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Nikiforova MN, Wald AI, Spagnolo DM, Melan MA, Grupillo M, Lai YT, Brand RE, O’Broin-Lennon AM, McGrath K, Park WG, Pfau PR, Polanco PM, Kubiliun N, DeWitt J, Easler JJ, Dam A, Mok SR, Wallace MB, Kumbhari V, Boone BA, Marsh W, Thakkar S, Fairley KJ, Afghani E, Bhat Y, Ramrakhiani S, Nasr J, Skef W, Thiruvengadam NR, Khalid A, Fasanella K, Chennat J, Das R, Singh H, Sarkaria S, Slivka A, Gabbert C, Sawas T, Tielleman T, Vanderveldt HD, Tavakkoli A, Smith LM, Smith K, Bell PD, Hruban RH, Paniccia A, Zureikat A, Lee KK, Ongchin M, Zeh H, Minter R, He J, Nikiforov YE, Singhi AD. A Combined DNA/RNA-based Next-Generation Sequencing Platform to Improve the Classification of Pancreatic Cysts and Early Detection of Pancreatic Cancer Arising From Pancreatic Cysts. Ann Surg 2023; 278:e789-e797. [PMID: 37212422 PMCID: PMC10481930 DOI: 10.1097/sla.0000000000005904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We report the development and validation of a combined DNA/RNA next-generation sequencing (NGS) platform to improve the evaluation of pancreatic cysts. BACKGROUND AND AIMS Despite a multidisciplinary approach, pancreatic cyst classification, such as a cystic precursor neoplasm, and the detection of high-grade dysplasia and early adenocarcinoma (advanced neoplasia) can be challenging. NGS of preoperative pancreatic cyst fluid improves the clinical evaluation of pancreatic cysts, but the recent identification of novel genomic alterations necessitates the creation of a comprehensive panel and the development of a genomic classifier to integrate the complex molecular results. METHODS An updated and unique 74-gene DNA/RNA-targeted NGS panel (PancreaSeq Genomic Classifier) was created to evaluate 5 classes of genomic alterations to include gene mutations (e.g., KRAS, GNAS, etc.), gene fusions and gene expression. Further, CEA mRNA ( CEACAM5 ) was integrated into the assay using RT-qPCR. Separate multi-institutional cohorts for training (n=108) and validation (n=77) were tested, and diagnostic performance was compared to clinical, imaging, cytopathologic, and guideline data. RESULTS Upon creation of a genomic classifier system, PancreaSeq GC yielded a 95% sensitivity and 100% specificity for a cystic precursor neoplasm, and the sensitivity and specificity for advanced neoplasia were 82% and 100%, respectively. Associated symptoms, cyst size, duct dilatation, a mural nodule, increasing cyst size, and malignant cytopathology had lower sensitivities (41-59%) and lower specificities (56-96%) for advanced neoplasia. This test also increased the sensitivity of current pancreatic cyst guidelines (IAP/Fukuoka and AGA) by >10% and maintained their inherent specificity. CONCLUSIONS PancreaSeq GC was not only accurate in predicting pancreatic cyst type and advanced neoplasia but also improved the sensitivity of current pancreatic cyst guidelines.
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Affiliation(s)
- Marina N. Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Abigail I. Wald
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel M. Spagnolo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melissa A. Melan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maria Grupillo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yi-Tak Lai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Randall E. Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Anne Marie O’Broin-Lennon
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Walter G. Park
- Department of Medicine, Stanford University, Stanford, CA
| | - Patrick R. Pfau
- Department of Medicine, University of Wisconsin, Madison, WI
| | - Patricio M. Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nisa Kubiliun
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN
| | - Jeffrey J. Easler
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, IN
| | - Aamir Dam
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Shaffer R. Mok
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - Michael B. Wallace
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Brian A. Boone
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV
| | - Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, WV
| | - Kimberly J. Fairley
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, WV
| | - Elham Afghani
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Yasser Bhat
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, CA
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, CA
| | - John Nasr
- Department of Medicine, Wheeling Hospital, West Virginia University Health Sciences Center, Morgantown, WV
| | - Wasseem Skef
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA
| | - Nikhil R. Thiruvengadam
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kenneth Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Charles Gabbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tarek Sawas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Tielleman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Anna Tavakkoli
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lynette M. Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Katelyn Smith
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Phoenix D. Bell
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ralph H. Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kenneth K. Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, TX
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Jin He
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Aatur D. Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Paniccia A, Polanco PM, Boone BA, Wald AI, McGrath K, Brand RE, Khalid A, Kubiliun N, O'Broin-Lennon AM, Park WG, Klapman J, Tharian B, Inamdar S, Fasanella K, Nasr J, Chennat J, Das R, DeWitt J, Easler JJ, Bick B, Singh H, Fairley KJ, Sarkaria S, Sawas T, Skef W, Slivka A, Tavakkoli A, Thakkar S, Kim V, Vanderveldt HD, Richardson A, Wallace MB, Brahmbhatt B, Engels M, Gabbert C, Dugum M, El-Dika S, Bhat Y, Ramrakhiani S, Bakis G, Rolshud D, Millspaugh G, Tielleman T, Schmidt C, Mansour J, Marsh W, Ongchin M, Centeno B, Monaco SE, Ohori NP, Lajara S, Thompson ED, Hruban RH, Bell PD, Smith K, Permuth JB, Vandenbussche C, Ernst W, Grupillo M, Kaya C, Hogg M, He J, Wolfgang CL, Lee KK, Zeh H, Zureikat A, Nikiforova MN, Singhi AD. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology 2023; 164:117-133.e7. [PMID: 36209796 PMCID: PMC9844531 DOI: 10.1053/j.gastro.2022.09.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Next-generation sequencing (NGS) of pancreatic cyst fluid is a useful adjunct in the assessment of patients with pancreatic cyst. However, previous studies have been retrospective or single institutional experiences. The aim of this study was to prospectively evaluate NGS on a multi-institutional cohort of patients with pancreatic cyst in real time. METHODS The performance of a 22-gene NGS panel (PancreaSeq) was first retrospectively confirmed and then within a 2-year timeframe, PancreaSeq testing was prospectively used to evaluate endoscopic ultrasound-guided fine-needle aspiration pancreatic cyst fluid from 31 institutions. PancreaSeq results were correlated with endoscopic ultrasound findings, ancillary studies, current pancreatic cyst guidelines, follow-up, and expanded testing (Oncomine) of postoperative specimens. RESULTS Among 1933 PCs prospectively tested, 1887 (98%) specimens from 1832 patients were satisfactory for PancreaSeq testing. Follow-up was available for 1216 (66%) patients (median, 23 months). Based on 251 (21%) patients with surgical pathology, mitogen-activated protein kinase/GNAS mutations had 90% sensitivity and 100% specificity for a mucinous cyst (positive predictive value [PPV], 100%; negative predictive value [NPV], 77%). On exclusion of low-level variants, the combination of mitogen-activated protein kinase/GNAS and TP53/SMAD4/CTNNB1/mammalian target of rapamycin alterations had 88% sensitivity and 98% specificity for advanced neoplasia (PPV, 97%; NPV, 93%). Inclusion of cytopathologic evaluation to PancreaSeq testing improved the sensitivity to 93% and maintained a high specificity of 95% (PPV, 92%; NPV, 95%). In comparison, other modalities and current pancreatic cyst guidelines, such as the American Gastroenterology Association and International Association of Pancreatology/Fukuoka guidelines, show inferior diagnostic performance. The sensitivities and specificities of VHL and MEN1/loss of heterozygosity alterations were 71% and 100% for serous cystadenomas (PPV, 100%; NPV, 98%), and 68% and 98% for pancreatic neuroendocrine tumors (PPV, 85%; NPV, 95%), respectively. On follow-up, serous cystadenomas with TP53/TERT mutations exhibited interval growth, whereas pancreatic neuroendocrine tumors with loss of heterozygosity of ≥3 genes tended to have distant metastasis. None of the 965 patients who did not undergo surgery developed malignancy. Postoperative Oncomine testing identified mucinous cysts with BRAF fusions and ERBB2 amplification, and advanced neoplasia with CDKN2A alterations. CONCLUSIONS PancreaSeq was not only sensitive and specific for various pancreatic cyst types and advanced neoplasia arising from mucinous cysts, but also reveals the diversity of genomic alterations seen in pancreatic cysts and their clinical significance.
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Affiliation(s)
- Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Patricio M Polanco
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Brian A Boone
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Abigail I Wald
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Randall E Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Nisa Kubiliun
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Marie O'Broin-Lennon
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Walter G Park
- Department of Medicine, Stanford University, Stanford, California
| | - Jason Klapman
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Benjamin Tharian
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sumant Inamdar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kenneth Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Nasr
- Department of Medicine, Wheeling Hospital, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Jeffrey J Easler
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Benjamin Bick
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kimberly J Fairley
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tarek Sawas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wasseem Skef
- Department of Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anna Tavakkoli
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Victoria Kim
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Michael B Wallace
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida; Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Bhaumik Brahmbhatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Megan Engels
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Charles Gabbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mohannad Dugum
- Digestive Health Center, Essentia Health-Duluth Clinic, Duluth, Minnesota
| | - Samer El-Dika
- Department of Medicine, Stanford University, Stanford, California
| | - Yasser Bhat
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | | | | | | | - Thomas Tielleman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carl Schmidt
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - John Mansour
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barbara Centeno
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Sara E Monaco
- Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth D Thompson
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Phoenix D Bell
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katelyn Smith
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer B Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christopher Vandenbussche
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wayne Ernst
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria Grupillo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Cihan Kaya
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Hogg
- Department of Surgery, NorthShore University Health System, Chicago, Illinois
| | - Jin He
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher L Wolfgang
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Mitchell K, El Naili R, Pillai L, Lopez EM, Riordan J, Marsh W, Luchey A, Hajiran A. Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs. Case Rep Urol 2023; 2023:3242986. [PMID: 37101564 PMCID: PMC10125746 DOI: 10.1155/2023/3242986] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Statistically, the chance of having concurrent renal cell carcinoma (RCC), urothelial carcinoma of the bladder (UC), and a neuroendocrine tumor (NET) of the renal parenchyma is less than one in a trillion. Herein, we describe an unusual case of a 67-year-old female who presented with bilateral flank pain and severe gross hematuria. Cross-sectional imaging revealed two large heterogeneous, endophytic renal masses with a single enlarged paracaval lymph node. Diagnostic cystoscopy was performed for completion of gross hematuria evaluation and revealed a concurrent papillary bladder tumor. Percutaneous biopsies of bilateral renal masses revealed clear cell RCC involving the left kidney and well-differentiated NET involving the right kidney, and transurethral resection of the bladder tumor revealed high-grade nonmuscle invasive urothelial carcinoma. The patient elected to undergo bilateral nephroureterectomy, radical cystectomy, and retroperitoneal and pelvic lymphadenectomy. Final pathology confirmed the presence of three different malignancies: noninvasive high-grade papillary UC of the bladder (pTaN0), left renal clear cell RCC (pT2bN0), right renal well-differentiated NET, and a single paracaval lymph nodes positive for metastatic NET (pT2aN1).
