planned to study the influence of definitive treatments for CVD on sequential RLS scores.
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Affiliation(s)
- B McDonagh
- Illinois Phlebology Group, Venous Research Foundation, Schaumburg, IL, USA
| | - T King
- Indiana Phlebology, Venous Research Foundation, Schaumburg, IL, USA
| | - R C Guptan
- Department of Clinical Research, Venous Research Foundation, Schaumburg, IL, USA
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McDonagh B, Sorenson S, Gray C, Huntley DE, Putterman P, King T, Eaton T, Martin C, Harry JL, Cohen A, Guptan RC. Clinical spectrum of recurrent postoperative varicose veins and efficacy of sclerotherapy management using the compass technique. Phlebology 2016. [DOI: 10.1258/026835503322597992] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: Tostudy the clinical spectrum of recurrent varices after surgery (REVAS) and the efficacy of sclerotherapy under the comprehensive objective mapping, precise image-guided injection, antireflux positioning and sequential sclerotherapy (COMPASS) technique in their management. Methods: Design: prospective open study with 1.5-5.7-year follow up. Patients: 253 legs of 168 consecutive patients who had received previous surgery for primary varicosity. Main outcome measures: obliteration, recanalization, residual reflux, neovascularization, venous dysfunction score and cumulative obliteration. Results: REVAS presents as a symptomatic chronic venous disease of women in their fifties, a decade later than primary varicosities are reported. Almost 75% of REVAS occurred at the groin, mostly with features of chronic venous disease. The COMPASS technique achieved sustained obliteration in 97% of the groin varices and in 100% of the thigh and isolated refluxes around the popliteal fossa. The cumulative obliteration rate was sustained at >90% and obliteration of perforator reflux was sustained. There was a significant decrease in the venous dysfunction score. In the mean 3.1±1.7 years of follow up, only 3% possible neovascularization was seen. There were no serious adverse experiences reported. Conclusions: REVAS is a symptomatic chronic venous disease requiring skilled medical attention. The COMPASS technique appears to be more efficacious than the presently available surgical approaches to its long-term management.
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McDonagh B, Huntley DE, Rosenfeld R, King T, Harry JL, Sorenson S, Guptan RC. Efficacy of the Comprehensive Objective Mapping, Precise Image Guided Injection, Anti-Reflux Positioning and Sequential Sclerotherapy (COMPASS) Technique in the Management of Greater Saphenous Varicosities with Saphenofemoral Incompetence. Phlebology 2016. [DOI: 10.1177/026835550201700106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the efficacy of the COMPASS technique in the management of greater saphenous varicosities with saphenofemoral incompetence. Design: Prospective open trial (2-6 year follow-up). Patients: One hundred and eighty-six limbs with refluxing greater saphenous vein (5.4–25.4 mm) and incompetent saphenofemoral junction (6.1–31.3 mm). Main outcome measure: Obliteration, recanalisation, residual veins, neovascularisation, venous dysfunction score. Results: Greater saphenous varicosity is commonly a disease of individuals in their forties, with morbid clinical presentations. Three stages of the COMPASS technique achieved 100% and 98% obliteration of the saphenofemoral junction and greater saphenous vein respectively. There was significant improvement in the venous dysfunction score. Residual refluxing veins were easily managed by sequential treatment. The results are sustained in the 3.4 SD 1.7 year follow up. There was no serious adverse experience reported. Conclusion: The COMPASS technique is safe and highly efficacious in the management of extensive large vein varicose disease.
