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Lee WT, Pfohl R, Doublestein BA. Building a Culture of Leadership Development. Otolaryngol Head Neck Surg 2024; 170:1480-1481. [PMID: 38123792 DOI: 10.1002/ohn.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Walter T Lee
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Pfohl
- Leadership Solutions, Loganville, Georgia, USA
- Department of Healthcare Leadership, School of Business and Leadership, Regent University, Virginia Beach, Virginia, USA
| | - Barry A Doublestein
- Leadership Solutions, Loganville, Georgia, USA
- Department of Healthcare Leadership, School of Business and Leadership, Regent University, Virginia Beach, Virginia, USA
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Assaad S, Dov D, Park C, Davis R, Kovalsky SZ, Lee WT, Kahmke RR, Rocke DJ, Cohen J, Weiss-Meilik A, Henao R, Carin L, Elliott Range D. A Preliminary Study Comparing the Performance of Thyroid Molecular Tests to a Deep Learning Algorithm in Predicting Malignancy in Indeterminate Thyroid Fine Needle Aspiration Biopsies. Thyroid 2024; 34:531-535. [PMID: 38010913 PMCID: PMC10998704 DOI: 10.1089/thy.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Serge Assaad
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - David Dov
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Davis
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shahar Z. Kovalsky
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Walter T. Lee
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Cohen
- Department of Head and Neck Surgery and Duke University Medical Center, Durham, North Carolina, USA
- Department of Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ricardo Henao
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Office of the Provost, King Abdullah University of Science and Technology, Thuwal, Makkah, Saudi Arabia
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
- Office of the Provost, King Abdullah University of Science and Technology, Thuwal, Makkah, Saudi Arabia
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Lee WT. Artificial Intelligence in Medicine: A Caution About Good Intentions and Where It May Lead. Otolaryngol Head Neck Surg 2024. [PMID: 38270270 DOI: 10.1002/ohn.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
Implementing Artificial Intelligence in medicine is revolutionizing how medicine is practiced. It has much promise in bringing about improved clinical outcomes and efficiency while decreasing costs. There are also concerns and unintended consequences that are being realized and significant efforts to consider ethical principles in the implementation of Artificial Intelligence in medicine. One potential consequence may be the loss of what has been described as the soul of medicine: the physician-patient relationship. This relationship is especially precious in the context of what the US Surgeon General Vivek H. Murthy MD has called an "Epidemic of Loneliness and Isolation." This commentary describes considerations and potential steps to protect this vital relationship while implementing Artificial Intelligence approaches to improving patient care. If not vigilant, Artificial Intelligence may unintentionally erode the physician-patient relationship resulting in physician/patient isolation.
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Affiliation(s)
- Walter T Lee
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Dov D, Elliott Range D, Cohen J, Bell J, Rocke DJ, Kahmke RR, Weiss-Meilik A, Lee WT, Henao R, Carin L, Kovalsky SZ. Deep-Learning-Based Screening and Ancillary Testing for Thyroid Cytopathology. Am J Pathol 2023; 193:1185-1194. [PMID: 37611969 PMCID: PMC10477952 DOI: 10.1016/j.ajpath.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/06/2023] [Accepted: 05/19/2023] [Indexed: 08/25/2023]
Abstract
Thyroid cancer is the most common malignant endocrine tumor. The key test to assess preoperative risk of malignancy is cytologic evaluation of fine-needle aspiration biopsies (FNABs). The evaluation findings can often be indeterminate, leading to unnecessary surgery for benign post-surgical diagnoses. We have developed a deep-learning algorithm to analyze thyroid FNAB whole-slide images (WSIs). We show, on the largest reported data set of thyroid FNAB WSIs, clinical-grade performance in the screening of determinate cases and indications for its use as an ancillary test to disambiguate indeterminate cases. The algorithm screened and definitively classified 45.1% (130/288) of the WSIs as either benign or malignant with risk of malignancy rates of 2.7% and 94.7%, respectively. It reduced the number of indeterminate cases (N = 108) by reclassifying 21.3% (N = 23) as benign with a resultant risk of malignancy rate of 1.8%. Similar results were reproduced using a data set of consecutive FNABs collected during an entire calendar year, achieving clinically acceptable margins of error for thyroid FNAB classification.
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Affiliation(s)
- David Dov
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; Department of Pathology, Duke University Medical Center, Durham, North Carolina.
| | | | - Jonathan Cohen
- Department of Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Jonathan Bell
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ricardo Henao
- Biological, Environmental Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Lawrence Carin
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering (CEMSE) Division, King Abdullah University of Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Shahar Z Kovalsky
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Campbell JC, Lee HJ, Cannon TY, Kahmke RR, Lee WT, Puscas L, Rocke DJ. Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy. Gland Surg 2023; 12:917-927. [PMID: 37727340 PMCID: PMC10506124 DOI: 10.21037/gs-22-385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
Background Increased surgeon volume is associated with decreased complications for many surgeries, including thyroidectomy. We sought to use two national databases to assess for associations between surgeon volume and complications in patients undergoing lateral neck dissection for thyroid or parathyroid malignancy. Methods Lateral neck dissections for thyroid and parathyroid cancer from the Nationwide Inpatient Sample and State Inpatient Database were analyzed. The primary outcome was any inpatient complication common to thyroidectomy, parathyroidectomy, or lateral neck dissection. The principle independent variable was surgeon volume. Multivariable analysis was then performed on this retrospective cohort study. Results The 1,094 Nationwide Inpatient Sample discharges had a 28% (305/1,094) complication rate. After adjustment, surgeons with volumes between 3-34 neck dissections/year demonstrated a surgeon volume-complication rate association [adjusted odds ratio: 1.03; 95% confidence interval (CI): 1.01-1.05]. The 1,235 State inpatient Database discharges had a 21% (258/1,235) overall complication rate, and no association between surgeon volume and complication rates (P=0.25). Conclusions This retrospective review of 2,329 discharges for patients undergoing lateral neck dissection for thyroid or parathyroidectomy demonstrated somewhat conflicting results. The Nationwide Inpatient Sample demonstrated increasing complication rates for increasing surgeon volume among intermediate volume surgeons, while the State Inpatient Database demonstrated no surgeon volume-complication association. Given these disparate results, and further limitations with these databases, conclusions regarding surgical volume and clinical decision making based on these data should be assessed cautiously.
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Affiliation(s)
- James C. Campbell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Trinitia Y. Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
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Assaad S, Dov D, Davis R, Kovalsky S, Lee WT, Kahmke R, Rocke D, Cohen J, Henao R, Carin L, Range DE. Thyroid Cytopathology Cancer Diagnosis from Smartphone Images Using Machine Learning. Mod Pathol 2023; 36:100129. [PMID: 36931041 PMCID: PMC10293075 DOI: 10.1016/j.modpat.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
We examined the performance of deep learning models on the classification of thyroid fine-needle aspiration biopsies using microscope images captured in 2 ways: with a high-resolution scanner and with a mobile phone camera. Our training set consisted of images from 964 whole-slide images captured with a high-resolution scanner. Our test set consisted of 100 slides; 20 manually selected regions of interest (ROIs) from each slide were captured in 2 ways as mentioned above. Applying a baseline machine learning algorithm trained on scanner ROIs resulted in performance deterioration when applied to the smartphone ROIs (97.8% area under the receiver operating characteristic curve [AUC], CI = [95.4%, 100.0%] for scanner images vs 89.5% AUC, CI = [82.3%, 96.6%] for mobile images, P = .019). Preliminary analysis via histogram matching showed that the baseline model was overly sensitive to slight color variations in the images (specifically, to color differences between mobile and scanner images). Adding color augmentation during training reduces this sensitivity and narrows the performance gap between mobile and scanner images (97.6% AUC, CI = [95.0%, 100.0%] for scanner images vs 96.0% AUC, CI = [91.8%, 100.0%] for mobile images, P = .309), with both modalities on par with human pathologist performance (95.6% AUC, CI = [91.6%, 99.5%]) for malignancy prediction (P = .398 for pathologist vs scanner and P = .875 for pathologist vs mobile). For indeterminate cases (pathologist-assigned Bethesda category of 3, 4, or 5), color augmentations confer some improvement (88.3% AUC, CI = [73.7%, 100.0%] for the baseline model vs 96.2% AUC, CI = [90.9%, 100.0%] with color augmentations, P = .158). In addition, we found that our model's performance levels off after 15 ROIs, a promising indication that ROI data collection would not be time-consuming for our diagnostic system. Finally, we showed that the model has sensible Bethesda category (TBS) predictions (increasing risk malignancy rate with predicted TBS category, with 0% malignancy for predicted TBS 2 and 100% malignancy for TBS 6).
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Affiliation(s)
- Serge Assaad
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
| | - David Dov
- I-Medata AI Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel; Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Richard Davis
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Shahar Kovalsky
- Department of Mathematics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Walter T Lee
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Daniel Rocke
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jonathan Cohen
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Ricardo Henao
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina; King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Lawrence Carin
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina; King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
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Stanford-Moore GB, Canick J, Kaplan S, Lee WT. International Collaboration Trends in Facial Plastic and Reconstructive Surgery: A Systematic Bibliometric Scoping Review. JAMA Otolaryngol Head Neck Surg 2023; 149:540-545. [PMID: 37103939 PMCID: PMC10141267 DOI: 10.1001/jamaoto.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/26/2023] [Indexed: 04/28/2023]
Abstract
Importance Research in facial plastic and reconstructive surgery (FPRS) in the global health setting, especially in low- and middle-income countries (LMICs), is increasing year by year. As this work progresses, it will be crucial to include voices and perspectives of individuals living in the LMICs being studied. Objective To characterize and understand international collaborations in published literature on FPRS care in a global health setting and report patterns in whether these articles included authors from the LMICs in which the studies took place. Evidence Review A systematic bibliometric scoping review of articles in Scopus from 1971 to 2022 was performed using a set list of search terms; studies were included using predetermined inclusion and exclusion criteria. Studies met criteria for inclusion if the abstract or text contained information regarding surgeons from a different country performing surgery or conducting research in an LMIC within the domain of FPRS. Exclusion criteria were studies that did not mention a facial plastic or reconstructive surgery and studies where both an HIC and LMIC were not mentioned. Findings A total of 286 studies met criteria for inclusion. The highest percentage of studies (n = 72, 25.2%) were conducted across multiple countries. A total of 120 studies (41.9%) discussed cleft lip/palate. Overall, 141 studies (49.5%) included at least 1 author from the host LMIC; 89 (31.1%) had first authors from LMICs, and 72 (25.2%) had senior authors from LMICs. A total of 79 studies (27.6%) described humanitarian clinical service trips without mentioning research or education in the text. The remaining studies described research, education projects, or a combination. The published literature on humanitarian service trips had the lowest rate of inclusion of a first or senior author from the host LMICs. Conclusions and Relevance In this systematic bibliometric scoping review, findings showed a general trend of increased international work in the field of FPRS. However, there continues to be a paucity of inclusive authorship trends, with the majority of studies not including first or senior authors from LMICs. The findings presented here encourage new collaborations worldwide, as well as the improvement of existing efforts.