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Affiliation(s)
| | - Reima El Naili
- West Virginia University Department of Pathology, Morgantown, WV, USA
| | - Lakshmikumar Pillai
- West Virginia University Department of Vascular Surgery, Morgantown, WV, USA
| | | | - John Riordan
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Wallis Marsh
- West Virginia University Department of Surgical Oncology, Morgantown, WV, USA
| | - Adam Luchey
- West Virginia University Department of Urology, Morgantown, WV, USA
| | - Ali Hajiran
- West Virginia University Department of Urology, Morgantown, WV, USA
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Aguilar-Arevalo AA, Brown BC, Conrad JM, Dharmapalan R, Diaz A, Djurcic Z, Finley DA, Ford R, Garvey GT, Gollapinni S, Hourlier A, Huang EC, Kamp NW, Karagiorgi G, Katori T, Kobilarcik T, Lin K, Louis WC, Mariani C, Marsh W, Mills GB, Mirabal-Martinez J, Moore CD, Nelson RH, Nowak J, Pavlovic Z, Ray H, Roe BP, Russell AD, Schneider A, Shaevitz MH, Spitz J, Stancu I, Tayloe R, Thornton RT, Tzanov M, Van de Water RG, White DH, Zimmerman ED. MiniBooNE and MicroBooNE Combined Fit to a 3+1 Sterile Neutrino Scenario. Phys Rev Lett 2022; 129:201801. [PMID: 36461983 DOI: 10.1103/physrevlett.129.201801] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 06/17/2023]
Abstract
This Letter presents the results from the MiniBooNE experiment within a full "3+1" scenario where one sterile neutrino is introduced to the three-active-neutrino picture. In addition to electron-neutrino appearance at short baselines, this scenario also allows for disappearance of the muon-neutrino and electron-neutrino fluxes in the Booster Neutrino Beam, which is shared by the MicroBooNE experiment. We present the 3+1 fit to the MiniBooNE electron-(anti)neutrino and muon-(anti)neutrino data alone and in combination with MicroBooNE electron-neutrino data. The best-fit parameters of the combined fit with the exclusive charged-current quasielastic analysis (inclusive analysis) are Δm^{2}=0.209 eV^{2}(0.033 eV^{2}), |U_{e4}|^{2}=0.016(0.500), |U_{μ4}|^{2}=0.500(0.500), and sin^{2}(2θ_{μe})=0.0316(1.0). Comparing the no-oscillation scenario to the 3+1 model, the data prefer the 3+1 model with a Δχ^{2}/d.o.f.=24.7/3(17.3/3), a 4.3σ(3.4σ) preference assuming the asymptotic approximation given by Wilks's theorem.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, CDMX 04510, México
| | - B C Brown
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J M Conrad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R Dharmapalan
- University of Alabama, Tuscaloosa, Alabama 35487, USA
- University of Hawaii, Manoa, Honolulu, Hawaii 96822, USA
| | - A Diaz
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z Djurcic
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - D A Finley
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Ford
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G T Garvey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Gollapinni
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Hourlier
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - E-C Huang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N W Kamp
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G Karagiorgi
- Columbia University, New York, New York 10027, USA
| | - T Katori
- King's College London, London WC2R 2LS, United Kingdom
| | - T Kobilarcik
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - K Lin
- Columbia University, New York, New York 10027, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W C Louis
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Mariani
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - W Marsh
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G B Mills
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - C D Moore
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R H Nelson
- University of Colorado, Boulder, Colorado 80309, USA
| | - J Nowak
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - Z Pavlovic
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Ray
- University of Florida, Gainesville, Florida 32611, USA
| | - B P Roe
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A D Russell
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Schneider
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - M H Shaevitz
- Columbia University, New York, New York 10027, USA
| | - J Spitz
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - I Stancu
- University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - R Tayloe
- Indiana University, Bloomington, Indiana 47405, USA
| | - R T Thornton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Tzanov
- University of Colorado, Boulder, Colorado 80309, USA
- Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - R G Van de Water
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D H White
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E D Zimmerman
- University of Colorado, Boulder, Colorado 80309, USA
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5
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Marsden M, Perkins Z, Marsh W, Christian M, Lyon R, Davenport R, Tai N. 92 Evaluation of an Artificial Intelligence (AI) System to Augment Clinical Risk Prediction of Trauma Induced Coagulopathy: A Prospective Observational Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac041.005] [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: 11/15/2022]
Abstract
Abstract
Introduction
The potential of AI systems to support pre-hospital clinical decision-making is significant. However, whilst such algorithms are increasingly available, far less attention has been paid to understanding the impact of such systems on clinical performance. This study had two aims; first, to compare the performance of expert clinicians against an AI system in a real-world clinical setting and second, to assess the impact of augmenting expert clinical prediction with an AI system.
Method
We performed a prospective study at two UK Air Ambulances services over a six-month period. Expert pre-hospital clinicians’ judgement of the risk of Trauma Induced Coagulopathy (TIC) in injured patients was assessed and compared to the performance of an AI system. Two TIC risk predictions were generated for every patient: an AI prediction and a human prediction.
Results
Overall, 51 expert clinicians were enrolled in the study providing 184 patient interactions for analysis.
Aim 1
The AI system performed better than clinicians; higher discrimination [AUROC 0.87 (0.79, 0.95) versus 0.83 (0.74, 0.92)] better calibration [0.37 (-0.14, 0.89) versus -1.19 (-1.73, -0.65)] and more accurate [Brier Skill Score 0.34 (0.19, 0.48) versus 0.00 (-0.41, 0.30)].
Aim 2
Risk prediction was better in all performance metrics when clinicians were assisted with the AI system [AUROC 0.88 (0.80, 0.95) versus 0.83 (0.74, 0.92)]
Conclusions
AI systems can improve human risk prediction in the pre-hospital setting. In settings of low resources where a lack of senior clinical expertise may affect outcomes, the benefit of implementing predictive AI is substantial.
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Affiliation(s)
- M. Marsden
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Z. Perkins
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
| | - W. Marsh
- School of Electronical Engineering and Computer Sciences, Queen Mary University of London, London, United Kingdom
| | | | - R. Lyon
- Air Ambulance Kent Surrey Sussex, Redhill, United Kingdom
| | - R. Davenport
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
| | - N. Tai
- Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
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Gulle H, Yuceturk H, Sakar C, Joyner C, Marsh W, Unal E, Morrissey D, Yet B. Can Bayesian statistical approaches reduce the questionnaire burden for respondents when PROMs and PREMs are administered electronically? Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hill A, Keith-Jopp C, Joyner C, Marsh W, Morrissey D. Developing BENDi: A BayEsian Network DecIsion support tool for managing low back pain. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Bou-Samra P, Scott P, Cheng H, Kallem C, Pathak R, Geller DA, Marsh W, Wang Y, Antoni M, Penedo F, Tsung A, Steel JL. Social Support is Associated with Survival in Patients Diagnosed with Gastrointestinal Cancer. J Gastrointest Cancer 2021; 53:854-861. [PMID: 34806126 DOI: 10.1007/s12029-021-00741-8] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to examine the link between psychological, behavioral, and social factors and survival in patients diagnosed with gastrointestinal cancer. METHODS A cohort of gastrointestinal cancer patients were administered a battery of questionnaires that assessed trauma, depression, social support, sleep, diet, exercise, quality of life, tobacco and alcohol use, pain, and fatigue. Analyses included Pearson's correlations, analyses of variance, Kaplan Meier survival, and Cox regression analyses. RESULTS Of the 568 patients, the majority were male (57.9%) and Caucasian (91.9%), with a mean age of 61 (S.D. = 10.7). The level of perceived social support was comparable to patients with other medical conditions. Sociodemographic predictors of social support included the number of years of education (r = 0.109, p = 0.05), marital status (F(6,387) = 5.465, p ≤ 0.001), and whether the patients' income met the family's basic needs (F(1,377) = 25.531, p < 0.001). Univariate analyses revealed that older age (p < 0.001), male gender (p = 0.007), being black (p = 0.005), diagnosis of hepatocellular carcinoma (p = 0.046), higher body mass index (p = 0.022), larger tumor size (p = 0.032), initial treatment including chemotherapy rather than surgery (p < 0.001), and lower level of perceived social support (p = 0.037) were associated with poorer survival. Using multivariate Cox regression and adjusting for all factors found to be significant in univariate survival analyses, older age (p = 0.024) and lower perceived social support (HR = 0.441, 95% CI = 0.233, 0.833; p = 0.012) were the factors that remained significantly associated with poorer survival. CONCLUSION There are several biological and psychosocial factors that predict cancer mortality. Social support appears to be a robust factor affecting mortality in gastrointestinal cancer patients.
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Affiliation(s)
- Patrick Bou-Samra
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul Scott
- Department of Psychology, School of Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah Cheng
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cramer Kallem
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ritambhara Pathak
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Frank Penedo
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Department of Psychiatry, University of Pittsburgh, 3459 Fifth Avenue; Montefiore 7S, Pittsburgh, PA, 15213, USA. .,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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9
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Cifarelli CP, McMichael JP, Forman AG, Mihm PA, Cifarelli DT, Lee MR, Marsh W. Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures. Cureus 2021; 13:e16259. [PMID: 34277303 PMCID: PMC8269978 DOI: 10.7759/cureus.16259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hospital length of stay (LOS) remains an important, albeit nonspecific, metric in the analysis of surgical services. Modifiable factors to reduce LOS are few in number and the ability to practically take action is limited. Surgical scheduling of elective cases remains an important task in optimizing workflow and may impact the post-surgical LOS. Methods Retrospective data from a single tertiary care academic institution were analyzed from elective adult surgical cases performed from 2017 through 2019. Emergent or urgent add-on cases were excluded. Variables included primary procedure, age, diabetes status, American Society of Anesthesiologists (ASA) class, and surgical start time. Analysis of the median LOS following surgery was performed using Mann-Whitney tests and Cox hazards model. Matched-cohort analysis of mean total hospitalization costs was performed using the Student’s t-test. Results 9,258 patients were analyzed across five surgical service lines, of which 777 patients had surgical start time after 3 PM. The median LOS for the after 3 PM group was 1 day longer than the before 3 PM start time cohort (3.0 vs 2.1, p < 0.001). Service line analysis revealed increased LOS for Orthopedics and Neurosurgery (3.0 vs 1.9, p < 0.001; 3.0 vs 2.0, p < 0.05). Multivariate analysis confirmed that start time before 3 PM predicted shorter LOS (HR = 1.214, 1.126-1.309; p < 0.001). Case-matched cost analysis for frequently performed orthopedic and neurosurgical cases with an after 3 PM start time failed to demonstrate a significant difference in total hospital charges. Conclusion Optimization of surgical services scheduling to increase the proportion of elective surgical cases started before 3 PM has the potential to decrease post-surgical LOS for adult patients undergoing Orthopedic or Neurosurgical procedures.
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Affiliation(s)
- Christopher P Cifarelli
- Neurological Surgery, West Virginia University School of Medicine, Morgantown, USA.,Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA
| | | | - Alex G Forman
- Strategic Analytics, West Virginia University School of Medicine, Morgantown, USA
| | - Paul A Mihm
- Surgical Services, West Virginia University School of Medicine, Morgantown, USA
| | - Daniel T Cifarelli
- Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Mark R Lee
- Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Wallis Marsh
- Surgery, West Virginia University School of Medicine, Morgantown, USA
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10
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Abstract
INTRODUCTION Although gallbladder disease is more common in women, there is a trend toward more complicated cases in male patients. METHODS All cholecystectomies captured by the National Surgical Quality Improvement Program database for the year 2016 were reviewed. This encompassed 38 736 records. Records were reviewed for age, sex, procedure performed, operative time, postoperative diagnosis, functional status, American Society of Anesthesiologists (ASA) class, preoperative lab values (total bilirubin, alkaline phosphatase, white blood cell count, and aspartate aminotransferase. Descriptive and inferential statistical analyses were conducted. RESULTS Male patients are more likely to undergo cholecystectomy for a diagnosis of cholecystitis, gallstone pancreatitis, or cholangitis than women who are more likely to carry a diagnosis of biliary dyskinesia. The average operative time increases for both sexes as the patients become older. The average operative time is higher for men than women in all age groups and the variance becomes greater as the patients become older. Age, sex, postoperative diagnosis, ASA class, and functional status were all independently significant in predicting operative time. There was no difference in need for cholangiogram between the sexes. Female patients were more likely to have their cholecystectomy completed laparoscopically and they were more likely to have their surgery performed as an outpatient. CONCLUSION These data show that women were more likely to present with uncomplicated gallbladder disease, while men were more likely to present with complicated gallbladder disease. This suggests that male patients present at a more advanced stage of disease.