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Affiliation(s)
| | | | | | - T. King
- Illinois Phlebology Group, USA
| | | | | | - R. C. Guptan
- Department of Clinical Research, Venous Research Foundation, USA
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Dearborn M, Pelletier I, Gentry J, Havelin J, Imbert I, Sukhtankar D, Remeniuk B, Porreca F, King T. (306) Pain and pain relief: using motivation to explore mechanisms underlying cancer-induced pain in rats. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Radosa JC, Eaton A, Stempel M, Khander A, Liedtke C, Solomayer EF, Radosa MP, Gunthner-Biller M, Morrow M, King T. Untersuchung der Abhängigkeit des Alters bei Diagnosestellung auf Lokalrezidiv- und Fernmetastasierraten triple negativer Mammakarzinome. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0035-1570054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Coleman R, King T, Nicoara CD, Bader M, McCarthy L, Chandran H, Parashar K. Nadir creatinine in posterior urethral valves: How high is low enough? J Pediatr Urol 2015; 11:356.e1-5. [PMID: 26292912 DOI: 10.1016/j.jpurol.2015.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 01/01/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Large retrospective studies of people with posterior urethral valves (PUV) have reported chronic renal insufficiency (CRI) in up to one third of the participants and end-stage renal failure in up to one quarter of them. Nadir creatinine (lowest creatinine during the first year following diagnosis) is the recognised prognostic indicator for renal outcome in PUV, the most commonly used cut-off being 1 mg/dl (88.4 umol/l). OBJECTIVE To conduct a statistical analysis of nadir creatinine in PUV patients in order to identify the optimal cut-off level as a prognostic indicator for CRI. STUDY DESIGN Patients treated by endoscopic valve ablation at the present institution between 1993 and 2004 were reviewed. Chronic renal insufficiency was defined as CKD2 or higher. Statistical methods included receiver operating characteristic (ROC) curve analysis, Fisher exact test and diagnostic utility tests. Statistical significance was defined as P < 0.05. RESULTS AND DISCUSSION Nadir creatinine was identified in 96 patients. The median follow-up was 9.4 (IQR 7.0, 13.4) years. A total of 29 (30.2%) patients developed CRI, with nine (9.4%) reaching end-stage renal failure. On ROC analysis, Nadir creatinine was highly prognostic for future CRI, with an Area Under the Curve of 0.887 (P < 0.001). Renal insufficiency occurred in all 10 (100%) patients with nadir creatinine >88.4 umol/l compared with 19 of 86 (22.2%) patients with lower nadir creatinine (P < 0.001). As a test for future CRI, a nadir creatinine cut-off of 88.4 umol/l gave a specificity of 100%, but poor sensitivity of 34.5%. Lowering the cut-off to 75 umol/l resulted in improvement in all diagnostic utility tests (Table). All 14 (100%) patients with nadir creatinine >75 umol/l developed CRI, compared with 15 of 82 (18.3%) patients with lower nadir creatinine (P < 0.001). Sensitivity only approached 95% at 35 umol/l, at which level specificity was low (Table). Two out of 36 (5.6%) patients with nadir creatinine <35 umol/l developed CRI. Multivariate analysis found recurrent UTI (OR 4.733; CI 1.297-17.280) and nadir creatinine >75 umol/l (OR 48.988; CI 4.9-490.11) to be independent risk factors for progression to CRI. Using cut-off values of 35 umol/l and 75 umol/l, patients can be stratified into low-, intermediate- and high-risk groups, with development of CRI in 5.3%, 28.3% and 100%, respectively (P <0.001). The stage of CKD was higher in higher risk groups. CONCLUSION Patients with nadir creatinine >75 umol/l (0.85 mg/dl) should be considered at high risk for CRI, while patients with nadir creatinine ≤35 umol/l (0.4 mg/dl) should be considered low risk. Patients with nadir creatinine between these two values have an intermediate risk of CRI.
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Affiliation(s)
- R Coleman
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - T King
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - C-D Nicoara
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - M Bader
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - L McCarthy
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - H Chandran
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - K Parashar
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
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Affiliation(s)
- R. Jones
- Department of Physics, University of Exeter Stocker Road, ExeterEX4 4QL, England
| | - T. King
- Department of Physics, University of Exeter Stocker Road, ExeterEX4 4QL, England
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Affiliation(s)
- R. Jones
- Department of Physics, University of Exeter, Stocker Road, Exeter, DevonEX4 4QL, England
| | - T. King
- Department of Physics, University of Exeter, Stocker Road, Exeter, DevonEX4 4QL, England
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Moore E, Bergin K, McQuilten Z, Wood E, Augustson B, Blacklock H, Ho P, Horvath N, King T, McNeil J, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Spencer A. Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Venkatraman N, King T, Woltmann G, Wiselka MJ, Bell D, Pareek M. P92 Miliary tuberculosis: data from a modern case-series in the United Kingdom. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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