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Affiliation(s)
| | - Julia Canick
- Duke University School of Medicine, Durham, North Carolina
| | - Samantha Kaplan
- Duke University Medical Center Library, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
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Rickard AG, Mikati H, Mansourati A, Stevenson D, Krieger M, Rocke D, Esclamado R, Dewhirst MW, Ramanujam N, Lee WT, Palmer GM. A Clinical Study to Assess Diffuse Reflectance Spectroscopy with an Auto-Calibrated, Pressure-Sensing Optical Probe in Head and Neck Cancer. Curr Oncol 2023; 30:2751-2760. [PMID: 36975421 PMCID: PMC10047590 DOI: 10.3390/curroncol30030208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Diffuse reflectance spectroscopy (DRS) is a powerful tool for quantifying optical and physiological tissue properties such as hemoglobin oxygen saturation and vascularity. DRS is increasingly used clinically for distinguishing cancerous lesions from normal tissue. However, its widespread clinical acceptance is still limited due to uncontrolled probe–tissue interface pressure that influences reproducibility and introduces operator-dependent results. In this clinical study, we assessed and validated a pressure-sensing and automatic self-calibration DRS in patients with suspected head and neck squamous cell carcinoma (HNSCC). The clinical study enrolled nineteen patients undergoing HNSCC surgical biopsy procedures. Patients consented to evaluation of this improved DRS system during surgery. For each patient, we obtained 10 repeated measurements on one tumor site and one distant normal location. Using a Monte Carlo-based model, we extracted the hemoglobin saturation data along with total hemoglobin content and scattering properties. A total of twelve cancer tissue samples from HNSCC patients and fourteen normal tissues were analyzed. A linear mixed effects model tested for significance between repeated measurements and compared tumor versus normal tissue. These results demonstrate that cancerous tissues have a significantly lower hemoglobin saturation compared to normal controls (p < 0.001), which may be reflective of tumor hypoxia. In addition, there were minimal changes over time upon probe placement and repeated measurement, indicating that the pressure-induced changes were minimal and repeated measurements did not differ significantly from the initial value. This study demonstrates the feasibility of conducting optical spectroscopy measurements on intact lesions prior to removal during HNSCC procedures, and established that this probe provides diagnostically-relevant physiologic information that may impact further treatment.
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Affiliation(s)
- Ashlyn G. Rickard
- Department of Radiation Oncology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Husam Mikati
- Department of Radiation Oncology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Antoine Mansourati
- Department of Radiation Oncology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | | | - Marlee Krieger
- Zenalux Biomedical, Inc., Durham, NC 27705, USA
- Department of Biomedical Engineering, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Daniel Rocke
- Department of Head and Neck Surgery & Communications Sciences, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Ramon Esclamado
- Department of Head and Neck Surgery & Communications Sciences, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Mark W. Dewhirst
- Department of Radiation Oncology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Nirmala Ramanujam
- Zenalux Biomedical, Inc., Durham, NC 27705, USA
- Department of Biomedical Engineering, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communications Sciences, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
| | - Gregory M. Palmer
- Department of Radiation Oncology, Duke University Medical Center, Box 3455, Durham, NC 27710, USA
- Zenalux Biomedical, Inc., Durham, NC 27705, USA
- Correspondence: ; Tel.: +1-(919)613-5053
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Cohen J, Reed W, Foster MW, Kahmke RR, Rocke DJ, Puscas L, Cannon TY, Lee WT. Octreotide may improve pharyngocutaneous fistula healing through downregulation of cystatins: A pilot study. Laryngoscope Investig Otolaryngol 2022; 8:113-119. [PMID: 36846407 PMCID: PMC9948565 DOI: 10.1002/lio2.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/27/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hypothesized that octreotide induces alterations in the saliva proteome and that these alterations may provide insight into the mechanism of action underlying improved PCF healing. We undertook an exploratory pilot study in healthy controls that involved collecting saliva before and after a subcutaneous injection of octreotide and performing proteomic analysis to determine the effects of octreotide. Methods Four healthy adult participants provided saliva samples before and after subcutaneous injection of octreotide. A mass-spectrometry based workflow optimized for the quantitative proteomic analysis of biofluids was then employed to analyze changes in salivary protein abundance after octreotide administration. Results There were 3076 human, 332 Streptococcus mitis, 102 G. haemolyans, and 42 Granulicatella adiacens protein groups quantified in saliva samples. A paired statistical analysis was performed using the generalized linear model (glm) function in edgeR. There were and ~300 proteins that had a p < .05 between the pre- and post-octreotide groups ~50 proteins with an FDR-corrected p < .05 between pre- and post-groups. These results were visualized using a volcano plot after filtering on proteins quantified by 2 more or unique precursors. Both human and bacterial proteins were among the proteins altered by octreotide treatment. Notably, four isoforms of the human cystatins, belonging to a family of cysteine proteases, that had significantly lower abundance after treatment. Conclusion This pilot study demonstrated octreotide-induced downregulation of cystatins. By downregulation of cystatins in the saliva, there is decreased inhibition of cysteine proteases such as Cathepsin S. This results in increased cysteine protease activity that has been linked to enhanced angiogenic response, cell proliferation and migration that have resulted in improved wound healing. These insights provide first steps at furthering our understanding of octreotide's effects on saliva and reports of improved PCF healing.
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Affiliation(s)
| | - William Reed
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Matthew W. Foster
- Department of Medicine, and Duke Proteomics and Metabolomics Core FacilityDuke University Health SystemDurhamNorth CarolinaUSA
| | - Russel R. Kahmke
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Daniel J. Rocke
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Trinitia Y. Cannon
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
| | - Walter T. Lee
- Department of Head and Neck Surgery and Communication SciencesDuke University Health SystemDurhamNorth CarolinaUSA
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Pan DR, Juhlin E, Tran AN, Wei Q, Tang S, Bui AT, Iyer NG, Lee WT. A Southeast Asian collaborative Delphi consensus on surveying risk factors for head and neck cancer screening and prevention. Glob Surg 2022; 8:243. [PMID: 36561123 PMCID: PMC9770631] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The objective of this study was to determine high value questions for early detection and prevention of head and neck cancer by querying content experts on patient risk factors relevant to local communities in Southeast Asia (i.e., Vietnam, Laos, China, and Singapore). The Delphi method was employed using three rounds of asynchronous surveying which included participants among five different collaborating medical centers. 60 total survey items were assessed for consensus defined by a priori measures on the relative level of value of these questions for use in head and neck cancer screening. 77% of items reached a consensus and no items were concluded to be of low value despite differences in conclusions regarding relative importance. Survey items focused on patient demographic information and physical examination were examined across variables such as expert department affiliation, academic designation, and years of experience and found to be without statistically significant differences. However, with consensus items related to social risk factors, it was determined that participants who had 15 or more years of experience or identified as otolaryngologists rated these items at a relatively lower value than their peers with less experience (p < 0.0001, p = 0.0017) or outside the field of otolaryngology (p = 0.0101). This study explicitly identifies patient variables to consider in head and neck cancer screening that have not previously been comprehensively or methodically assessed in current literature. Increasing awareness of these risk factors may benefit the design and implementation of future head and neck cancer early detection and prevention programs in Southeast Asia and beyond as well as positively impact head and neck cancer outcomes.
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Affiliation(s)
- DR Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, United States of America
| | - E Juhlin
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, United States of America
| | - AN Tran
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, United States of America
| | - Q Wei
- Department of Population Health Science, Duke University, Durham, North Carolina, United States of America,Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - S Tang
- Department of Population Health Science, Duke University, Durham, North Carolina, United States of America,Department of Medicine, Duke University, Durham, North Carolina, United States of America,Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - AT Bui
- National Otolaryngology Hospital of Vietnam, Hanoi, Vietnam
| | - NG Iyer
- Department of Head and Neck Surgery, National Cancer Centre Singapore Duke-NUS Medical School, Singapore
| | - WT Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, United States of America,Correspondence to: Walter T Lee, Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, United States of America,
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Osazuwa-Peters N, Barnes JM, Okafor SI, Taylor DB, Hussaini AS, Adjei Boakye E, Simpson MC, Graboyes EM, Lee WT. Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas. JAMA Otolaryngol Head Neck Surg 2021; 147:1045-1052. [PMID: 34297790 PMCID: PMC8304170 DOI: 10.1001/jamaoto.2021.1728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 01/13/2023]
Abstract
Importance Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Somtochi I. Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Adnan S. Hussaini
- Department of Otolaryngology–Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield
- Simmons Cancer Institute, Springfield, Illinois
| | - Matthew C. Simpson
- Department of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Advanced Health Data Research Institute, St Louis University, St Louis, Missouri
| | - Evan M. Graboyes
- Editorial Board Member, JAMA Otolaryngology–Head & Neck Surgery
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Walter T. Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Lee WT, Ng KW, Liao J, Luk ACS, Suen HC, Chan THT, Cheung MY, Chu D, Zhao M, Chan YL, Li TC, Lee TL. P–547 Single-cell RNA sequencing identifies molecular regulations associated with poor maturation performance on rescue in vitro matured oocytes. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.546] [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: 11/12/2022] Open
Abstract
Abstract
Study question
What is the transcriptome signature associated with rescuein vitro matured (rIVM) oocytes?
Summary answer
GATA–1/CREB1/WNT signaling axis was repressed in rIVM oocytes of poor quality.