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Affiliation(s)
| | - Wallis Marsh
- General Surgery, 5631West Virginia University, Morgantown, WV, USA
| | - Levi Daughtery
- General Surgery, 5631West Virginia University, Morgantown, WV, USA
| | - Gerry Hobbs
- Statistics and Computer Science, 5631West Virginia University, Morgantown, WV, USA
| | - David Borgstrom
- General Surgery, 5631West Virginia University, Morgantown, WV, USA
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11
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Fontes P, Komori J, Lopez R, Marsh W, Lagasse E. Development of Ectopic Livers by Hepatocyte Transplantation Into Swine Lymph Nodes. Liver Transpl 2020; 26:1629-1643. [PMID: 32810371 PMCID: PMC7756213 DOI: 10.1002/lt.25872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Abstract
Orthotopic liver transplantation continues to be the only effective therapy for patients with end-stage liver disease. Unfortunately, many of these patients are not considered transplant candidates, lacking effective therapeutic options that would address both the irreversible progression of their hepatic failure and the control of their portal hypertension. In this prospective study, a swine model was exploited to induce subacute liver failure. Autologous hepatocytes, isolated from the left hepatic lobe, were transplanted into the mesenteric lymph nodes (LNs) by direct cell injection. At 30-60 days after transplantation, hepatocyte engraftment in LNs was successfully identified in all transplanted animals with the degree of ectopic liver mass detected being proportional to the induced native liver injury. These ectopic livers developed within the LNs showed remarkable histologic features of swine hepatic lobules, including the formation of sinusoids and bile ducts. On the basis of our previous tyrosinemic mouse model and the present pig models of induced subacute liver failure, the generation of auxiliary liver tissue using the LNs as hepatocyte engraftment sites represents a potential therapeutic approach to supplement declining hepatic function in the treatment of liver disease.
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Affiliation(s)
- Paulo Fontes
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV,LyGenesis, Inc.PittsburghPA
| | - Junji Komori
- McGowan Institute for Regenerative MedicineDepartment of PathologySchool of MedicineUniversity of PittsburghPittsburghPA,Department of SurgeryTakamatsu Red Cross HospitalKagawaJapan
| | - Roberto Lopez
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV,LyGenesis, Inc.PittsburghPA
| | - Wallis Marsh
- WVU MedicineDepartment of SurgerySchool of MedicineWest Virginia UniversityMorgantownWV
| | - Eric Lagasse
- LyGenesis, Inc.PittsburghPA,McGowan Institute for Regenerative MedicineDepartment of PathologySchool of MedicineUniversity of PittsburghPittsburghPA
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12
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Abdelsattar JM, McClain K, Afridi FG, Wen S, Cai Y, Musgrove KA, Bailey K, Shaikh PM, Jacobson GM, Marsh W, Lupinacci K, Cowher MS, Jenkins HH. Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia. Am Surg 2020; 86:1666-1671. [PMID: 32776782 DOI: 10.1177/0003134820940735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Intraoperative radiation therapy (IORT) is an alternate accelerated form of radiation following breast-conserving surgery (BCS). Lack of data regarding long-term outcomes has limited adoption. We report our experience with IORT in patients undergoing BCS versus whole breast radiation therapy (WBRT). METHODS Retrospective review of patients undergoing BCS with IORT versus WBRT (2012-2017). Inclusion: low grade, T1-2N0M0, estrogen receptor/progesterone receptor positive, and Her2-negative infiltrating ductal carcinomas. IORT was delivered as a single fraction of radiation (20 Gy) intraoperatively. Outcomes were compared using Fisher's test for discrete variables or Wilcoxon signed-rank test for continuous variables. Kaplan-Meier method was used to estimate disease-free survival (DFS). RESULTS Fifty-one patients (44%) received IORT, and 66 (56%) received WBRT. There was no difference in age, tumor size, receptor status, or in-breast recurrence (1.9% vs 0%, all P > .05). Length of follow-up was longer in the WBRT group due to time to inception of IORT (mean ± SD: 44 ± 8.1 vs 73 ± 13 months, P < .001). There was no difference in DFS between the 2 groups (HR 2.5; P = .44). IORT patients experienced delay to BCS (mean ± SD: 38 ± 12.7 vs 27 ± 12.2 days, P < .001) likely due to coordination of care. Analysis demonstrated IORT patients would have traveled a mean distance of 20 miles to the closest WBRT center (range 1-70, miles) for a mean travel time of 31 minutes (range 4-90, minutes) per WBRT treatment. DISCUSSION IORT produces noninferior oncologic outcomes and decreased skin toxicity compared with WBRT. It can be convenient for patients in rural regions with limited health care access.
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Affiliation(s)
- Jad M Abdelsattar
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | | | - Faryal G Afridi
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Yilin Cai
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Kelsey A Musgrove
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Kimberly Bailey
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Parvez M Shaikh
- Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | | | - Wallis Marsh
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Kristin Lupinacci
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Michael S Cowher
- 24041 Department of Surgery, West Virginia University, Morgantown, WV, USA
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13
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Abstract
Although gallbladder disease (GBD) is more common in females, we have noticed a trend toward more complicated cases in male patients. We reviewed all cholecystectomies performed at our institution over the last five years. After eliminating cases with confounding variables, we identified 1529 records. Charts were reviewed for age, gender, BMI, procedure performed, operative time, length of stay, and preoperative diagnosis. Descriptive and inferential statistical analyses were conducted along with linear regression. There were 1444 laparoscopic, 64 laparoscopic converted to open, and 21 primary open cases. Patients were 1008 (66%) females and 521 (34%) males. Average operative time was 89.8 minutes. Cholecystectomy averaged 17.7 minutes longer in males ( P = 0.0046). Two per cent of female patients and 7.9 per cent male patient converted to open. Males were more likely to have complicated GBD, whereas women had uncomplicated disease. Average age was 51.9 years for males versus 42.7 years for females. Age, gender, BMI, length of stay, and preoperative diagnosis were all independently significant in predicting operative time. In our study, women presented with uncomplicated GBD, whereas men presented with complicated GBD. This suggests that male patients present at a later stage of disease.
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Affiliation(s)
| | - Wallis Marsh
- Departments of General Surgery, West Virginia University, Morgantown, West Virginia
| | - Levi Daughtery
- Departments of General Surgery, West Virginia University, Morgantown, West Virginia
| | - Gerry Hobbs
- Statistics and Computer Science, West Virginia University, Morgantown, West Virginia
| | - David Borgstrom
- Departments of General Surgery, West Virginia University, Morgantown, West Virginia
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Chen Q, Terhorst L, Geller DA, Marsh W, Antoni M, Dew MA, Biala M, Weinstein J, Tsung A, Steel J. Trajectories and predictors of stress and depressive symptoms in spousal and intimate partner cancer caregivers. J Psychosoc Oncol 2020; 38:527-542. [PMID: 32367788 DOI: 10.1080/07347332.2020.1752879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of the study is to investigate trajectories of stress and depressive symptoms of spousal and intimate partner caregivers in the context of cancer. We also examined the patient-related predictors of caregiver stress and depression. DESIGN This is a longitudinal cohort study. PARTICIPANTS Patients diagnosed with cancers affecting the hepatobiliary and pancreatic system and their spousal or intimate partner caregivers were recruited at a large tertiary cancer center. METHODS The patients and caregivers were assessed for their level of stress, depressive symptoms, relationship quality, and quality of life at the time of the patients' diagnosis, every 2 months for 12 months and then at 18 months. FINDINGS One hundred and seventy-nine caregivers were included in the trajectory analyses. Amongst the 179 caregivers, 120 patient and caregiver dyads had complete data at baseline to 6-months. The majority of the spousal caregivers were female (84%) and the mean age was 57 years. 25% of caregivers reported high levels of chronic depressive symptoms. However, significant reductions were observed at 6 months. High and moderate levels of caregiver stress were also reported in 21% and 36% of caregivers, respectively. The caregivers who reported moderate levels of stress had a decrease in stress over time while those in the high stress group reported stable levels of stress over time. Caregivers' stress is predicted by the cancer patients' depressive symptoms but not patients' quality of life. CONCLUSIONS Caregivers who reported high levels of stress and depressive symptoms at patients' cancer diagnosis remain high even after the initial adjustment. A bidirectional relationship between the caregivers' stress and the patients' depressive symptoms was observed. IMPLICATIONS The development of dyadic interventions focusing on the patients' and caregivers' distress is warranted to decrease psychological morbidities of the dyad.
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Affiliation(s)
- Qi Chen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Biala
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josh Weinstein
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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15
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Bauer M, Rasgon N, Grof P, Glenn T, Lapp M, Marsh W, Munoz R, Suwalska A, Baethge C, Bschor T, Alda M, Whybrow PC. Do antidepressants influence mood patterns? A naturalistic study in bipolar disorder. Eur Psychiatry 2020; 21:262-9. [PMID: 16782312 DOI: 10.1016/j.eurpsy.2006.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AbstractThis prospective, longitudinal study compared the frequency and pattern of mood changes between outpatients receiving usual care for bipolar disorder who were either taking or not taking antidepressants. One hundred and eighty-two patients with bipolar disorder self-reported mood and psychiatric medications for 4 months using a computerized system (ChronoRecord) and returned 22,626 days of data. One hundred and four patients took antidepressants, 78 did not. Of the antidepressants taken, 95% were selective serotonin or norepinephrine reuptake inhibitors, or second-generation antidepressants. Of the patients taking an antidepressant, 91.3% were concurrently taking a mood stabilizer. The use of antidepressants did not influence the daily rate of switching from depression to mania or the rate of rapid cycling, independent of diagnosis of bipolar I or II. The primary difference in mood pattern was the time spent normal or depressed. Patients taking antidepressants frequently remained in a subsyndromal depression. In this naturalistic study using self-reported data, patients with bipolar disorder who were taking antidepressants—overwhelmingly not tricyclics and with a concurrent mood stabilizer—did not experience an increase in the rate of switches to mania or rapid cycling compared to those not taking antidepressants. Antidepressants had little impact on the mood patterns of bipolar patients taking mood stabilizers.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Charité Mitte (CCM), Schumannstrasse 20/21, 10117 Berlin, Germany.
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16
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Bauer M, Glenn T, Alda M, Andreassen O, Angelopoulos E, Ardau R, Baethge C, Bauer R, Bellivier F, Belmaker R, Berk M, Bjella T, Bossini L, Bersudsky Y, Cheung E, Conell J, Del Zompo M, Dodd S, Etain B, Fagiolini A, Frye M, Fountoulakis K, Garneau-Fournier J, Gonzalez-Pinto A, Harima H, Hassel S, Henry C, Iacovides A, Isometsä E, Kapczinski F, Kliwicki S, König B, Krogh R, Kunz M, Lafer B, Larsen E, Lewitzka U, Lopez-Jaramillo C, MacQueen G, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Melle I, Monteith S, Morken G, Munoz R, Nery F, O’Donovan C, Osher Y, Pfennig A, Quiroz D, Ramesar R, Rasgon N, Reif A, Ritter P, Rybakowski J, Sagduyu K, Scippa A, Severus E, Simhandl C, Stein D, Strejilevich S, Hatim Sulaiman A, Suominen K, Tagata H, Tatebayashi Y, Torrent C, Vieta E, Viswanath B, Wanchoo M, Zetin M, Whybrow P. Influence of birth cohort on age of onset cluster analysis in bipolar I disorder. Eur Psychiatry 2020; 30:99-105. [DOI: 10.1016/j.eurpsy.2014.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/10/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractPurpose:Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.Methods:The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.Results:There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.Conclusion:These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
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17
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Bauer M, Glenn T, Alda M, Bauer R, Grof P, Marsh W, Monteith S, Munoz R, Rasgon N, Sagduyu K, Whybrow PC. Trajectories of adherence to mood stabilizers in patients with bipolar disorder. Int J Bipolar Disord 2019; 7:19. [PMID: 31482209 PMCID: PMC6722168 DOI: 10.1186/s40345-019-0154-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/24/2019] [Indexed: 01/27/2023] Open
Abstract
Background Nonadherence with mood stabilizers is a major problem that negatively impacts the course of bipolar disorder. Medication adherence is a complex individual behavior, and adherence rates often change over time. This study asked if distinct classes of adherence trajectories with mood stabilizers over time could be found, and if so, which patient characteristics were associated with the classes. Methods This analysis was based on 12 weeks of daily self-reported data from 273 patients with bipolar 1 or II disorder using ChronoRecord computer software. All patients were taking at least one mood stabilizer. The latent class mixed model was used to detect trajectories of adherence based on 12 weekly calculated adherence datapoints per patient. Results Two distinct trajectory classes were found: an adherent class (210 patients; 77%) and a less adherent class (63 patients; 23%). The characteristics associated with the less adherent class were: more time not euthymic (p < 0.001) and female gender (p = 0.016). No other demographic associations were found. Conclusion In a sample of motivated patients who complete daily mood charting, about one quarter were in the less adherent class. Even patients who actively participate in their care, such as by daily mood charting, may be nonadherent. Demographic characteristics may not be useful in assessing individual adherence. Future research on longitudinal adherence patterns in bipolar disorder is needed.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - T Glenn
- ChronoRecord Association Inc., Fullerton, CA, USA
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - R Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - P Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, Canada
| | - W Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - S Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - R Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - N Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - K Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - P C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Shilling Bailey K, Marsh W, Daughtery L, Hobbs G, Borgstrom D. Gender Disparities in the Presentation of Gallbladder Disease. Am Surg 2019; 85:830-833. [PMID: 31560302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although gallbladder disease (GBD) is more common in females, we have noticed a trend toward more complicated cases in male patients. We reviewed all cholecystectomies performed at our institution over the last five years. After eliminating cases with confounding variables, we identified 1529 records. Charts were reviewed for age, gender, BMI, procedure performed, operative time, length of stay, and preoperative diagnosis. Descriptive and inferential statistical analyses were conducted along with linear regression. There were 1444 laparoscopic, 64 laparoscopic converted to open, and 21 primary open cases. Patients were 1008 (66%) females and 521 (34%) males. Average operative time was 89.8 minutes. Cholecystectomy averaged 17.7 minutes longer in males (P = 0.0046). Two per cent of female patients and 7.9 per cent male patient converted to open. Males were more likely to have complicated GBD, whereas women had uncomplicated disease. Average age was 51.9 years for males versus 42.7 years for females. Age, gender, BMI, length of stay, and preoperative diagnosis were all independently significant in predicting operative time. In our study, women presented with uncomplicated GBD, whereas men presented with complicated GBD. This suggests that male patients present at a later stage of disease.
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Steel JL, Cheng H, Pathak R, Wang Y, Miceli J, Hecht CL, Haggerty D, Peddada S, Geller DA, Marsh W, Antoni M, Jones R, Kamarck T, Tsung A. Psychosocial and behavioral pathways of metabolic syndrome in cancer caregivers. Psychooncology 2019; 28:1735-1742. [PMID: 31206896 DOI: 10.1002/pon.5147] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cancer caregivers are at increased risk for cardiovascular disease (CVD) and mortality. The aims of this study were to examine psychosocial and behavioral predictors of metabolic syndrome, an intermediate endpoint of CVD. METHODS Cancer caregivers were administered a battery of questionnaires assessing sociodemographic characteristics, depressive symptoms, perceived stress, caregiver quality of life, sleep, physical activity, alcohol and tobacco use, social support, relationship quality, and loneliness. Metabolic syndrome was defined using the American Heart Association guidelines and the National Cholesterol Education Program's Adult Treatment Panel (ATP) III, which includes the presence of at least three of the following abnormalities: blood pressure, glucose, abdominal girth, high-density lipoprotein (HDL), and triglycerides. RESULTS Of the 104 caregivers, 77% were female, 94% were Caucasian, and the mean age was 59.5 (SD = 12.8). Of the 104 caregivers, 35.6% reported depressive symptoms in the clinical range of the Center for Epidemiologic Studies-Depression (CES-D) and 69.2% reported Perceived Stress Scale scores at least one standard deviation above the general population norms. A total of 16.3% of caregivers currently used tobacco, 28.8% consumed alcohol, and 26.7% were overweight (BMI = 25-29.9) and 48.5% were obese (BMI ≥ 30). Forty-nine percent of the caregivers met the criteria for metabolic syndrome. After age, gender, and race were adjusted, the following remained as significant predictors of metabolic syndrome: low levels of caregiver quality of life (Odds Ratio (OR) = 1.067; 95% CI, 1.019-1.117; P = .006), high levels of hostility (OR = 1.142; 95% CI, 1.030-1.267; P = .012), and current alcohol use (OR = 4.193; 95% CI, 1.174-14.978; P = .027). CONCLUSION Development of interventions to reduce the risk of metabolic syndrome in cancer caregivers is recommended.
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Affiliation(s)
- Jennifer L Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hannah Cheng
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ritambhara Pathak
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Miceli
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carol Lynn Hecht
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Denise Haggerty
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shyamal Peddada
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Antoni
- Department of Psychology, University of Miami, Miami, Florida
| | - Reyna Jones
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas Kamarck
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Miceli J, Geller D, Tsung A, Hecht CL, Wang Y, Pathak R, Cheng H, Marsh W, Antoni M, Penedo F, Burke L, Ell K, Shen S, Steel J. Illness perceptions and perceived stress in patients with advanced gastrointestinal cancer. Psychooncology 2019; 28:1513-1519. [PMID: 31090125 PMCID: PMC6610754 DOI: 10.1002/pon.5108] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE According to the Common-Sense Model of Self-Regulation, when faced with a health threat, we make cognitive and emotional assumptions about the illness. The aims of this study were to (a) examine the role of sociodemographic and disease-specific factors on illness perception and perceived stress and (b) test the association between perceived stress and illness perception in participants diagnosed with gastrointestinal cancer. METHODS Participants completed a battery of questionnaires including a Sociodemographic and Disease-Specific Questionnaire, the Illness Perception Questionnaire, Brief Version (Brief-IPQ), and the Perceived Stress Scale (PSS-14). Descriptive statistics, Pearson correlations, analysis of variance (ANOVA), and linear regression were performed to test the hypotheses. RESULTS Of the 627 participants, the mean age was 62 years (SD = 11); the majority were male (63.3%) and Caucasian (90.9%). Younger (F3,625 = 5.80, P < .01) and divorced or never married participants reported higher levels of perceived stress when compared with older and married participants (F4,618 = 3.52, P < .01). Younger participants (18-74 years old) reported more negative illness perceptions than older participants (75 years and older) (F3,511 = 4.08, P < .01). A weak, positive relationship between perceived stress and illness perceptions was observed (r = 0.22, P < .01), and illness perceptions predicted 36.1% of the variance of perceived stress. CONCLUSIONS Our findings suggest that participants who negatively perceived their illness experienced greater levels of perceived stress. Interventions that aim to adjust patients' illness perceptions in order to facilitate a reduction of stress and improvement in quality of life are needed.
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Affiliation(s)
- Jessica Miceli
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Carol Lynn Hecht
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ritambhara Pathak
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Hannah Cheng
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael Antoni
- Department of Psychology, University of Miami, Miami, FL
| | - Frank Penedo
- Department of Medical Social Sciences, Psychiatry and Behavioral Sciences and Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL
| | - Lora Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles, CA
| | - Shutian Shen
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer Steel
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Steel JL, Miceli J, Hecht CL, Tsung A, Marsh W, Antoni M, Vodovotz Y, Peddada S, Spring M, Jackson H, Vanegas Y, Olejniczak D, Chen Q, Geller DA. Interim analyses of the efficacy of a collaborative care intervention for patients diagnosed with comorbid cancer and depression. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11599 Background: There is an urgent need for evidence-based and scalable interventions to reduce depression, pain, and fatigue and improve quality of life in patients diagnosed with cancer. The aims of this study were to share the interim analyses of testing the efficacy of a stepped collaborative care intervention for patients diagnosed with cancers affecting the hepatobiliary and pancreatic system. Methods: Patients were screened for clinical levels of depression, pain, or fatigue and were enrolled in the study if they screened positive for depression, pain, and/or fatigue. After completing a baseline battery of instruments, patients were randomized to the stepped collaborative care intervention or the screening and referral arm. Post-treatment data was collected at 6 months and 12 months to assess efficacy and maintenance of change in depressive symptoms. Results: A total of 100 patients have completed the post-treatment assessment. Interim data analyses revealed that the mean age of patients was 64.0 years (SD = 10.3) and the majority of patient were male (51%), Caucasian (89%), diagnosed with liver cancer (47%) and stage III and IV (60%). Patients randomized to the stepped collaborative care intervention reported significant reductions in depressive symptoms (F(1,92) = 6.22, p = 0.014) and improvements in quality of life (F(1,92) = 7.36, p = 0.008) with moderate effect sizes (Cohen’s d = 0.547 and 0.652, respectively) at 6-months. The mean change in depressive symptoms from randomization to 6-month post- treatment was -4.3 (SD = 9.7) for the patients randomized to the collaborative care intervention and +0.71 (SD = 9.4) for the patients randomized to the screening and referral arm of the study. The mean change in quality of life from randomization to 6-month post-treatment was +4.5 (SD = 16.2) for the patients randomized to the collaborative care intervention and -4.4 (SD = 15.2) for the patients randomized to the screening and referral arm of the study. Conclusions: This promising evidence-based, scalable intervention to treat comorbid cancer and depression was shown to be effective in reducing depressive symptoms and improving quality of life in patients with cancer. Clinical trial information: NCT02939755.
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Affiliation(s)
| | | | | | - Allan Tsung
- Comprehensive Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Michael Antoni
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | | | | | | | | | - Qi Chen
- University of Pittsburgh, Pittsburgh, PA
| | - David A. Geller
- University of Pittsburgh Medical Center Liver Cancer Center, Pittsburgh, PA
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22
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Richards G, Steel JL, Geller DA, Billiar T, Procopio J, Kucinski B, Murphy E, Tsung A, Marsh W, Antoni M, Vodovotz Y, Spring M, Pathak R, Cheng H, Sidleck B. Efficacy of a stepped collaborative care intervention for comorbid cancer and depression: Health care utilization and costs. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18348 Background: The aims of this study were to test the efficacy of a stepped collaborative care intervention for comorbid cancer and depression on outcomes including complication rates, health care utilization and costs. Methods: Patients diagnosed with cancer were enrolled in a randomized controlled trial testing the efficacy of a stepped collaborative care intervention. Patients were administered a battery of questionnaires prior to randomization. Rates and severity of surgical complications, health care utilization and costs were collected for a one-year period after randomization. Descriptive statistics, Chi-square analyses, and Ordered Restricted Inference analyses were performed. Results: Of the 100 patients, the mean age was 64.0 (SD = 10.3), the majority of the patients were male (51%), Caucasian (89%), diagnosed with hepatocellular or cholangiocarcinoma (47%) and stage III and IV (60%). For patients less than 75 years, patients randomized to the collaborative care intervention had lower rates of complications after surgery [Χ2= 5.45, P = 0.02]. We observed that 16% of patients randomized to the collaborative care intervention had complications versus 66.7% of the patients in the screening and referral arm. For patients who survived 6 months or less, those who were randomized to the collaborative care intervention had lower rates of 90-day readmissions than patients randomized to the screening and referral arm [Χ2= 4.0, P = 0.046]. The patients randomized to the collaborative care intervention did not have any readmissions while 2 patients in the screening and referral arm were readmitted. Patients randomized to the collaborative care intervention arm had lower median costs associated with the loss of workforce productivity ($2340 versus $3001; P = 0.07), hospital costs ($13,008 versus $21,109, P = 0.09), and cost per hospital registration ($1158 versus $2219, P = 0.07) when compared to the screening and referral arm. Conclusions: The stepped collaborative care intervention not only reduced depressive symptoms, but patients randomized to this intervention had lower complication rates, health care utilization, loss of work productivity, and hospital related costs. Clinical trial information: NCT02939755.