What is known already
rIVM aims to produce mature oocytes (MII) for in vitro fertilization (IVF) through IVM of immature oocytes collected from stimulated ovaries. It is less popular due to limited success rate in infertility treatment. Genetic aberrations, cellular stress, and the absence of cumulus cell support in oocytes could account for the failure of rIVM.
Study design, size, duration
We applied single-cell RNA sequencing (scRNA-seq) to capture the transcriptomes of human in vivo (IVO) oocytes (n = 10) from 7 donors and rIVM oocytes (n = 10) from 10 donors, followed by studying the maternal age effect and ovarian responses on rIVM oocyte transcriptomes.
Participants/materials, setting, methods
Human oocytes were collected from donors aged 28–41 years with a body mass index of < 30. RNA extraction, cDNA generation, library construction and sequencing were performed in one preparation. scRNA-seq data were then processed and analyzed. Selected genes in therIVM vs. IVO comparison were validated by quantitative real-time PCR.
Main results and the role of chance
The transcriptome profiles of rIVM/IVO showed distinctive differences. A total of 1559 differentially expressed genes (DEGs, genes with at least two-fold change and adjusted p < 0.05) were found to be enriched in metabolic processes, biosynthesis, and oxidative phosphorylation. Among these DEGs, we identified a repression of WNT/β-catenin signaling in rIVM when compared with IVO oocytes. We found that estradiol level exhibited a significant age-independent correlation with the IVO mature oocyte ratio (MII ratio). rIVM oocytes with higher MII ratio showed over-represented cellular processes such as anti-apoptosis. To further identify targets that contribute to the poor outcomes of rIVM, we compared oocytes collected from young donors with high MII ratio versus donors of advanced maternal age and revealed CREB1was an important regulator in rIVM. Our study identified GATA–1/CREB1/WNT signaling was repressed in both rIVM condition and rIVM oocytes of low-quality.
Limitations, reasons for caution
In the rIVM oocytes of high- and low-quality comparison, the number of samples was limited after data filtering with stringent selection criteria. For the oocyte stage identification, we were unable to predict the presence of oocyte spindle so polar body extrusion was the only indicator.
Wider implications of the findings: This study showed that GATA–1/CREB1/WNT signaling and antioxidant actions were repressed in rIVM condition and was further downregulated in rIVM oocytes of low-quality, providing us the foundation of subsequent follow-up research on human subjects.
Trial registration number
Not applicable
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Affiliation(s)
- W T Lee
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - K W Ng
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - J Liao
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - A C S Luk
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - H C Suen
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - T H T Chan
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - M Y Cheung
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - D Chu
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
| | - M Zhao
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - Y L Chan
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T L Lee
- The Chinese University of Hong Kong, School of Biomedical Sciences, Hong Kong, Hong Kong
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Affiliation(s)
- K H Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - W K Tsang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - P C H Kwok
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - W T Lee
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K W Tang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
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Wibonele BK, Smith BD, Altonji S, Kaplan S, Cho J, Lee WT. Head and neck cancer research collaborations between the United States and low- and middle-income countries: 10-year publication analysis. Head Neck 2021; 43:2395-2404. [PMID: 33818838 DOI: 10.1002/hed.26703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/19/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Disparities exist for head and neck cancer (HNC) patients between those in developed countries and low- and middle-income countries (LMICs). To improve HNC care globally, collaborations between the United States and LMICs have been established. Our objectives are: (1) define trends of collaborative HNC publications among LMICs and the United States and (2) assess the global distribution of these publications by region. METHODS A Scopus search identified all HNC research publications during 2009 to 2018. These were then categorized by type (basic vs. clinical) and by global regions. RESULTS Five thousand one hundred and seventy collaborative publications were identified, of which 41% were basic science and 59% clinical. The highest rate of collaborative publications for both basic science and clinical papers was seen in the East Asia/Pacific region. CONCLUSIONS The number of collaborative research publications per year in HNC is increasing across the globe, at varying rates in different global regions.
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Affiliation(s)
- Benjamin K Wibonele
- Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Samuel Altonji
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Samantha Kaplan
- Duke University Medical Center Library, Duke University Medical Center, Durham, North Carolina, USA
| | - Junghae Cho
- Department of Otolaryngology Head and Neck Surgery, The Catholic University of Korea, Seoul, South Korea
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Campbell JC, Lee HJ, Cannon T, Kahmke RR, Lee WT, Puscas L, Rocke DJ. Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis. Otolaryngol Head Neck Surg 2021; 165:838-844. [PMID: 33689518 DOI: 10.1177/01945998211000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. STUDY DESIGN Retrospective review. SETTING Two US databases spanning 2000 to 2014. METHODS Neck dissections for squamous cell carcinoma from the National Inpatient Sample and State Inpatient Databases were analyzed. The primary outcome was any in-hospital complication common to neck dissection. The principal independent variable was surgeon volume. A multivariable logistic generalized estimating equation with a piecewise linear spline for surgeon volume was fit to assess its association with complication. RESULTS The National Inpatient Sample had 3517 discharges fitting criteria, a median surgeon volume of 12, and an 11.1% complication rate. A 1-unit increase in surgeon volume was associated with a 7% increase in the odds of complication when volume ranged between 4 and 19 (adjusted odds ratio [AOR], 1.07; 95% CI, 1.04-1.11) and with a 3% decrease in the odds of complication when volume ranged between 19 and 51 (AOR, 0.97; 95% CI, 0.96-0.99). The State Inpatient Databases had 2876 discharges fitting criteria, a median surgeon volume of 30, and a 13.5% complication rate. Surgeon volume was not associated with complication when <27 (AOR, 1.01; 95% CI, 0.99-1.02), but a 5-unit increase in volume was associated with a 7% decrease in the odds of complication with volume ≥27 (AOR, 0.93; 95% CI, 0.88-0.98). CONCLUSIONS Surgeon volume was associated with complications for most volume ranges and with lower odds of complication for high-volume surgeons.
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Affiliation(s)
- James C Campbell
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Trinitia Cannon
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Russel R Kahmke
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Walter T Lee
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
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Salama AKS, Palta M, Rushing CN, Selim MA, Linney KN, Czito BG, Yoo DS, Hanks BA, Beasley GM, Mosca PJ, Dumbauld C, Steadman KN, Yi JS, Weinhold KJ, Tyler DS, Lee WT, Brizel DM. Ipilimumab and Radiation in Patients with High-risk Resected or Regionally Advanced Melanoma. Clin Cancer Res 2021; 27:1287-1295. [PMID: 33172894 PMCID: PMC8759408 DOI: 10.1158/1078-0432.ccr-20-2452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In this prospective trial, we sought to assess the feasibility of concurrent administration of ipilimumab and radiation as adjuvant, neoadjuvant, or definitive therapy in patients with regionally advanced melanoma. PATIENTS AND METHODS Twenty-four patients in two cohorts were enrolled and received ipilimumab at 3 mg/kg every 3 weeks for four doses in conjunction with radiation; median dose was 4,000 cGy (interquartile range, 3,550-4,800 cGy). Patients in cohort 1 were treated adjuvantly; patients in cohort 2 were treated either neoadjuvantly or as definitive therapy. RESULTS Adverse event profiles were consistent with those previously reported with checkpoint inhibition and radiation. For the neoadjuvant/definitive cohort, the objective response rate was 64% (80% confidence interval, 40%-83%), with 4 of 10 evaluable patients achieving a radiographic complete response. An additional 3 patients in this cohort had a partial response and went on to surgical resection. With 2 years of follow-up, the 6-, 12-, and 24-month relapse-free survival for the adjuvant cohort was 85%, 69%, and 62%, respectively. At 2 years, all patients in the neoadjuvant/definitive cohort and 10/13 patients in the adjuvant cohort were still alive. Correlative studies suggested that response in some patients were associated with specific CD4+ T-cell subsets. CONCLUSIONS Overall, concurrent administration of ipilimumab and radiation was feasible, and resulted in a high response rate, converting some patients with unresectable disease into surgical candidates. Additional studies to investigate the combination of radiation and checkpoint inhibitor therapy are warranted.
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Affiliation(s)
- April K S Salama
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina.
| | - Manisha Palta
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | | | - M Angelica Selim
- Department of Pathology, Duke University, Durham, North Carolina
| | | | - Brian G Czito
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - David S Yoo
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Brent A Hanks
- Department of Medicine, Division of Medical Oncology, Duke University, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Durham, North Carolina
| | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, North Carolina
| | - Chelsae Dumbauld
- Department of Immunology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | | | - John S Yi
- Department of Surgery, Duke University, Durham, North Carolina
| | - Kent J Weinhold
- Department of Surgery, Duke University, Durham, North Carolina
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Walter T Lee
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - David M Brizel
- Department of Radiation Oncology, Duke University, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
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Lee WT, Hill RW, Baidya J, Choudhry DK, Brenn BR. Comparative Evaluation of Tube First Versus Video Laryngoscope First Techniques in a Normal and Simulated Difficult Airway Model: A Randomized Controlled Trial. AANA J 2020; 88:479-483. [PMID: 33218384] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In patients with difficult airways, there can be difficulty with advancing the endotracheal tube into the airway even with a good view of the glottis using video laryngoscopy. The purpose of this study was to determine if the time required to intubate an airway and the number of gaze changes by the laryngoscopist could be decreased by using a novel video laryngoscope technique. Sixteen experienced Certified Registered Nurse Anesthetists were recruited to intubate a manikin with a normal or difficult airway using both the laryngoscope first technique and a new endotracheal tube first technique (4 intubations total) in a randomized sequence. The data were analyzed with the Mann-Whitney (U) test to compare the differences between the normal and difficult airway conditions. Although no significant difference was noted in the time to intubation between intubation techniques, the number of gaze changes was found to be significantly fewer in the tube first technique (P=.0009). A steep learning curve, associated with the accommodation of the manikin, was demonstrated by a decrease in time and gaze changes with subsequent intubations. Incorporating the endotracheal tube first technique into an education curriculum could increase patient safety by decreasing the time to secure a difficult airway.