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Affiliation(s)
| | | | - David A. Geller
- University of Pittsburgh Medical Center Liver Cancer Center, Pittsburgh, PA
| | | | | | | | | | - Allan Tsung
- Comprehensive Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Michael Antoni
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
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Kosciusko R, Geller D, Kucinski B, Shadel W, Vanegas Y, Tsung A, Marsh W, Steel J. Substance Use, Depression, and Illness Perception Among Cancer Patients. Am J Health Behav 2019; 43:287-299. [PMID: 30808469 DOI: 10.5993/ajhb.43.2.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Research demonstrates a link between alcohol and tobacco use in the development of cancer, but limited research exists regarding substance use after a cancer diagnosis. In this study, we examine the rates of alcohol and tobacco use in advanced cancer patients, investigate the link between depression and tobacco and alcohol use pre- and post-diagnosis, and determine the relationship between illness perception and tobacco and alcohol use post-diagnosis.Methods: We performed a secondary data analysis on 2 prospective studies of patients with advanced gastrointestinal cancers. We administered a battery of questionnaires to assess substance use, depression, and illness perception. Results: Patients who reported tobacco use post-diagnosis had higher levels of depressive symptoms when compared to patients with a history of tobacco use or no alcohol or tobacco use (Kruskal-Wallis = 25.77, p < .0125). Patients who reported being more emotionally affected by their illness reported greater tobacco use (Mann-Whitney U = 17, 284.5, p < .003). Conclusions: Tobacco use post-diagnosis was associated with higher levels of depression.
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Affiliation(s)
| | - David Geller
- Director, UPMC Liver Cancer Center, Pittsburgh, PA
| | | | - William Shadel
- Adjunct Associate Professor of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Yanet Vanegas
- Clinical Instructor, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Allan Tsung
- Vice Chair of Research, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Wallis Marsh
- Professor and Chairman, West Virginia University School of Medicine, Morgantown, WV
| | - Jennifer Steel
- Director, Center for Excellence in Behavioral Medicine, University of Pittsburgh, Pittsburgh, PA;,
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24
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Aguilar-Arevalo AA, Brown BC, Bugel L, Cheng G, Conrad JM, Cooper RL, Dharmapalan R, Diaz A, Djurcic Z, Finley DA, Ford R, Garcia FG, Garvey GT, Grange J, Huang EC, Huelsnitz W, Ignarra C, Johnson RA, Karagiorgi G, Katori T, Kobilarcik T, Louis WC, Mariani C, Marsh W, Mills GB, Mirabal J, Monroe J, Moore CD, Mousseau J, Nienaber P, Nowak J, Osmanov B, Pavlovic Z, Perevalov D, Ray H, Roe BP, Russell AD, Shaevitz MH, Spitz J, Stancu I, Tayloe R, Thornton RT, Tzanov M, Van de Water RG, White DH, Wickremasinghe DA, Zimmerman ED. Significant Excess of Electronlike Events in the MiniBooNE Short-Baseline Neutrino Experiment. Phys Rev Lett 2018; 121:221801. [PMID: 30547637 DOI: 10.1103/physrevlett.121.221801] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/28/2018] [Indexed: 06/09/2023]
Abstract
The MiniBooNE experiment at Fermilab reports results from an analysis of ν_{e} appearance data from 12.84×10^{20} protons on target in neutrino mode, an increase of approximately a factor of 2 over previously reported results. A ν_{e} charged-current quasielastic event excess of 381.2±85.2 events (4.5σ) is observed in the energy range 200<E_{ν}^{QE}<1250 MeV. Combining these data with the ν[over ¯]_{e} appearance data from 11.27×10^{20} protons on target in antineutrino mode, a total ν_{e} plus ν[over ¯]_{e} charged-current quasielastic event excess of 460.5±99.0 events (4.7σ) is observed. If interpreted in a two-neutrino oscillation model, ν_{μ}→ν_{e}, the best oscillation fit to the excess has a probability of 21.1%, while the background-only fit has a χ^{2} probability of 6×10^{-7} relative to the best fit. The MiniBooNE data are consistent in energy and magnitude with the excess of events reported by the Liquid Scintillator Neutrino Detector (LSND), and the significance of the combined LSND and MiniBooNE excesses is 6.0σ. A two-neutrino oscillation interpretation of the data would require at least four neutrino types and indicate physics beyond the three neutrino paradigm. Although the data are fit with a two-neutrino oscillation model, other models may provide better fits to the data.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, CDMX 04510, Mexico
| | - B C Brown
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Bugel
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G Cheng
- Columbia University, New York, New York 10027, USA
| | - J M Conrad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R L Cooper
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - R Dharmapalan
- University of Alabama, Tuscaloosa, Alabama 35487, USA
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - A Diaz
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z Djurcic
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - D A Finley
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Ford
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - F G Garcia
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G T Garvey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Grange
- University of Florida, Gainesville, Florida 32611, USA
| | - E-C Huang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W Huelsnitz
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Ignarra
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R A Johnson
- University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - G Karagiorgi
- Columbia University, New York, New York 10027, USA
| | - T Katori
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Queen Mary University of London, London E1 4NS, United Kingdom
| | - T Kobilarcik
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - W C Louis
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Mariani
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - W Marsh
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G B Mills
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Mirabal
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Monroe
- Royal Holloway, University of London, Egham TW20 0EX, United Kingdom
| | - C D Moore
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Mousseau
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - P Nienaber
- Saint Mary's University of Minnesota, Winona, Minnesota 55987, USA
| | - J Nowak
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - B Osmanov
- University of Florida, Gainesville, Florida 32611, USA
| | - Z Pavlovic
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Perevalov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Ray
- University of Florida, Gainesville, Florida 32611, USA
| | - B P Roe
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A D Russell
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M H Shaevitz
- Columbia University, New York, New York 10027, USA
| | - J Spitz
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - I Stancu
- University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - R Tayloe
- Indiana University, Bloomington, Indiana 47405, USA
| | - R T Thornton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Tzanov
- University of Colorado, Boulder, Colorado 80309, USA
- Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - R G Van de Water
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D H White
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - E D Zimmerman
- University of Colorado, Boulder, Colorado 80309, USA
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Marsden MER, Mossadegh S, Marsh W, Tai N. Development of a major incident triage tool: the importance of evidence from implementation studies. BMJ Mil Health 2018; 166:204. [PMID: 30257931 DOI: 10.1136/jramc-2018-001057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Max E R Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine Ringgold Standard Institution, Birmingham, UK .,Queen Mary University of London - Whitechapel Campus Ringgold Standard Institution, Queen Mary University of London, London, UK
| | - S Mossadegh
- Queen Mary University of London - Whitechapel Campus Ringgold Standard Institution, Queen Mary University of London, London, UK
| | - W Marsh
- Risk and Information Systems Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London - Mile End Campus Ringgold Standard Institution, London, UK
| | - N Tai
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine Ringgold Standard Institution, Birmingham, UK.,Queen Mary University of London - Whitechapel Campus Ringgold Standard Institution, Queen Mary University of London, London, UK
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Krane A, Terhorst L, Bovbjerg DH, Scheier MF, Kucinski B, Geller DA, Marsh W, Tsung A, Steel JL. Putting the life in lifestyle: Lifestyle choices after a diagnosis of cancer predicts overall survival. Cancer 2018; 124:3417-3426. [PMID: 29975412 DOI: 10.1002/cncr.31572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/29/2017] [Revised: 03/18/2018] [Accepted: 04/05/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to examine predictors of health behaviors over time and the link between health behaviors and survival after a diagnosis of advanced cancer. METHODS Patients with a diagnosis of advanced cancer were administered a battery of questionnaires measuring optimism, depressive symptoms, physical activity, intake of fruits and vegetables, and alcohol and tobacco use over an 18-month period. Analyses included generalized linear mixed models and Cox regression survival analyses. RESULTS Of the 334 patients enrolled in the study, the mean age at cancer diagnosis was 62 years; the majority were male (62.3%) and white (91%). Twenty percent of the patients reported using alcohol, 19% reported using tobacco, 19% reported eating fewer fruits and vegetables than recommended by the Centers for Disease Control and Prevention and 28% reported physical inactivity after the diagnosis of advanced cancer. Clinical levels of depressive symptoms were associated with lower intake of fruits and vegetables (t = 2.67, P = .007) and physical inactivity (t = 2.11, P = .035). Dispositional optimism was positively associated with physical activity (t = -2.16, P = .031) and a lower frequency of tobacco use (Z = -2.42, P = .015). Multivariate analyses revealed that after adjusting for demographic variables (age and sex), depressive symptoms, and disease-specific factors (diagnosis, tumor size, cirrhosis, vascular invasion, and number of lesions), alcohol use (χ2 = 4.1186, P = .042) and physical inactivity (χ2 = 5.6050, P = .018) were linked to an poorer survival. CONCLUSIONS Greater dissemination and implementation of effective interventions to reduce alcohol use and increase physical activity in cancer patients are recommended.
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Affiliation(s)
- Andrew Krane
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana H Bovbjerg
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, Pennsylvania.,Biobehavioral Oncology Program, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Michael F Scheier
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Barbara Kucinski
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Aguilar-Arevalo AA, Brown BC, Bugel L, Cheng G, Church ED, Conrad JM, Cooper RL, Dharmapalan R, Djurcic Z, Finley DA, Fitzpatrick RS, Ford R, Garcia FG, Garvey GT, Grange J, Huelsnitz W, Ignarra C, Imlay R, Johnson RA, Jordan JR, Karagiorgi G, Katori T, Kobilarcik T, Louis WC, Mahn K, Mariani C, Marsh W, Mills GB, Mirabal J, Moore CD, Mousseau J, Nienaber P, Osmanov B, Pavlovic Z, Perevalov D, Ray H, Roe BP, Russell AD, Shaevitz MH, Spitz J, Stancu I, Tayloe R, Thornton RT, Van de Water RG, Wascko MO, White DH, Wickremasinghe DA, Zeller GP, Zimmerman ED. First Measurement of Monoenergetic Muon Neutrino Charged Current Interactions. Phys Rev Lett 2018; 120:141802. [PMID: 29694148 DOI: 10.1103/physrevlett.120.141802] [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] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Indexed: 06/08/2023]
Abstract
We report the first measurement of monoenergetic muon neutrino charged current interactions. MiniBooNE has isolated 236 MeV muon neutrino events originating from charged kaon decay at rest (K^{+}→μ^{+}ν_{μ}) at the NuMI beamline absorber. These signal ν_{μ}-carbon events are distinguished from primarily pion decay in flight ν_{μ} and ν[over ¯]_{μ} backgrounds produced at the target station and decay pipe using their arrival time and reconstructed muon energy. The significance of the signal observation is at the 3.9σ level. The muon kinetic energy, neutrino-nucleus energy transfer (ω=E_{ν}-E_{μ}), and total cross section for these events are extracted. This result is the first known-energy, weak-interaction-only probe of the nucleus to yield a measurement of ω using neutrinos, a quantity thus far only accessible through electron scattering.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, D.F. 04510, Mexico
| | - B C Brown
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Bugel
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G Cheng
- Columbia University, New York, New York 10027, USA
| | - E D Church
- Yale University, New Haven, Connecticut 06520, USA
| | - J M Conrad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R L Cooper
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - R Dharmapalan
- University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - Z Djurcic
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - D A Finley
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - R Ford
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - F G Garcia
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G T Garvey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Grange
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - W Huelsnitz
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Ignarra
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R Imlay
- Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - R A Johnson
- University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - J R Jordan
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - G Karagiorgi
- Columbia University, New York, New York 10027, USA
| | - T Katori
- Queen Mary University of London, London E1 4NS, United Kingdom
| | - T Kobilarcik
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - W C Louis
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - K Mahn
- Columbia University, New York, New York 10027, USA
- Michigan State University, East Lansing, Michigan 48824, USA
| | - C Mariani
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - W Marsh
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G B Mills
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Mirabal
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C D Moore
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Mousseau
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - P Nienaber
- Saint Mary's University of Minnesota, Winona, Minnesota 55987, USA
| | - B Osmanov
- University of Florida, Gainesville, Florida 32611, USA
| | - Z Pavlovic
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D Perevalov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Ray
- University of Florida, Gainesville, Florida 32611, USA
| | - B P Roe
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A D Russell
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M H Shaevitz
- Columbia University, New York, New York 10027, USA
| | - J Spitz
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - I Stancu
- University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - R Tayloe
- Indiana University, Bloomington, Indiana 47405, USA
| | - R T Thornton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R G Van de Water
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M O Wascko
- Imperial College London, London SW7 2AZ, United Kingdom
| | - D H White
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - G P Zeller
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E D Zimmerman
- University of Colorado, Boulder, Colorado 80309, USA
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Subotin M, Marsh W, McMichael J, Fung JJ, Dvorchik I. Performance of Multi-Layer Feedforward Neural Networks to Predict Liver Transplantation Outcome. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractA novel multisolutional clustering and quantization (MCO) algorithm has been developed that provides a flexible way to preprocess data. It was tested whether it would impact the neural network’s performance favorably and whether the employment of the proposed algorithm would enable neural networks to handle missing data. This was assessed by comparing the performance of neural networks using a well-documented data set to predict outcome following liver transplantation. This new approach to data preprocessing leads to a statistically significant improvement in network performance when compared to simple linear scaling. The obtained results also showed that coding missing data as zeroes in combination with the MCO algorithm, leads to a significant improvement in neural network performance on a data set containing missing values in 59.4% of cases when compared to replacement of missing values with either series means or medians.
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Bauer M, Glenn T, Alda M, Aleksandrovich MA, Andreassen OA, Angelopoulos E, Ardau R, Ayhan Y, Baethge C, Bharathram SR, Bauer R, Baune BT, Becerra-Palars C, Bellivier F, Belmaker RH, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Bossini L, Cabrera J, Cheung EYW, Del Zompo M, Dodd S, Donix M, Etain B, Fagiolini A, Fountoulakis KN, Frye MA, Gonzalez-Pinto A, Gottlieb JF, Grof P, Harima H, Henry C, Isometsä ET, Janno S, Kapczinski F, Kardell M, Khaldi S, Kliwicki S, König B, Kot TL, Krogh R, Kunz M, Lafer B, Landén M, Larsen ER, Lewitzka U, Licht RW, Lopez-Jaramillo C, MacQueen G, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Melle I, Meza-Urzúa F, Yee Ming M, Monteith S, Morken G, Mosca E, Munoz R, Mythri SV, Nacef F, Nadella RK, Nery FG, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Østermark Sørensen H, Ouali U, Pica Ruiz Y, Pilhatsch M, Pinna M, da Ponte FDR, Quiroz D, Ramesar R, Rasgon N, Reddy MS, Reif A, Ritter P, Rybakowski JK, Sagduyu K, Scippa ÂM, Severus E, Simhandl C, Stein DJ, Strejilevich S, Subramaniam M, Sulaiman AH, Suominen K, Tagata H, Tatebayashi Y, Tondo L, Torrent C, Vaaler AE, Veeh J, Vieta E, Viswanath B, Yoldi-Negrete M, Zetin M, Zgueb Y, Whybrow PC. Solar insolation in springtime influences age of onset of bipolar I disorder. Acta Psychiatr Scand 2017; 136:571-582. [PMID: 28722128 DOI: 10.1111/acps.12772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Accepted: 06/16/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To confirm prior findings that the larger the maximum monthly increase in solar insolation in springtime, the younger the age of onset of bipolar disorder. METHOD Data were collected from 5536 patients at 50 sites in 32 countries on six continents. Onset occurred at 456 locations in 57 countries. Variables included solar insolation, birth-cohort, family history, polarity of first episode and country physician density. RESULTS There was a significant, inverse association between the maximum monthly increase in solar insolation at the onset location, and the age of onset. This effect was reduced in those without a family history of mood disorders and with a first episode of mania rather than depression. The maximum monthly increase occurred in springtime. The youngest birth-cohort had the youngest age of onset. All prior relationships were confirmed using both the entire sample, and only the youngest birth-cohort (all estimated coefficients P < 0.001). CONCLUSION A large increase in springtime solar insolation may impact the onset of bipolar disorder, especially with a family history of mood disorders. Recent societal changes that affect light exposure (LED lighting, mobile devices backlit with LEDs) may influence adaptability to a springtime circadian challenge.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - T Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - M Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - O A Andreassen
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E Angelopoulos
- Department of Psychiatry, Medical School, Eginition Hospital, National and Capodistrian University of Athens, Athens, Greece
| | - R Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Y Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - C Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | | | - R Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B T Baune
- Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - C Becerra-Palars
- National Institute of Psychiatry '"Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - F Bellivier
- Psychiatry and Addiction Medicine, Assistance Publique - Hôpitaux de Paris, FondaMental Foundation, INSERM UMR-S1144, Denis Diderot University, René Descartes University, Paris, France
| | - R H Belmaker
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - M Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Vic., Australia.,Department of Psychiatry, Orygen, the National Centre for Excellence in Youth Mental Health, the Centre for Youth Mental Health and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Vic., Australia
| | - Y Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ş Bicakci
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - T D Bjella
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Bossini
- Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy
| | - J Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | - E Y W Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
| | - M Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - S Dodd
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Vic., Australia.,Department of Psychiatry, University of Melbourneo, Parkville, Vic, Australia
| | - M Donix
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B Etain
- Psychiatry and Addiction Medicine, Assistance Publique - Hôpitaux de Paris, FondaMental Foundation, INSERM UMR-S1144, Denis Diderot University, René Descartes University, Paris, France
| | - A Fagiolini
- Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy
| | - K N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M A Frye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - A Gonzalez-Pinto
- Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - J F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - P Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, ON, Canada
| | - H Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - C Henry
- AP-HP, Hopitaux Universitaires Henri Mondor and INSERM U955 (IMRB) and Université Paris Est and Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - E T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - S Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - F Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - M Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Khaldi
- Private practice, Tunis, Tunisia
| | - S Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - B König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - T L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - R Krogh
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - M Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - B Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - M Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg and Mölndal, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E R Larsen
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - U Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - R W Licht
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - G MacQueen
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - W Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - M Martinez-Cengotitabengoa
- Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - I Melle
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Meza-Urzúa
- National Institute of Psychiatry '"Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - M Yee Ming
- Department of General Psychiatry, Mood Disorders Unit, Institute of Mental Health, Singapore City, Singapore
| | - S Monteith
- Traverse City Campus, Michigan State University College of Human Medicine, Traverse City, MI, USA
| | - G Morken
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - E Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - R Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - S V Mythri
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - F Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - R K Nadella
- Department of Psychiatry, NIMHANS, Bangalore, India
| | - F G Nery
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - R E Nielsen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - A Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Tunis, Tunisia
| | - Y Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - H Østermark Sørensen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - U Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Y Pica Ruiz
- Hospital "Ángeles del Pedregal", Mexico City, Mexico
| | - M Pilhatsch
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - F D R da Ponte
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - D Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | - R Ramesar
- UCT/MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - N Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - P Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - K Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Â M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - E Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Simhandl
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - D J Stein
- Department of Psychiatry, MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - S Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - M Subramaniam
- Research Division, Institute of Mental Health, Singapore City, Singapore
| | - A H Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Helsinki, Finland
| | - H Tagata
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Y Tatebayashi
- Schizophrenia & Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Seatagaya, Tokyo, Japan
| | - L Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA.,Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy
| | - C Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - J Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - E Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Viswanath
- Department of Psychiatry, NIMHANS, Bangalore, India
| | - M Yoldi-Negrete
- Consejo Nacional de Ciencia y Tecnología - Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - M Zetin
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Y Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - P C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Outhwaite H, Evans S, Bell D, Manchini M, Stansfield J, Marsh W, South J. A pilot project to develop community-centred public health practice examples, England, UK. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - D Bell
- Public Health England, Leeds, UK
| | | | | | - W Marsh
- Public Health England, Cambridge, UK
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31
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Affiliation(s)
| | - W Marsh
- Department of Psychological Medicine, Southern General Hospital, Glasgow G51 4TF
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32
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Steel JL, Geller DA, Kim KH, Butterfield LH, Spring M, Grady J, Sun W, Marsh W, Antoni M, Dew MA, Helgeson V, Schulz R, Tsung A. Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting. Cancer 2016; 122:1270-82. [PMID: 26970434 DOI: 10.1002/cncr.29906] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/23/2015] [Accepted: 12/28/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life. METHODS A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression. RESULTS At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm. CONCLUSIONS The integration of screening and symptom management into cancer care is recommended.
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Affiliation(s)
- Jennifer L Steel
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin H Kim
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa H Butterfield
- Departments of Medicine, Surgery and Immunology, Hillman Cancer Center, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Michael Spring
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Grady
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Weiing Sun
- Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Antoni
- Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vicki Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Richard Schulz
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Perkins ZB, Yet B, Glasgow S, Cole E, Marsh W, Brohi K, Rasmussen TE, Tai NRM. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Br J Surg 2015; 102:436-50. [DOI: 10.1002/bjs.9689] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/16/2014] [Accepted: 09/29/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT.
Methods
A systematic review was conducted to identify potential prognostic factors. Bayesian meta-analysis was used to calculate an absolute (pooled proportion) and relative (pooled odds ratio, OR) measure of the amputation risk for each factor.
Results
Forty-five studies, totalling 3187 discrete LEVT repairs, were included. The overall amputation rate was 10·0 (95 per cent credible interval 7·4 to 13·1) per cent. Significant prognostic factors for secondary amputation included: associated major soft tissue injury (26 versus 8 per cent for no soft tissue injury; OR 5·80), compartment syndrome (28 versus 6 per cent; OR 5·11), multiple arterial injuries (18 versus 9 per cent; OR 4·85), duration of ischaemia exceeding 6 h (24 versus 5 per cent; OR 4·40), associated fracture (14 versus 2 per cent; OR 4·30), mechanism of injury (blast 19 per cent, blunt 16 per cent, penetrating 5 per cent), anatomical site of injury (iliac 18 per cent, popliteal 14 per cent, tibial 10 per cent, femoral 4 per cent), age over 55 years (16 versus 9 per cent; OR 3·03) and sex (men 7 per cent versus women 8 per cent; OR 0·64). Shock and nerve or venous injuries were not significant prognostic factors for secondary amputation.
Conclusion
A significant proportion of patients who undergo lower extremity vascular trauma repair will require secondary amputation. This meta-analysis describes significant prognostic factors needed to inform surgical judgement, risk assessment and patient counselling.
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Affiliation(s)
- Z B Perkins
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - B Yet
- Department of Computer Science, Queen Mary, University of London, London, UK
| | - S Glasgow
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - E Cole
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - W Marsh
- Department of Computer Science, Queen Mary, University of London, London, UK
| | - K Brohi
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
| | - T E Rasmussen
- US Army Medical Research and Materiel Command, Fort Detrick, Maryland, USA
| | - N R M Tai
- Centre for Trauma Sciences, Queen Mary, University of London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Aguilar-Arevalo A, Brown B, Bugel L, Cheng G, Church E, Conrad J, Dharmapalan R, Djurcic Z, Finley D, Ford R, Garcia F, Garvey G, Grange J, Huelsnitz W, Ignarra C, Imlay R, Johnson R, Karagiorgi G, Katori T, Kobilarcik T, Louis W, Mariani C, Marsh W, Mills G, Mirabal J, Moore C, Mousseau J, Nienaber P, Osmanov B, Pavlovic Z, Perevalov D, Polly C, Ray H, Roe B, Russell A, Shaevitz M, Spitz J, Stancu I, Tayloe R, Van de Water R, Wascko M, White D, Wickremasinghe D, Zeller G, Zimmerman E. Measurement of the antineutrino neutral-current elastic differential cross section. Int J Clin Exp Med 2015. [DOI: 10.1103/physrevd.91.012004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Spolverato G, Ejaz A, Kim Y, Sotiropoulos GC, Pau A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Bauer TW, Walters DM, Groeschl R, Gamblin TC, Marsh W, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Gigot JF, Mentha G, Pawlik TM. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg 2014; 18:1284-91. [PMID: 24841438 DOI: 10.1007/s11605-014-2533-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/01/2014] [Indexed: 02/06/2023]
Abstract
The association between tumor size and survival in patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection is controversial. We sought to define the incidence of major and microscopic vascular invasion relative to ICC tumor size, and identify predictors of microscopic vascular invasion in patients with ICC ≥5 cm. A total of 443 patients undergoing surgical resection for ICC between 1973 and 2011 at one of 11 participating institutions were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. As tumor sized increased, the incidence of microscopic vascular invasion increased: <3 cm, 3.6 %; 3-5 cm, 24.7 %; 5-7 cm, 38.3 %; 7-15 cm, 32.9 %, ≥15 cm, 55.6 %; (p < 0.001). Increasing tumor size was also found to be associated with worsening tumor grade. The incidence of poorly differentiated tumors increased with increasing ICC tumor size: <3 cm, 9.7 %; 3-5 cm, 19.8 %; 5-7 cm, 24.2 %; 7-15 cm, 21.1 %; >15 cm, 31.6 % (p = 0.04). The presence of perineural invasion (odds ratio [OR] = 2.98) and regional lymph node metastasis (OR = 4.43) were independently associated with an increased risk of microscopic vascular invasion in tumors ≥5 cm (both p < 0.05). Risk of microscopic vascular invasion and worse tumor grade increased with tumor size. Large tumors likely harbor worse pathologic features; this information should be considered when determining therapy and prognosis of patients with large ICC.