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Affiliation(s)
- Walter T Lee
- is a CRNA manager at Monroe Carrell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Ryan W Hill
- is a staff CRNA at Vanderbilt University Medical Center
| | - Joydeep Baidya
- is a senior undergraduate student at Cornell University in Ithaca, New York
| | - Dinesh K Choudhry
- is a pediatric anesthesiologist and director of research in the Department of Anesthesiology at Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, and a clinical professor of anesthesiology at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - B Randall Brenn
- is a pediatric anesthesiologist and associate professor of anesthesiology, medical director of perioperative informatics, and director of pediatric clinical informatics at Monroe Carrell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
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Dukes PV, Strobbia P, Ngo HT, Odion RA, Rocke D, Lee WT, Vo-Dinh T. Plasmonic assay for amplification-free cancer biomarkers detection in clinical tissue samples. Anal Chim Acta 2020; 1139:111-118. [PMID: 33190693 DOI: 10.1016/j.aca.2020.09.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
Developing countries have seen a rise in cancer incidence and are projected to harbor three-quarters of all cancer-related mortality by 2030. While disproportionally affected by the burden of cancer, these regions are ill-equipped to handle the diagnostic caseload. The low number of trained pathologists per capita results in delayed diagnosis and treatment, ultimately contributing to increased mortality rates. To address this issue, we developed a point-of-care (POC) plasmonic assay for direct detection of cancer as an alternative to pathological review. Whereas our assay has general applicability in many cancer diagnoses that involve tissue biopsies, we use head and neck cancer (HNC) as a model system because these tumors are increasingly prevalent in lower-income and underserved regions, due to risk factors such as smoking, drinking, and viral infection. Our method uses surface-enhanced Raman scattering (SERS) to detect unique RNA biomarkers from human biopsy samples without the need for complex target amplification machinery (e.g., PCR), making it time and resource-efficient. Unlike previous studies that required target amplification, this work represents a significant advance for HNC diagnosis directly in clinical samples, using only our SERS-based assay for RNA biomarkers. In this study, we tested our assay on 20 clinical samples, demonstrating the accuracy of the method in the diagnosis of head and neck squamous cell carcinoma. We reported sensitivity of 100% and specificity of 97%. Furthermore, we used a handheld Raman device to read the results in order to illustrate the applicability of our method for POC diagnosis of cancer in low-resource settings.
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Affiliation(s)
- Priya V Dukes
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Department of Head and Neck Surgery and Communication Sciences, Duke School of Medicine, Durham, NC, USA
| | - Pietro Strobbia
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Biomedical Engineering Department, Duke University, Durham, NC, USA
| | - Hoan T Ngo
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Biomedical Engineering Department, Duke University, Durham, NC, USA; Biomedical Engineering Department, International University, Vietnam National University - Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ren A Odion
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Biomedical Engineering Department, Duke University, Durham, NC, USA
| | - Daniel Rocke
- Department of Head and Neck Surgery and Communication Sciences, Duke School of Medicine, Durham, NC, USA
| | - Walter T Lee
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Department of Head and Neck Surgery and Communication Sciences, Duke School of Medicine, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Tuan Vo-Dinh
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA; Biomedical Engineering Department, Duke University, Durham, NC, USA; Chemistry Department, Duke University, Durham, NC, USA.
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Brown CS, Cunningham CD, Lee WT, Puscas L. Development of a Surgical Video Atlas for Resident Education: 3-Year Experience. OTO Open 2020; 4:2473974X20939067. [PMID: 32704610 PMCID: PMC7361475 DOI: 10.1177/2473974x20939067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. Methods Videos are recorded from multiple viewpoints within the operating room and compiled into a single stream. Postediting includes chaptering videos and overlaying relevant text annotations. Videos are published online and viewership trends analyzed. Results Over 3 years, 29 otolaryngology videos were published out of 161 journal publications (18%). Eight of the 14 key indicator procedures are included (57%). From the beginning of 2017 to the end of 2019, viewership of otolaryngology pages increased from 548 to 11,139 views per month, totaling >150,000 views. These now represent 10% of the total journal monthly views and 10% of the overall views. Users originate from the United States and from >10 other countries. Discussion Residents and faculty face challenges of providing the highest standard of clinical care, teaching, and learning in and out of the operating room. Inherent difficulties of surgical training, high-fidelity surgical simulation, and imposed work hour restrictions necessitate additional, more efficient and effective means of teaching and learning. Surgical videos demonstrating key anatomy, procedural steps, and surgical dexterity with hand positioning are increasing in their popularity among learners. Implications for Practice Surgical video atlases provide a unique adjunct for resident education. They are enduring and easily accessible. In a climate of work hour restrictions or elective case reduction, they may supplement how residents learn to operate outside the operating theater.
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Affiliation(s)
- C Scott Brown
- Department of Otolaryngology-Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Calhoun D Cunningham
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Walter T Lee
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Liana Puscas
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Brown CS, Cunningham CD, Lee WT, Puscas L. Response to Letter "Regarding Development of a Surgical Video Atlas for Resident Education: 3-Year Experience". OTO Open 2020; 4:2473974X20959277. [PMID: 32999952 PMCID: PMC7506778 DOI: 10.1177/2473974x20959277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rocke DJ, Mulder H, Cyr D, Kahmke R, Lee WT, Puscas L, Schulz K, Witsell DL. The effect of lateral neck dissection on complication rate for total thyroidectomy. Am J Otolaryngol 2020; 41:102421. [PMID: 32089352 DOI: 10.1016/j.amjoto.2020.102421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the complication profile for total thyroidectomy with and without concomitant lateral neck dissection using a large administrative database. MATERIALS AND METHODS The IBM MarketScan® Commercial Database (2010-2014) analytic cohort was queried for patients ≥18 years or older undergoing total thyroidectomy (or equivalent procedures) from January 1, 2010 to June 30, 2014. Subgroup analysis was performed for patients undergoing concomitant unilateral and bilateral lateral neck dissection. The complication profiles were described. RESULTS 55,204 patients underwent total thyroidectomy or equivalent procedures. Hypoparathyroidism or hypocalcemia was coded in 20.3% overall, with 4.7% having permanent hypoparathyroidism. Vocal cord paralysis was coded in 3.3% overall with permanent rate of 0.7%. Tracheotomy was performed in 0.3% of patients. 2743 underwent total thyroidectomy with concomitant unilateral lateral neck dissection, and 560 of these patients underwent bilateral lateral neck dissection. In patients undergoing unilateral lateral neck dissection, 30.5% of patients have hypoparathyroidism/hypocalcemia coded, with a permanent rate of 8.8%. Vocal cord paralysis was coded in 8.3% of patients, with a permanent rate of 1.9%. Tracheotomy was performed in 1.2% of patients. In patients undergoing bilateral lateral neck dissection, 39.6% had hypoparathyroidism/hypocalcemia coded, with a permanent rate of 10.9%. These patients had vocal cord paralysis coded in 10.2% of cases, with a permanent rate of 2.1%. Tracheotomy was performed in 2.5% of patients. CONCLUSION The addition of unilateral and especially bilateral lateral neck dissection increases both overall and permanent complication rates for total thyroidectomy. These data may help to inform preoperative discussions with patients.
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Abstract
Efficient and timely diagnosis of head and neck squamous cell carcinoma (HNSCC) is a critical challenge, particularly in low and middle income countries. These regions, which are expected to witness a drastic increase in HNSCC rates, are ill-prepared to handle the diagnostic burden due to limited resources, especially the low ratio of pathologists per population, resulting in delayed diagnosis and treatment. Here, we demonstrate the potential of an alternative diagnostic method as a low-cost, resource-efficient alternative to histopathological analysis. Our novel technology employs unique surface-enhanced Raman scattering (SERS) "nanorattles" targeting cytokeratin nucleic acid biomarkers specific for HNSCC. In this first study using SERS diagnostics for head and neck cancers, we tested the diagnostic accuracy of our assay using patient tissue samples. In a blinded trial, our technique demonstrated a sensitivity of 100% and specificity of 89%, supporting its use as a useful alternative to histopathological diagnosis. The implications of our method are vast and significant in the setting of global health. Our method can provide a rapid diagnosis, allowing for earlier treatment before the onset of distant metastases. In comparison to histopathology, which can take several months in remote limited-resources regions, our method provides a diagnosis within a few hours.
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Affiliation(s)
- P Vohra
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA
- Division of Head and Neck Surgery and Communication Sciences, Duke School of Medicine, Durham, NC, USA
| | - P Strobbia
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA
| | - H T Ngo
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA
- Biomedical Engineering Department, International University, Vietnam National University-Ho Chi Minh City (VNU-HCMC), Ho Chi Minh City, Vietnam
| | - W T Lee
- Division of Head and Neck Surgery and Communication Sciences, Duke School of Medicine, Durham, NC, USA
| | - T Vo-Dinh
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Chemistry, Duke University, Durham, NC, USA.
- Fitzpatrick Institute for Photonics, Duke University, Durham, NC, USA.
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23
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Palmer GM, Zhang H, Lee CT, Mikati H, Herbert JA, Krieger M, von Windheim J, Koester D, Stevenson D, Rocke DJ, Esclamado R, Erkanli A, Ramanujam N, Dewhirst MW, Lee WT. Assessing effects of pressure on tumor and normal tissue physiology using an automated self-calibrated, pressure-sensing probe for diffuse reflectance spectroscopy. J Biomed Opt 2018; 23:1-8. [PMID: 29766688 PMCID: PMC5981029 DOI: 10.1117/1.jbo.23.5.057004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/25/2018] [Indexed: 05/03/2023]
Abstract
Diffuse reflectance spectroscopy (DRS) represents a quantitative, noninvasive, nondestructive means of assessing vascular oxygenation, vascularity, and structural properties. However, it is known that such measurements can be influenced by the effects of pressure, which is a major concern for reproducible and operator-independent assessment of tissues. Second, regular calibration is a necessary component of quantitative DRS to account for factors such as lamp decay and fiber bending. Without a means of reliably controlling for these factors, the accuracy of any such assessments will be reduced, and potentially biased. To address these issues, a self-calibrating, pressure-controlled DRS system is described and applied to both a patient-derived xenograft glioma model, as well as a set of healthy volunteers for assessments of oral mucosal tissues. It was shown that pressure had a significant effect on the derived optical parameters, and that the effects on the optical parameters were magnified with increasing time and pressure levels. These findings indicate that not only is it critical to integrate a pressure sensor into a DRS device, but that it is also important to do so in an automated way to trigger a measurement as soon as possible after probe contact is made to minimize the perturbation to the tissue site.