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Affiliation(s)
- Gaya Spolverato
- Department of Surgery at Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bauer M, Glenn T, Alda M, Sagduyu K, Marsh W, Grof P, Munoz R, Baethge C, Lewitzka U, Pilhatsch M, Bauer R, Whybrow PC. Regularity in daily mood stabilizer dosage taken by patients with bipolar disorder. Pharmacopsychiatry 2013; 46:163-8. [PMID: 23797414 DOI: 10.1055/s-0033-1343398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate regularity in the daily mood stabilizer dosage taken by patients with bipolar disorder, and identify factors associated with irregularity. METHODS Self-reported daily mood and medication data were available from 206 patients who took the same mood stabilizer for ≥100 days. Approximate entropy (ApEn) was used to measure serial regularity in daily mood stabilizer dosage. Generalized estimating equations (GEE) were used to estimate if demographic or clinical variables were associated with ApEn. RESULTS There was a wide range of regularity in the daily mood stabilizer dosage. The mean percent of days of missing doses was 13.6%. The number of psychotropic medications (p=0.007), pill burden (p=0.004) and percent of days with depressed mood (p=0.013) were associated with more irregularity, while the percent of days euthymic (p=0.014) was associated with less irregularity. The percent of days missing doses was not associated with the number of medications, pill burden or mood ratings. DISCUSSION Patients may have irregularity in daily dosage in spite of a low percent of days missing doses. Psychotropic medication regimen complexity and depression are associated with increased dosage irregularity. Research is needed on how irregularity in daily dosage impacts the continuity of drug action of mood stabilizers.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Nasr JY, Hashash JG, Orons P, Marsh W, Slivka A. Rendezvous procedure for the treatment of bile leaks and injury following segmental hepatectomy. Dig Liver Dis 2013; 45:433-6. [PMID: 23352315 DOI: 10.1016/j.dld.2012.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography is a minimally invasive procedure used for the evaluation and management of biliary injuries. At times, ERCP fails and percutaneous modalities may be required. Rendezvous procedures are combined endoscopic and percutaneous techniques that have been used to restore anatomic continuity and biliary drainage in cases where retrograde and/or transhepatic access alone has failed either due to anatomic variation or traumatic injury with biloma formation. AIMS To assess if the Rendezvous technique plays a role in establishing biliary continuity in patients with a bile leak after segmental hepatectomy. METHODS We herby present a series of 3 patients who had complex bile leaks after segmental liver resection and underwent a combined percutaneous and endoscopic Rendezvous procedure to establish biliary continuity. RESULTS This technique was successful in restoring biliary continuity and avoiding hepaticojejunostomy in 2 of the 3 patients. CONCLUSION The Rendezvous technique may play a role in establishing biliary continuity in patients with biliary leak secondary to hepatic surgery.
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Affiliation(s)
- John Y Nasr
- Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Aguilar-Arevalo AA, Brown BC, Bugel L, Cheng G, Church ED, Conrad JM, Dharmapalan R, Djurcic Z, Finley DA, Ford R, Garcia FG, Garvey GT, Grange J, Huelsnitz W, Ignarra C, Imlay R, Johnson RA, Karagiorgi G, Katori T, Kobilarcik T, Louis WC, Mariani C, Marsh W, Mills GB, Mirabal J, Moore CD, Mousseau J, Nienaber P, Osmanov B, Pavlovic Z, Perevalov D, Polly CC, Ray H, Roe BP, Russell AD, Shaevitz MH, Spitz J, Stancu I, Tayloe R, Van de Water RG, White DH, Wickremasinghe DA, Zeller GP, Zimmerman ED. Improved search for ν¯(μ)→ν¯(e) oscillations in the MiniBooNE experiment. Phys Rev Lett 2013; 110:161801. [PMID: 23679593 DOI: 10.1103/physrevlett.110.161801] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Indexed: 06/02/2023]
Abstract
The MiniBooNE experiment at Fermilab reports results from an analysis of ν[over ¯](e) appearance data from 11.27×10(20) protons on target in the antineutrino mode, an increase of approximately a factor of 2 over the previously reported results. An event excess of 78.4±28.5 events (2.8σ) is observed in the energy range 200<E(ν)(QE)<1250 MeV. If interpreted in a two-neutrino oscillation model, ν[over ¯](μ)→ν[over ¯](e), the best oscillation fit to the excess has a probability of 66% while the background-only fit has a χ(2) probability of 0.5% relative to the best fit. The data are consistent with antineutrino oscillations in the 0.01<Δm(2)<1.0 eV(2) range and have some overlap with the evidence for antineutrino oscillations from the Liquid Scintillator Neutrino Detector. All of the major backgrounds are constrained by in situ event measurements so nonoscillation explanations would need to invoke new anomalous background processes. The neutrino mode running also shows an excess at low energy of 162.0±47.8 events (3.4σ) but the energy distribution of the excess is marginally compatible with a simple two neutrino oscillation formalism. Expanded models with several sterile neutrinos can reduce the incompatibility by allowing for CP violating effects between neutrino and antineutrino oscillations.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, 04510 México, D.F., Mexico
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Baumgartner JM, Krasinskas A, Daouadi M, Zureikat A, Marsh W, Lee K, Bartlett D, Moser AJ, Zeh HJ. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic adenocarcinoma following neoadjuvant therapy. J Gastrointest Surg 2012; 16:1152-9. [PMID: 22399269 DOI: 10.1007/s11605-012-1839-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/02/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Celiac trunk encasement by adenocarcinoma of the pancreatic body is generally regarded as a contraindication for surgical resection. Recent studies have suggested that a subset of stage III patients will succumb to their disease in the absence of distant metastases. We hypothesized that patients with stage III tumors invading the celiac trunk, who are free of distant disease following neoadjuvant therapy, may derive prolonged survival benefit from aggressive surgical resection. METHODS We performed a retrospective review of distal pancreatectomies with en bloc celiac axis resection for pancreatic adenocarcinoma. RESULTS Eleven patients underwent a distal pancreatectomy with en bloc celiac axis resection after completing neoadjuvant chemoradiation therapy. Median operative time was 8 h, 14 min, and median estimated blood loss was 700 ml. Median length of stay was 9 days. Five patients (45%) had postoperative complications; three were Clavien grade I. Four patients (35%) had pancreatic leaks; two were ISGPF grade B, and two were grade A. There were two 90-day perioperative deaths. Ten patients had R0 resections (91%). After a median follow-up of 41 weeks, six patients recurred. Four of the five patients with SMAD4 loss recurred, and two of the five patients with intact SMAD4 recurred. Median disease-free and overall survival were 21 weeks and 26 months, respectively. CONCLUSIONS Resection of pancreatic body adenocarcinoma with celiac axis resection is technically feasible with acceptable perioperative morbidity and mortality.
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Affiliation(s)
- Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, PA 15232, USA
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Aguilar-Arevalo AA, Anderson CE, Brice SJ, Brown BC, Bugel L, Conrad JM, Dharmapalan R, Djurcic Z, Fleming BT, Ford R, Garcia FG, Garvey GT, Mirabal J, Grange J, Green JA, Imlay R, Johnson RA, Karagiorgi G, Katori T, Kobilarcik T, Linden SK, Louis WC, Mahn KBM, Marsh W, Mauger C, Metcalf W, Mills GB, Moore CD, Mousseau J, Nelson RH, Nguyen V, Nienaber P, Nowak JA, Osmanov B, Pavlovic Z, Perevalov D, Polly CC, Ray H, Roe BP, Russell AD, Schirato R, Shaevitz MH, Sorel M, Spitz J, Stancu I, Stefanski RJ, Tayloe R, Tzanov M, Van de Water RG, Wascko MO, White DH, Wilking MJ, Zeller GP, Zimmerman ED. Event excess in the MiniBooNE search for ¯νμ→¯νe oscillations. Phys Rev Lett 2010; 105:181801. [PMID: 21231096 DOI: 10.1103/physrevlett.105.181801] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Indexed: 05/30/2023]
Abstract
The MiniBooNE experiment at Fermilab reports results from a search for ¯ν_{μ}→¯ν_{e} oscillations, using a data sample corresponding to 5.66×10²⁰ protons on target. An excess of 20.9±14.0 events is observed in the energy range 475<E_{ν}^{QE}<1250 MeV, which, when constrained by the observed ¯ν_{μ} events, has a probability for consistency with the background-only hypothesis of 0.5%. On the other hand, fitting for ¯ν_{μ}→¯ν_{e} oscillations, the best-fit point has a χ² probability of 8.7%. The data are consistent with ¯ν_{μ}→¯ν_{e} oscillations in the 0.1 to 1.0 eV² Δm² range and with the evidence for antineutrino oscillations from the Liquid Scintillator Neutrino Detector at Los Alamos National Laboratory.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, D.F. 04510, México
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Aguilar-Arevalo AA, Anderson CE, Bazarko AO, Brice SJ, Brown BC, Bugel L, Cao J, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fisher M, Fleming BT, Ford R, Garcia FG, Garvey GT, Grange J, Green C, Green JA, Hart TL, Hawker E, Imlay R, Johnson RA, Karagiorgi G, Kasper P, Katori T, Kobilarcik T, Kourbanis I, Koutsoliotas S, Laird EM, Linden SK, Link JM, Liu Y, Liu Y, Louis WC, Mahn KBM, Marsh W, Mauger C, McGary VT, McGregor G, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Mousseau J, Nelson RH, Nienaber P, Nowak JA, Osmanov B, Ouedraogo S, Patterson RB, Pavlovic Z, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smith D, Soderberg M, Sorel M, Spentzouris P, Spitz J, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Van de Water RG, Wascko MO, White DH, Wilking MJ, Yang HJ, Zeller GP, Zimmerman ED. Search for core-collapse supernovae using the MiniBooNE neutrino detector. Int J Clin Exp Med 2010. [DOI: 10.1103/physrevd.81.032001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Aguilar-Arevalo AA, Anderson CE, Brice SJ, Brown BC, Bugel L, Conrad JM, Djurcic Z, Fleming BT, Ford R, Garcia FG, Garvey GT, Gonzales J, Grange J, Green C, Green JA, Imlay R, Johnson RA, Karagiorgi G, Katori T, Kobilarcik T, Linden SK, Louis WC, Mahn KBM, Marsh W, Mauger C, McGary VT, Metcalf W, Mills GB, Moore CD, Mousseau J, Nelson RH, Nienaber P, Nowak JA, Osmanov B, Pavlovic Z, Perevalov D, Polly CC, Ray H, Roe BP, Russell AD, Shaevitz MH, Sorel M, Spitz J, Stancu I, Stefanski RJ, Tayloe R, Tzanov M, Van de Water RG, Wascko MO, White DH, Wilking MJ, Zeller GP, Zimmerman ED. Search for electron antineutrino appearance at the deltam(2) approximately 1 eV(2) Scale. Phys Rev Lett 2009; 103:111801. [PMID: 19792365 DOI: 10.1103/physrevlett.103.111801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Indexed: 05/28/2023]
Abstract
The MiniBooNE Collaboration reports initial results from a search for nu(mu)-->nu(e) oscillations. A signal-blind analysis was performed using a data sample corresponding to 3.39x10(20) protons on target. The data are consistent with background prediction across the full range of neutrino energy reconstructed assuming quasielastic scattering, 200<E(nu)(QE)<3000 MeV: 144 electronlike events have been observed in this energy range, compared to an expectation of 139.2+/-17.6 events. No significant excess of events has been observed, both at low energy, 200-475 MeV, and at high energy, 475-1250 MeV. The data are inconclusive with respect to antineutrino oscillations suggested by data from the Liquid Scintillator Neutrino Detector at Los Alamos National Laboratory.