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Affiliation(s)
- Gregory M. Palmer
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Address all correspondence to: Gregory M. Palmer, E-mail:
| | - Hengtao Zhang
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Chen-Ting Lee
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Husam Mikati
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Joseph A. Herbert
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Marlee Krieger
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | | | - Dave Koester
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
| | | | - Daniel J. Rocke
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
| | - Ramon Esclamado
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
| | - Alaatin Erkanli
- Duke University Medical Center, Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States
| | - Nirmala Ramanujam
- Zenalux Biomedical, Inc., Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Mark W. Dewhirst
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
- Duke University, Department of Biomedical Engineering, Durham, North Carolina, United States
| | - Walter T. Lee
- Duke University Medical Center, Department of Surgery, Durham, North Carolina, United States
- Durham Veterans Affairs Medical Center, Durham, North Carolina, United States
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24
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Han P, Liu H, Shi Q, Liu Z, Troy JD, Lee WT, Zevallos JP, Li G, Sturgis EM, Wei Q. Associations between expression levels of nucleotide excision repair proteins in lymphoblastoid cells and risk of squamous cell carcinoma of the head and neck. Mol Carcinog 2018. [PMID: 29528139 DOI: 10.1002/mc.22801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Squamous cell carcinoma of head and neck (SCCHN) is one of the most common malignancies worldwide, and nucleotide excision repair (NER) is involved in SCCHN susceptibility. In this analysis of 349 newly diagnosed SCCHN patients and 295 cancer-free controls, we investigated whether expression levels of eight core NER proteins were associated with risk of SCCHN. We quantified NER protein expression levels in cultured peripheral lymphocytes using a reverse-phase protein microarray. Compared with the controls, SCCHN patients had statistically significantly lower expression levels of ERCC3 and XPA (P = 0.001 and 0.001, respectively). After dividing the subjects by controls' median values of expression levels, we found a dose-dependent association between an increased risk of SCCHN and low expression levels of ERCC3 (adjusted OR, 1.75, and 95% CI: 1.26-2.42; Ptrend = 0.008) and XPA (adjusted OR, 1.88; 95% CI, 1.35-2.60; Ptrend = 0.001). We also identified a significant multiplicative interaction between smoking status and ERCC3 expression levels (P = 0.014). Finally, after integrating demographic and clinical variables, we found that the addition of ERCC3 and XPA expression levels to the model significantly improved the sensitivity of the expanded model on SCCHN risk. In conclusion, reduced protein expression levels of ERCC3 and XPA were associated with an increased risk of SCCHN. However, these results need to be confirmed in additional large studies.
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Affiliation(s)
- Peng Han
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, P.R. China
| | - Hongliang Liu
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Qiong Shi
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Zhensheng Liu
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jesse D Troy
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Guojun Li
- Departments of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Departments of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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Puza CJ, Josyula S, Terando AM, Howard JH, Agnese DM, Mosca PJ, Lee WT, Beasley GM. Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma? J Surg Oncol 2018. [PMID: 29513892 DOI: 10.1002/jso.25025] [Citation(s) in RCA: 13] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Head and neck (HN) cutaneous melanoma is associated with worse disease-free survival compared to non-HN cutaneous melanoma, possibly due to inadequate staging. We aim to determine if a higher yield of sentinel lymph nodes (SLNs) affected rates of sentinel lymph node biopsy (SLNB) positivity. METHODS Two Cancer Registries were used to identify patients who underwent SLNB for HN melanoma. A false negative (FN) was defined by nodal recurrence after negative SLNB. RESULTS Out of 333 patients who underwent SLNB, 20% (n = 69) had a positive SLN with a FN rate of 6.3%. Those with three or more SLNs had a higher rate of SLN positivity (23.8% [17.5-29.9% CI] vs 16.4% [10.7-23.6% CI]), a lower FN rate (16.7% [10.2-21.2% CI] vs 35.3% [27.1-42.9% CI]), and higher sensitivity (83.3% [82.59-84.09% CI] vs 65.7% [64.87-66.53% CI]) compared to those with one or two SLNs. Of patients in Group 1 (one or two SLNs) with a positive SLN who underwent completion lymph node dissection (20/23), 47% (33-61% CI) had one or more positive non-sentinel nodes compared to 29% (16-51%) of patients in Group 2 (three or more SLNs) (42/46). CONCLUSION In HN melanoma cases in which multiple nodes are identified, removal of all SLNs will more adequately stage patients.
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Affiliation(s)
- Charles J Puza
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Srirama Josyula
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Alicia M Terando
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - John H Howard
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Doreen M Agnese
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Georgia M Beasley
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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26
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Vo QT, Pham D, Choi KJ, Nguyen UTT, Le L, Shanewise T, Tran L, Nguyen N, Lee WT. Solar-powered hearing aids for children with impaired hearing in Vietnam: a pilot study. Paediatr Int Child Health 2018; 38:40-45. [PMID: 28121245 DOI: 10.1080/20469047.2016.1276119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hearing loss is a barrier to speech and social and cognitive development. This can be especially pronounced in children living in low- and middle-income countries with limited resources. AIM To determine the feasibility, durability and social impact of ComCare GLW solar-powered hearing aids provided for Vietnamese children with hearing impairment. METHODS A retrospective review of data from an international, multi-discipline humanitarian visit was performed. Hearing aids were given to 28 children enrolled at the Khoai Chau Functional Rehabilitation School, Hung Yen Province, Vietnam. Device inspection and observational assessments were performed by teachers using a modified Parents' Evaluation of Aural/Oral Performance of Children and an Infant Hearing Program Amplification Benefit Questionnaire. Qualitative interviews were undertaken to assess the study aims. RESULTS Hearing aids were well tolerated for use during regular school hours. All units remained functional during the study period (12 months). Teachers noted increased student awareness and responsiveness to surrounding sounds, but the degree of response to amplification varied between children. There was no significant improvement in speech development as all subjects had prelingual deafness. Teachers felt confident in troubleshooting any potential device malfunction. CONCLUSIONS A solar-powered hearing aid may be a viable option for children in low- and middle-income countries. This study demonstrates that device distribution, maintenance and function can be established in countries with limited resources, while providing feasibility data to support future studies investigating how similar devices may improve the quality of life of those with hearing loss.
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Affiliation(s)
| | - Dung Pham
- a National ENT Hospital , Hanoi , Vietnam
| | - Kevin J Choi
- b Division of Head and Neck Surgery and Communication Sciences , Duke University Medical Center , Durham , NC , USA
| | | | - Lan Le
- a National ENT Hospital , Hanoi , Vietnam
| | | | - Lien Tran
- d Resource Exchange International - Vietnam , Colorado Springs , CO , USA
| | - Nga Nguyen
- d Resource Exchange International - Vietnam , Colorado Springs , CO , USA
| | - Walter T Lee
- b Division of Head and Neck Surgery and Communication Sciences , Duke University Medical Center , Durham , NC , USA.,c Durham VA Medical Center , Durham NC , USA
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27
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Xu XY, Lee WT, Chan AKY, Lo HS, Shin PKS, Cheung SG. Microplastic ingestion reduces energy intake in the clam Atactodea striata. Mar Pollut Bull 2017; 124:798-802. [PMID: 28038767 DOI: 10.1016/j.marpolbul.2016.12.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/29/2016] [Accepted: 12/11/2016] [Indexed: 05/27/2023]
Abstract
The effects of microplastic concentrations (10itemsl-1 and 1000itemsl-1) on the physiological responses of Atactodea striata (clearance rate, absorption efficiency, respiration rate) were investigated. The fates of ingested microplastics and the efficiency of depuration in removing ingested microplastics were also studied. A. striata ingested microplastics and the clearance rate was reduced at high concentration of microplastics. Since the respiration rate and absorption efficiency remained unchanged in exposed A. striata, reduction in the clearance rate would reduce the energy intake. Ingestion and retention of microplastics in the body were further limited by the production of pseudofaeces and faeces, and depuration in clean water, resulting in a very small amount of microplastics stored in the body of the clam.
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Affiliation(s)
- X-Y Xu
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong
| | - W T Lee
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong
| | - A K Y Chan
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong
| | - H S Lo
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong
| | - P K S Shin
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong; State Key Laboratory in Marine Pollution, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong
| | - S G Cheung
- Department of Biology and Chemistry, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong; State Key Laboratory in Marine Pollution, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong.
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28
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Hu F, Martin H, Martinez A, Everitt J, Erkanli A, Lee WT, Dewhirst M, Ramanujam N. Distinct Angiogenic Changes during Carcinogenesis Defined by Novel Label-Free Dark-Field Imaging in a Hamster Cheek Pouch Model. Cancer Res 2017; 77:7109-7119. [PMID: 29021136 DOI: 10.1158/0008-5472.can-17-1058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/03/2017] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Abstract
There remain gaps in knowledge concerning how vascular morphology evolves during carcinogenesis. In this study, we imaged neovascularization by label-free dark-field microscopy of a 7,12-Dimethylbenz[a]anthracene (DMBA)-induced hamster cheek pouch model of oral squamous cell carcinoma (SCC). Wavelength-dependent imaging revealed distinct vascular features at different imaging depths and vessel sizes. Vascular tortuosity increased significantly in high-risk lesions, whereas diameter decreased significantly in hyperplastic and SCC lesions. Large vessels preserved the same trends seen in the original images, whereas small vessels displayed different trends, with length and diameter increasing during carcinogenesis. On the basis of these data, we developed and validated a classification algorithm incorporating vascular features from different vessel masks. Receiver operator curves generated from the classification results demonstrated high accuracies in discriminating normal and hyperplasia from high-grade lesions (AUC > 0.94). Overall, these results provided automated imaging of vasculature in the earliest stages of carcinogenesis from which one can extract robust endpoints. The optical toolbox described here is simple, low-cost and portable, and can be used in a variety of health care and research settings for cancer prevention and pharmacology research. Cancer Res; 77(24); 7109-19. ©2017 AACR.
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Affiliation(s)
- Fangyao Hu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Hannah Martin
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Amy Martinez
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Jeffrey Everitt
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Division of Head and Neck Surgery and Communicative Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mark Dewhirst
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina.
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29
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Vohra P, Ngo HT, Lee WT, Vo Dinh T. Squamous Cell Carcinoma DNA Detection Using Ultrabright SERS Nanorattles and Magnetic Beads for Head and Neck Cancer Molecular Diagnostics. Anal Methods 2017; 9:5550-5556. [PMID: 37131959 PMCID: PMC10151024 DOI: 10.1039/c7ay01913k] [Citation(s) in RCA: 6] [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: 05/04/2023]
Abstract
A rise in head and neck cancers in low and middle countries over recent years has prompted the need for low-cost, resource-efficient diagnostic technologies. Standard diagnosis with histopathology is often not feasible due to the low number of trained pathologists in these regions, resulting in delayed diagnosis and treatment. This study presents an alternative diagnostic method to standard histopathology. We developed a surface enhanced raman scattering (SERS) based method to distinguish squamous cell carcinoma from other cell lines. Using a "sandwich" method employing ultrabright SERA nanorattles and magnetic beads, we directly targeted specific nucleic acid markers of squamous cells. Our method was able to detect the presence of squamous cells with high sensitivity and specificity, supporting its potential for use as a diagnostic tool in head and neck fine needle aspirations (FNA).
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Affiliation(s)
- P Vohra
- Duke University, Biomedical Engineering Durham, NC, USA 27708
| | - H T Ngo
- Duke University, Biomedical Engineering Durham, NC, USA 27708
| | - W T Lee
- Duke University Division of Head and Neck Surgery and Communication SciencesDurham, NC, USA
| | - T Vo Dinh
- Duke University, Biomedical Engineering Durham, NC, USA 27708
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30
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Luo X, Tseng LT, Lee WT, Tan TT, Bao NN, Liu R, Ding J, Li S, Lauter V, Yi JB. Probing the magnetic profile of diluted magnetic semiconductors using polarized neutron reflectivity. Sci Rep 2017; 7:6341. [PMID: 28740239 PMCID: PMC5524716 DOI: 10.1038/s41598-017-06793-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/16/2017] [Indexed: 11/09/2022] Open
Abstract
Room temperature ferromagnetism has been observed in the Cu doped ZnO films deposited under an oxygen partial pressure of 10-3 and 10-5 torr on Pt (200 nm)/Ti (45 nm)/Si (001) substrates using pulsed laser deposition. Due to the deposition at relatively high temperature (873 K), Cu and Ti atoms diffuse to the surface and interface, which significantly affects the magnetic properties. Depth sensitive polarized neutron reflectometry method provides the details of the composition and magnetization profiles and shows that an accumulation of Cu on the surface leads to an increase in the magnetization near the surface. Our results reveal that the presence of the copper at Zn sites induces ferromagnetism at room temperature, confirming intrinsic ferromagnetism.
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Affiliation(s)
- X Luo
- School of Materials Science and Engineering, UNSW, Sydney, NSW, 2052, Australia
| | - L T Tseng
- School of Materials Science and Engineering, UNSW, Sydney, NSW, 2052, Australia
| | - W T Lee
- Bragg Institute, ANSTO, New Illawarra Road, Lucas Heights, NSW, 2234, Australia
| | - T T Tan
- School of Materials Science and Engineering, UNSW, Sydney, NSW, 2052, Australia
| | - N N Bao
- Department of Materials Science and Engineering, National University of Singapore, 119260, Singapore, Singapore
| | - R Liu
- SIMS Facility, Office of the Deputy-Vice Chancellor (Research and Development), Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia
| | - J Ding
- Department of Materials Science and Engineering, National University of Singapore, 119260, Singapore, Singapore
| | - S Li
- School of Materials Science and Engineering, UNSW, Sydney, NSW, 2052, Australia
| | - V Lauter
- Quantum Condensed Matter Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee, 37831, USA
| | - J B Yi
- School of Materials Science and Engineering, UNSW, Sydney, NSW, 2052, Australia.
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31
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Parham K, Chapurin N, Schulz K, Shin JJ, Pynnonen MA, Witsell DL, Langman A, Nguyen-Huynh A, Ryan SE, Vambutas A, Wolfley A, Roberts R, Lee WT. Thyroid Disease and Surgery in CHEER: The Nation's Otolaryngology-Head and Neck Surgery Practice-Based Network. Otolaryngol Head Neck Surg 2017; 155:22-7. [PMID: 27371622 DOI: 10.1177/0194599815627641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) Describe thyroid-related diagnoses and procedures in Creating Healthcare Excellence through Education and Research (CHEER) across academic and community sites. (2) Compare management of malignant thyroid disease across these sites. (3) Provide practice-based data related to flexible laryngoscopy vocal fold assessment before and after thyroid surgery based on the American Academy of Otolaryngology-Head and Neck Surgery Foundation's clinical practice guidelines. STUDY DESIGN Review of retrospective data collection (RDC) database of the CHEER network using ICD-9 and CPT codes related to thyroid conditions. SETTING Multisite practice-based network. SUBJECTS AND METHODS There were 3807 thyroid patients (1392 malignant, 2415 benign) with 10,160 unique visits identified from 1 year of patient data in the RDC. Analysis was performed for identified cohort of patients using demographics, site characteristics, and diagnostic and procedural distribution. RESULTS Mean number of patients with thyroid disease per site was 238 (range, 23-715). In community practices, 19% of patients with thyroid disease had cancer versus 45% in the academic setting (P < .001). While academic sites manage more cancer patients, community sites are also surgically treating thyroid cancer and performed more procedures per cancer patient (4.2 vs 3.5, P < .001). Vocal fold function was assessed by flexible laryngoscopy in 34.0% of preoperative patients and in 3.7% postoperatively. CONCLUSION This is the first overview of malignant and benign thyroid disease through CHEER. It shows how the RDC can be used alone and with national guidelines to inform of clinical practice patterns in academic and community sites. This demonstrates the potential for future thyroid-related studies utilizing the otolaryngology-head and neck surgery practice-based research network.
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Affiliation(s)
- Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Nikita Chapurin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kris Schulz
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - David L Witsell
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alan Langman
- Puget Sound Hearing & Balance Group, Seattle, Washington, USA
| | - Anh Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Sheila E Ryan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Anne Wolfley
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rhonda Roberts
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Walter T Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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32
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Crowson MG, Schulz K, Parham K, Vambutas A, Witsell D, Lee WT, Shin JJ, Pynnonen MA, Nguyen-Huynh A, Ryan SE, Langman A. Ménière's Disease: A CHEER Database Study of Local and Regional Patient Encounter and Procedure Patterns. Otolaryngol Head Neck Surg 2017; 155:15-21. [PMID: 27371621 DOI: 10.1177/0194599815617752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 06/17/2015] [Accepted: 10/27/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE (1) Integrate practice-based patient encounters using the Dartmouth Atlas Medicare database to understand practice treatments for Ménière's disease (MD). (2) Describe differences in the practice patterns between academic and community providers for MD. STUDY DESIGN Practice-based research database review. SETTING CHEER (Creating Healthcare Excellence through Education and Research) network academic and community providers. SUBJECTS AND METHODS MD patient data were identified with ICD-9 and CPT codes. Demographics, unique visits, and procedures per patient were tabulated. The Dartmouth Atlas of Health Care was used to reference regional health care utilization. Statistical analysis included 1-way analyses of variance, bivariate linear regression, and Student's t tests, with significance set at P < .05. RESULTS A total of 2071 unique patients with MD were identified from 8 academic and 10 community otolaryngology-head and neck surgery provider centers nationally. Average age was 56.5 years; 63.9% were female; and 91.4% self-reported white ethnicity. There was an average of 3.2 visits per patient. Western providers had the highest average visits per patient. Midwest providers had the highest average procedures per patient. Community providers had more visits per site and per patient than did academic providers. Academic providers had significantly more operative procedures per site (P = .0002) when compared with community providers. Health care service areas with higher total Medicare reimbursements per enrollee did not report significantly more operative procedures being performed. CONCLUSION This is the first practice-based clinical research database study to describe MD practice patterns. We demonstrate that academic otolaryngology-head and neck surgery providers perform significantly more operative procedures than do community providers for MD, and we validate these data with an independent Medicare spending database.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kristine Schulz
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, New York, USA
| | - David Witsell
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Walter T Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anh Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Sheila E Ryan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alan Langman
- Northwest Hearing & Balance, University of Washington, Seattle, Washington, USA
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Bellmunt AM, Roberts R, Lee WT, Schulz K, Pynnonen MA, Crowson MG, Witsell D, Parham K, Langman A, Vambutas A, Ryan SE, Shin JJ. Does an Otolaryngology-Specific Database Have Added Value? A Comparative Feasibility Analysis. Otolaryngol Head Neck Surg 2017; 155:56-64. [PMID: 27371627 DOI: 10.1177/0194599816651036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES There are multiple nationally representative databases that support epidemiologic and outcomes research, and it is unknown whether an otolaryngology-specific resource would prove indispensable or superfluous. Therefore, our objective was to determine the feasibility of analyses in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases as compared with the otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) database. STUDY DESIGN Parallel analyses in 2 data sets. SETTING Ambulatory visits in the United States. SUBJECTS AND METHODS To test a fixed hypothesis that could be directly compared between data sets, we focused on a condition with expected prevalence high enough to substantiate availability in both. This query also encompassed a broad span of diagnoses to sample the breadth of available information. Specifically, we compared an assessment of suspected risk factors for sensorineural hearing loss in subjects 0 to 21 years of age, according to a predetermined protocol. We also assessed the feasibility of 6 additional diagnostic queries among all age groups. RESULTS In the NAMCS/NHAMCS data set, the number of measured observations was not sufficient to support reliable numeric conclusions (percentage standard error among risk factors: 38.6-92.1). Analysis of the CHEER database demonstrated that age, sex, meningitis, and cytomegalovirus were statistically significant factors associated with pediatric sensorineural hearing loss (P < .01). Among the 6 additional diagnostic queries assessed, NAMCS/NHAMCS usage was also infeasible; the CHEER database contained 1585 to 212,521 more observations per annum. CONCLUSION An otolaryngology-specific database has added utility when compared with already available national ambulatory databases.