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Affiliation(s)
- A A Aguilar-Arevalo
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Distrito Federal 04510, México
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Aguilar-Arevalo AA, Anderson CE, Bazarko AO, Brice SJ, Brown BC, Bugel L, Cao J, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fleming BT, Ford R, Garcia FG, Garvey GT, Green C, Green JA, Hart TL, Hawker E, Imlay R, Johnson RA, Karagiorgi G, Kasper P, Katori T, Kobilarcik T, Kourbanis I, Koutsoliotas S, Laird EM, Linden SK, Link JM, Liu Y, Liu Y, Louis WC, Mahn KBM, Marsh W, McGary VT, McGregor G, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Nelson RH, Nienaber P, Nowak JA, Osmanov B, Ouedraogo S, Patterson RB, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smith D, Soderberg M, Sorel M, Spentzouris P, Spitz J, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Van de Water R, Wascko MO, White DH, Wilking MJ, Yang HJ, Zeller GP, Zimmerman ED. Measurement of the ratio of the numu charged-current single-pion production to quasielastic scattering with a 0.8 GeV neutrino beam on mineral oil. Phys Rev Lett 2009; 103:081801. [PMID: 19792715 DOI: 10.1103/physrevlett.103.081801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Indexed: 05/28/2023]
Abstract
Using high statistics samples of charged-current numu interactions, the MiniBooNE [corrected] Collaboration reports a measurement of the single-charged-pion production to quasielastic cross section ratio on mineral oil (CH2), both with and without corrections for hadron reinteractions in the target nucleus. The result is provided as a function of neutrino energy in the range 0.4 GeV<Enu<2.4 GeV with 11% precision in the region of highest statistics. The results are consistent with previous measurements and the prediction from historical neutrino calculations.
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Aguilar-Arevalo AA, Anderson CE, Bazarko AO, Brice SJ, Brown BC, Bugel L, Cao J, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fleming BT, Ford R, Garcia FG, Garvey GT, Grange J, Green C, Green JA, Hart TL, Hawker E, Imlay R, Johnson RA, Karagiorgi G, Kasper P, Katori T, Kobilarcik T, Kourbanis I, Koutsoliotas S, Laird EM, Linden SK, Link JM, Liu Y, Liu Y, Louis WC, Mahn KBM, Marsh W, Mauger C, McGary VT, McGregor G, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Mousseau J, Nelson RH, Nienaber P, Nowak JA, Osmanov B, Ouedraogo S, Patterson RB, Pavlovic Z, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smith D, Soderberg M, Sorel M, Spentzouris P, Spitz J, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Van de Water RG, Wascko MO, White DH, Wilking MJ, Yang HJ, Zeller GP, Zimmerman ED. Search for muon neutrino and antineutrino disappearance in MiniBooNE. Phys Rev Lett 2009; 103:061802. [PMID: 19792551 DOI: 10.1103/physrevlett.103.061802] [Citation(s) in RCA: 2] [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: 03/11/2009] [Indexed: 05/28/2023]
Abstract
The MiniBooNE Collaboration reports a search for nu_{micro} and nu[over]_{micro} disappearance in the Deltam;{2} region of 0.5-40 eV;{2}. These measurements are important for constraining models with extra types of neutrinos, extra dimensions, and CPT violation. Fits to the shape of the nu_{micro} and nu[over]_{micro} energy spectra reveal no evidence for disappearance at the 90% confidence level (C.L.) in either mode. The test of nu[over]_{micro} disappearance probes a region below Deltam;{2} = 40 eV;{2} never explored before.
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Adamson P, Aguilar-Arevalo AA, Anderson CE, Bazarko AO, Bishai M, Brice SJ, Brown BC, Bugel L, Cao J, Choudhary BC, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fleming BT, Ford R, Gallagher HR, Garcia FG, Garvey GT, Green C, Green JA, Harris D, Hart TL, Hawker E, Hylen J, Imlay R, Johnson RA, Karagiorgi G, Kasper P, Katori T, Kobilarcik T, Kopp S, Kourbanis I, Koutsoliotas S, Laird EM, Linden SK, Link JM, Liu Y, Liu Y, Loiacono L, Louis WC, Marchionni A, Mahn KBM, Marsh W, McGregor G, Messier MD, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Nelson JK, Nelson RH, Nguyen VT, Nienaber P, Nowak JA, Ouedraogo S, Patterson RB, Pavlovic Z, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smart W, Smith D, Sodeberg M, Sorel M, Spentzouris P, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Vahle P, Van de Water R, Viren B, Wascko MO, White DH, Wilking MJ, Yang HJ, Yumiceva FX, Zeller GP, Zimmerman ED, Zwaska R. Measurement of numicro and nue events in an off-axis horn-focused neutrino beam. Phys Rev Lett 2009; 102:211801. [PMID: 19519094 DOI: 10.1103/physrevlett.102.211801] [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: 09/12/2008] [Indexed: 05/27/2023]
Abstract
We report the first observation of off-axis neutrino interactions in the MiniBooNE detector from the NuMI beam line at Fermilab. The MiniBooNE detector is located 745 m from the NuMI production target, at 110 mrad angle (6.3 degrees) with respect to the NuMI beam axis. Samples of charged-current quasielastic numicro and nue interactions are analyzed and found to be in agreement with expectation. This provides a direct verification of the expected pion and kaon contributions to the neutrino flux and validates the modeling of the NuMI off-axis beam.
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Affiliation(s)
- P Adamson
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
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Aguilar-Arevalo AA, Anderson CE, Bazarko AO, Brice SJ, Brown BC, Bugel L, Cao J, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fleming BT, Ford R, Garcia FG, Garvey GT, Green C, Green JA, Hart TL, Hawker E, Imlay R, Johnson RA, Karagiorgi G, Kasper P, Katori T, Kobilarcik T, Kourbanis I, Koutsoliotas S, Laird EM, Linden SK, Link JM, Liu Y, Liu Y, Louis WC, Mahn KBM, Marsh W, McGregor G, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Nelson RH, Nguyen VT, Nienaber P, Nowak JA, Ouedraogo S, Patterson RB, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smith D, Sodeberg M, Sorel M, Spentzouris P, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Van de Water R, Wascko MO, White DH, Wilking MJ, Yang HJ, Zeller GP, Zimmerman ED. Unexplained excess of electronlike events from a 1-GeV neutrino beam. Phys Rev Lett 2009; 102:101802. [PMID: 19392103 DOI: 10.1103/physrevlett.102.101802] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Indexed: 05/27/2023]
Abstract
The MiniBooNE Collaboration observes unexplained electronlike events in the reconstructed neutrino energy range from 200 to 475 MeV. With 6.46x10;{20} protons on target, 544 electronlike events are observed in this energy range, compared to an expectation of 415.2+/-43.4 events, corresponding to an excess of 128.8+/-20.4+/-38.3 events. The shape of the excess in several kinematic variables is consistent with being due to either nu_{e} and nu[over ]_{e} charged-current scattering or nu_{mu} neutral-current scattering with a photon in the final state. No significant excess of events is observed in the reconstructed neutrino energy range from 475 to 1250 MeV, where 408 events are observed compared to an expectation of 385.9+/-35.7 events.
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Marsh W, Marsh H. Management of Closed Head Injuries. Semin Respir Crit Care Med 2008. [DOI: 10.1055/s-2007-1012210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aguilar-Arevalo AA, Bazarko AO, Brice SJ, Brown BC, Bugel L, Cao J, Coney L, Conrad JM, Cox DC, Curioni A, Djurcic Z, Finley DA, Fleming BT, Ford R, Garcia FG, Garvey GT, Green C, Green JA, Hart TL, Hawker E, Imlay R, Johnson RA, Kasper P, Katori T, Kobilarcik T, Kourbanis I, Koutsoliotas S, Laird EM, Link JM, Liu Y, Liu Y, Louis WC, Mahn KBM, Marsh W, Martin PS, McGregor G, Metcalf W, Meyers PD, Mills F, Mills GB, Monroe J, Moore CD, Nelson RH, Nienaber P, Ouedraogo S, Patterson RB, Perevalov D, Polly CC, Prebys E, Raaf JL, Ray H, Roe BP, Russell AD, Sandberg V, Schirato R, Schmitz D, Shaevitz MH, Shoemaker FC, Smith D, Sorel M, Spentzouris P, Stancu I, Stefanski RJ, Sung M, Tanaka HA, Tayloe R, Tzanov M, Van de Water R, Wascko MO, White DH, Wilking MJ, Yang HJ, Zeller GP, Zimmerman ED. Measurement of muon neutrino quasielastic scattering on carbon. Phys Rev Lett 2008; 100:032301. [PMID: 18232974 DOI: 10.1103/physrevlett.100.032301] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Indexed: 05/25/2023]
Abstract
The observation of neutrino oscillations is clear evidence for physics beyond the standard model. To make precise measurements of this phenomenon, neutrino oscillation experiments, including MiniBooNE, require an accurate description of neutrino charged current quasielastic (CCQE) cross sections to predict signal samples. Using a high-statistics sample of nu_(mu) CCQE events, MiniBooNE finds that a simple Fermi gas model, with appropriate adjustments, accurately characterizes the CCQE events observed in a carbon-based detector. The extracted parameters include an effective axial mass, M_(A)(eff)=1.23+/-0.20 GeV, that describes the four-momentum dependence of the axial-vector form factor of the nucleon, and a Pauli-suppression parameter, kappa=1.019+/-0.011. Such a modified Fermi gas model may also be used by future accelerator-based experiments measuring neutrino oscillations on nuclear targets.
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Mason D, Brau J, Drucker RB, Frey R, Spentzouris P, Conrad J, Fleming BT, Formaggio J, Kim JH, Koutsoliotas S, McNulty C, Romosan A, Shaevitz MH, Stern EG, Vaitaitis A, Zimmerman ED, Johnson RA, Suwonjandee N, Vakili M, Bernstein RH, Bugel L, Lamm MJ, Marsh W, Nienaber P, Tobien N, Yu J, Adams T, Alton A, Bolton T, Goldman J, Goncharov M, de Barbaro L, Buchholz D, Schellman H, Zeller GP, Boyd S, McDonald J, Naples D, Radescu V, Tzanov M, Avvakumov S, de Barbaro P, Bodek A, Budd H, Harris DA, McFarland KS, Sakumoto WK, Yang UK. Measurement of the nucleon strange-antistrange asymmetry at next-to-leading order in QCD from NuTeV Dimuon data. Phys Rev Lett 2007; 99:192001. [PMID: 18233069 DOI: 10.1103/physrevlett.99.192001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Indexed: 05/25/2023]
Abstract
We present a new measurement of the difference between the nucleon strange and antistrange quark distributions from dimuon events recorded by the NuTeV experiment at Fermilab. This analysis is the first to use a complete next to leading order QCD description of charm production from neutrino scattering. Dimuon events in neutrino deep inelastic scattering allow direct and independent study of the strange and antistrange content of the nucleon. We find a positive strange asymmetry with a significance of 1.6sigma. We also report a new measurement of the charm mass.
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Affiliation(s)
- D Mason
- University of Oregon, Eugene, OR, USA
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