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Affiliation(s)
- Angela M Bellmunt
- Ear Nose Throat Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Rhonda Roberts
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Walter T Lee
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kris Schulz
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew G Crowson
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David Witsell
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health, Farmington, Connecticut, USA
| | - Alan Langman
- Puget Sound Hearing & Balance Group, Northwest Hospital, University of Washington, Seattle, Washington, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Sheila E Ryan
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Lee WT, Witsell DL, Parham K, Shin JJ, Chapurin N, Pynnonen MA, Langman A, Nguyen-Huynh A, Ryan SE, Vambutas A, Roberts RS, Schulz K. Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement. Otolaryngol Head Neck Surg 2017; 155:28-32. [PMID: 27371623 DOI: 10.1177/0194599816630523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/13/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES (1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines. STUDY DESIGN Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients. SETTING Multisite practice-based network. SUBJECTS AND METHODS A total of 8347 subjects underwent tonsillectomy as determined by procedure code within the retrospective data collection database, and 107 had postoperative hemorrhage. These subjects had demographic information and related diagnoses based on the CPT and ICD-9 codes collected. Postoperative ICD-9 and CPT codes were used to identify patients who also had postoperative bleed. Variables included age (<12 vs ≥12 years), diagnoses (infectious vs noninfectious), and practice type (community vs academic). Statistical analysis included multivariate logistic regression variables predictive of postoperative bleeding, with P < .05 considered significant. RESULTS Thirteen sites contributed data to the study (7 academic, 6 community). There was postoperative bleeding for an overall bleed rate of 1.3%. Patients ≥12 years old had a significantly increased bleed rate when compared with the younger group (odds ratio, 5.98; 95% confidence interval: 3.79-9.44; P < .0001). There was no significant difference in bleed rates when practices or diagnoses were compared. CONCLUSION A site descriptor database built to expedite clinical research can be used for practice assessment and quality improvement. These data were also useful to identify patient risk factors for posttonsillectomy bleed.
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Affiliation(s)
- Walter T Lee
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA Section of Otolaryngology-Head and Neck Surgery, Durham VA Medical Center, Durham, North Carolina, USA
| | - David L Witsell
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikita Chapurin
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alan Langman
- Northwest Hearing & Balance, University of Washington, Seattle, Washington, USA
| | - Anh Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Sheila E Ryan
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Rhonda S Roberts
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kris Schulz
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Piker EG, Schulz K, Parham K, Vambutas A, Witsell D, Tucci D, Shin JJ, Pynnonen MA, Nguyen-Huynh A, Crowson M, Ryan SE, Langman A, Roberts R, Wolfley A, Lee WT. Variation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness. Otolaryngol Head Neck Surg 2017; 155:42-7. [PMID: 27371625 DOI: 10.1177/0194599816650173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We used a national otolaryngology practice-based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder. STUDY DESIGN Database review. SETTING The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers SUBJECTS AND METHODS Dizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit. RESULTS A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics. CONCLUSION There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing.
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Affiliation(s)
- Erin G Piker
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kris Schulz
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health, Farmington, Connecticut, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - David Witsell
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Debara Tucci
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anh Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthew Crowson
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Sheila E Ryan
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alan Langman
- Northwest Hearing & Balance Group, Seattle, Washington, USA
| | - Rhonda Roberts
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anne Wolfley
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Walter T Lee
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Chapurin N, Pynnonen MA, Roberts R, Schulz K, Shin JJ, Witsell DL, Parham K, Langman A, Carpenter D, Vambutas A, Nguyen-Huynh A, Wolfley A, Lee WT. CHEER National Study of Chronic Rhinosinusitis Practice Patterns: Disease Comorbidities and Factors Associated with Surgery. Otolaryngol Head Neck Surg 2017; 156:751-756. [PMID: 28195023 DOI: 10.1177/0194599817691476] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives (1) Describe national patterns of chronic rhinosinusitis (CRS) care across academic and community practices. (2) Determine the prevalence of comorbid disorders in CRS patients, including nasal polyposis, allergic rhinitis, asthma, and cystic fibrosis. (3) Identify demographic, clinical, and practice type factors associated with endoscopic sinus surgery (ESS). Study Design Multisite cross-sectional study. Setting Otolaryngology's national research network CHEER (Creating Healthcare Excellence through Education and Research). Subjects and Methods A total of 17,828 adult patients with CRS were identified, of which 10,434 were seen at community practices (59%, n = 8 sites) and 7394 at academic practices (41%, n = 10 sites). Multivariate logistic regression was used to evaluate the association between demographic, practice type, and clinical factors and the odds of a patient undergoing ESS. Results The average age was 50.4 years; 59.5% of patients were female; and 88.3% were Caucasian. The prevalence of comorbid diseases was as follows: allergic rhinitis (35.1%), nasal polyposis (13.3%), asthma (4.4%), and cystic fibrosis (0.2%). In addition, 24.8% of patients at academic centers underwent ESS, as compared with 12.3% at community sites. In multivariate analyses, nasal polyposis (odds ratio [OR], 4.28), cystic fibrosis (OR, 2.42), and academic site type (OR, 1.86) were associated with ESS ( P < .001), while adjusting for other factors. Conclusions We describe practice patterns of CRS care, as well as demographic and clinical factors associated with ESS. This is the first study of practice patterns in CRS utilizing the CHEER network and may be used to guide future research.
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Affiliation(s)
- Nikita Chapurin
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Melissa A Pynnonen
- 2 Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rhonda Roberts
- 3 Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kristine Schulz
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer J Shin
- 4 Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David L Witsell
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Kourosh Parham
- 5 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Alan Langman
- 6 Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - David Carpenter
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrea Vambutas
- 7 Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Anh Nguyen-Huynh
- 8 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Anne Wolfley
- 3 Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Walter T Lee
- 1 Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Wang H, Funchain P, Bebek G, Altemus J, Zhang H, Niazi F, Peterson C, Lee WT, Burkey BB, Eng C. Microbiomic differences in tumor and paired-normal tissue in head and neck squamous cell carcinomas. Genome Med 2017; 9:14. [PMID: 28173873 PMCID: PMC5297129 DOI: 10.1186/s13073-017-0405-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND While the role of the gut microbiome in inflammation and colorectal cancers has received much recent attention, there are few data to support an association between the oral microbiome and head and neck squamous cell carcinomas. Prior investigations have been limited to comparisons of microbiota obtained from surface swabs of the oral cavity. This study aims to identify microbiomic differences in paired tumor and non-tumor tissue samples in a large group of 121 patients with head and neck squamous cell carcinomas and correlate these differences with clinical-pathologic features. METHODS Total DNA was extracted from paired normal and tumor resection specimens from 169 patients; 242 samples from 121 patients were included in the final analysis. Microbiomic content of each sample was determined using 16S rDNA amplicon sequencing. Bioinformatic analysis was performed using QIIME algorithms. F-testing on cluster strength, Wilcoxon signed-rank testing on differential relative abundances of paired tumor-normal samples, and Wilcoxon rank-sum testing on the association of T-stage with relative abundances were conducted in R. RESULTS We observed no significant difference in measures of alpha diversity between tumor and normal tissue (Shannon index: p = 0.13, phylogenetic diversity: p = 0.42). Similarly, although we observed statistically significantly differences in both weighted (p = 0.01) and unweighted (p = 0.04) Unifrac distances between tissue types, the tumor/normal grouping explained only a small proportion of the overall variation in the samples (weighted R2 = 0.01, unweighted R2 < 0.01). Notably, however, when comparing the relative abundances of individual taxa between matched pairs of tumor and normal tissue, we observed that Actinomyces and its parent taxa up to the phylum level were significantly depleted in tumor relative to normal tissue (q < 0.01), while Parvimonas was increased in tumor relative to normal tissue (q = 0.01). These differences were more pronounced among patients with more extensive disease as measured by higher T-stage. CONCLUSIONS Matched pairs analysis of individual tumor-normal pairs revealed significant differences in relative abundance of specific taxa, namely in the genus Actinomyces. These differences were more pronounced among patients with higher T-stage. Our observations suggest further experiments to interrogate potential novel mechanisms relevant to carcinogenesis associated with alterations of the oral microbiome that may have consequences for the human host.
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Affiliation(s)
- Hannah Wang
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195, USA
| | - Pauline Funchain
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA.,Taussig Cancer Institute, Cleveland, OH, 44195, USA
| | - Gurkan Bebek
- Center for Proteomics and Bioinformatics, Cleveland, OH, 44106, USA.,Department of Electrical Engineering and Computer Science, Cleveland, OH, 44106, USA
| | - Jessica Altemus
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Huan Zhang
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195, USA
| | - Farshad Niazi
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Charissa Peterson
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Walter T Lee
- Department of Surgery, Duke University Medical Center, Durham, NC, 27710, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland, OH, 44195, USA. .,Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195, USA. .,Taussig Cancer Institute, Cleveland, OH, 44195, USA. .,Department of Genetics and Genome Sciences, Cleveland, OH, 44106, USA. .,CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA. .,Cleveland Clinic Genomic Medicine Institute, 9500 Euclid Avenue NE50, Cleveland, OH, 44195, USA.
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Chaudhuri R, Thomson NC, McCallum C, O’Pray H, Barclay ST, Murray D, MacBride-Stewart S, Sharma V, Shepherd M, Lee WT. P125 A primary care audit on asthma patients with frequent exacerbations and the potential impact of national review of asthma deaths (NRAD) recommendations. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ryser MD, Lee WT, Ready NE, Leder KZ, Foo J. Quantifying the Dynamics of Field Cancerization in Tobacco-Related Head and Neck Cancer: A Multiscale Modeling Approach. Cancer Res 2016; 76:7078-7088. [PMID: 27913438 DOI: 10.1158/0008-5472.can-16-1054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/26/2016] [Accepted: 09/19/2016] [Indexed: 01/23/2023]
Abstract
High rates of local recurrence in tobacco-related head and neck squamous cell carcinoma (HNSCC) are commonly attributed to unresected fields of precancerous tissue. Because they are not easily detectable at the time of surgery without additional biopsies, there is a need for noninvasive methods to predict the extent and dynamics of these fields. Here, we developed a spatial stochastic model of tobacco-related HNSCC at the tissue level and calibrated the model using a Bayesian framework and population-level incidence data from the Surveillance, Epidemiology, and End Results (SEER) registry. Probabilistic model analyses were performed to predict the field geometry at time of diagnosis, and model predictions of age-specific recurrence risks were tested against outcome data from SEER. The calibrated models predicted a strong dependence of the local field size on age at diagnosis, with a doubling of the expected field diameter between ages at diagnosis of 50 and 90 years, respectively. Similarly, the probability of harboring multiple, clonally unrelated fields at the time of diagnosis was found to increase substantially with patient age. On the basis of these findings, we hypothesized a higher recurrence risk in older than in younger patients when treated by surgery alone; we successfully tested this hypothesis using age-stratified outcome data. Further clinical studies are needed to validate the model predictions in a patient-specific setting. This work highlights the importance of spatial structure in models of epithelial carcinogenesis and suggests that patient age at diagnosis may be a critical predictor of the size and multiplicity of precancerous lesions. Cancer Res; 76(24); 7078-88. ©2016 AACR.
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Affiliation(s)
- Marc D Ryser
- Duke University, Department of Mathematics, Durham, North Carolina.
| | - Walter T Lee
- Division of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.,Section of Otolaryngology-Head and Neck Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Neal E Ready
- Division of Medical Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Kevin Z Leder
- Department of Industrial & Systems Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Jasmine Foo
- School of Mathematics, University of Minnesota, Minneapolis, Minnesota.
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Hu F, Vishwanath K, Salama JK, Erkanli A, Peterson B, Oleson JR, Lee WT, Brizel DM, Ramanujam N, Dewhirst MW. Oxygen and Perfusion Kinetics in Response to Fractionated Radiation Therapy in FaDu Head and Neck Cancer Xenografts Are Related to Treatment Outcome. Int J Radiat Oncol Biol Phys 2016; 96:462-469. [PMID: 27598811 DOI: 10.1016/j.ijrobp.2016.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/28/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To test whether oxygenation kinetics correlate with the likelihood for local tumor control after fractionated radiation therapy. METHODS AND MATERIALS We used diffuse reflectance spectroscopy to noninvasively measure tumor vascular oxygenation and total hemoglobin concentration associated with radiation therapy of 5 daily fractions (7.5, 9, or 13.5 Gy/d) in FaDu xenografts. Spectroscopy measurements were obtained immediately before each daily radiation fraction and during the week after radiation therapy. Oxygen saturation and total hemoglobin concentration were computed using an inverse Monte Carlo model. RESULTS First, oxygenation kinetics during and after radiation therapy, but before tumor volumes changed, were associated with local tumor control. Locally controlled tumors exhibited significantly faster increases in oxygenation after radiation therapy (days 12-15) compared with tumors that recurred locally. Second, within the group of tumors that recurred, faster increases in oxygenation during radiation therapy (day 3-5 interval) were correlated with earlier recurrence times. An area of 0.74 under the receiver operating characteristic curve was achieved when classifying the local control tumors from all irradiated tumors using the oxygen kinetics with a logistic regression model. Third, the rate of increase in oxygenation was radiation dose dependent. Radiation doses ≤9.5 Gy/d did not initiate an increase in oxygenation, whereas 13.5 Gy/d triggered significant increases in oxygenation during and after radiation therapy. CONCLUSIONS Additional confirmation is required in other tumor models, but these results suggest that monitoring tumor oxygenation kinetics could aid in the prediction of local tumor control after radiation therapy.
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Affiliation(s)
- Fangyao Hu
- : Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Joseph K Salama
- : Department of Radiation Oncology, Duke University, Durham, NC, USA.,: Division of Radiation Oncology, Veterans Administration Medical Center, Durham, NC
| | - Alaattin Erkanli
- : Department of Biostatistics and Bioinformatics, Duke University Medical Center
| | - Bercedis Peterson
- : Department of Biostatistics and Bioinformatics, Duke University Medical Center
| | - James R Oleson
- : Department of Radiation Oncology, Duke University, Durham, NC, USA.,: Division of Radiation Oncology, Veterans Administration Medical Center, Durham, NC
| | - Walter T Lee
- : Department of Radiation Oncology, Duke University, Durham, NC, USA.,: Division of Head and Neck Surgery & Communicative Sciences, Duke University Medical Center, Durham, NC.,: Section of Otolaryngology Head and Neck Surgery, Veterans Administration Medical Center, Durham, NC
| | - David M Brizel
- : Department of Radiation Oncology, Duke University, Durham, NC, USA.,: Division of Head and Neck Surgery & Communicative Sciences, Duke University Medical Center, Durham, NC
| | - Nimmi Ramanujam
- : Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Mark W Dewhirst
- : Department of Radiation Oncology, Duke University, Durham, NC, USA
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Affiliation(s)
- Walter T Lee
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Lee WT, Milstein C, Hicks D, Akst LM, Esclamado RM. Results of ansa to recurrent laryngeal nerve reinnervation. Otolaryngol Head Neck Surg 2016; 136:450-4. [PMID: 17321876 DOI: 10.1016/j.otohns.2006.11.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 11/20/2006] [Indexed: 11/18/2022]
Abstract
Objective We sought to describe the results of ansa cervicalis to recurrent laryngeal nerve (ansa-RLN) reinnervation for unilateral vocal fold paralysis. Study Design A chart review was performed on patients undergoing ansa-RLN reinnervation for unilateral vocal cord paralysis at a tertiary care center. Patient perceptions of preoperative and postoperative voice quality was surveyed. Acoustic and visual parameters were assessed from videostroboscopy. Results From a total of 25 study patients, 15 patients underwent both preoperative and postoperativ video stroboscopies. In stroboscopies within 6 months, the average improvement in overall severity, roughness, and breathiness was 69, 79, and 100 percent, respectively. In stroboscopies after 6 months, the average improvement in overall severity, roughness, and breathiness was 63, 66, and 100 percent, respectively. Postoperatively, all patients had reinnervation of the vocal fold. Conclusions Voice outcomes were improved in patients with preoperative and postoperative stroboscopies. Significance Ansa-RLN reinnervation should be considered as a treatment for unilateral vocal fold paralysis.
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Affiliation(s)
- Walter T Lee
- Department of Otolaryngology, Head and Neck Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Abstract
OBJECTIVE: To establish the basis for use of allogeneic dendritic-tumor fusion cells. STUDY DESIGN: Fusion cells were created by electrofusion. We used 2 allogeneic murine tumor lines (D5 and 4T1) that were virally transduced to express the antigen (β-galactosidase) as a surrogate tumor marker. RESULTS: Cross-immunization was achieved with irradiated allogenic tumor cells. Successful electrofusion of dendritic cells and tumor cells was confirmed by using fluorescence-activated cell sorting and cytospin. Significant responses were shown in immunized mice against tumor challenge and established 3-day pulmonary metastasis with fusion cells. CONCLUSIONS: Allogeneic tumor sharing a common tumor antigen can immunize against syngeneic tumor challenge. Fusion cells showed successful immunization against tumor challenge and showed regression of 3-day established pulmonary metastasis. SIGNIFICANCE: These preclinical studies provide evidence that an allogenic tumor-dendritic cell fusion vaccine is a valid approach for head and neck cancer immunotherapy. (Otolaryngol Head Neck Surg 2005;132:755-64.)
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Affiliation(s)
- Walter T Lee
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Affiliation(s)
| | | | - Walter T. Lee
- Corresponding author: Walter T. Lee, MD, MHSc, Duke University Medical Center, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Room 3532–Blue Zone, DUMC 3805, Durham, NC 27710, 919.681.8449, fax 919.613.6524,
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Abstract
Laryngeal cysts are relatively rare benign lesions of the larynx. Congenital cysts can cause neonatal respiratory distress and death, but airway obstruction due to acquired cysts in adults is rare. We present a case report of 51-year-old male with dysphagia who was found to have a mobile pedunculated epiglottic cyst that intermittently caused partial obstruction of the laryngeal inlet. Patient was taken to operating room and following transoral fiberoptic intubation, endoscopic excision of this cyst was accomplished. Patient's postoperative course was uneventful.
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Affiliation(s)
- Alissa M Collins
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nikita Chapurin
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Walter T Lee
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Agrawal A, Civantos FJ, Brumund KT, Chepeha DB, Hall NC, Carroll WR, Smith RB, Zitsch RP, Lee WT, Shnayder Y, Cognetti DM, Pitman KT, King DW, Christman LA, Lai SY. [(99m)Tc]Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial. Ann Surg Oncol 2015; 22:3708-15. [PMID: 25670018 PMCID: PMC4565859 DOI: 10.1245/s10434-015-4382-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND [(99m)Tc]Tilmanocept, a novel CD206 receptor-targeted radiopharmaceutical, was evaluated in an open-label, phase III trial to determine the false negative rate (FNR) of sentinel lymph node biopsy (SLNB) relative to the pathologic nodal status in patients with intraoral or cutaneous head and neck squamous cell carcinoma (HNSCC) undergoing tumor resection, SLNB, and planned elective neck dissection (END). Negative predictive value (NPV), overall accuracy of SLNB, and the impact of radiopharmaceutical injection timing relative to surgery were assessed. METHODS AND FINDINGS This multicenter, non-randomized, single-arm trial (ClinicalTrials.gov identifier NCT00911326) enrolled 101 patients with T1-T4, N0, and M0 HNSCC. Patients received 50 µg [(99m)Tc]tilmanocept radiolabeled with either 0.5 mCi (same day) or 2.0 mCi (next day), followed by lymphoscintigraphy, SLNB, and END. All excised tissues were evaluated for tissue type and tumor presence. [(99m)Tc]Tilmanocept identified one or more SLNs in 81 of 83 patients (97.6 %). Of 39 patients identified with any tumor-positive nodes (SLN or non-SLN), one patient had a single tumor-positive non-SLN in whom all SLNs were tumor-negative, yielding an FNR of 2.56 %; NPV was 97.8 % and overall accuracy was 98.8 %. No significant differences were observed between same-day and next-day procedures. CONCLUSIONS Use of receptor-targeted [(99m)Tc]tilmanocept for lymphatic mapping allows for a high rate of SLN identification in patients with intraoral and cutaneous HNSCC. SLNB employing [(99m)Tc]tilmanocept accurately predicts the pathologic nodal status of intraoral HNSCC patients with low FNR, high NPV, and high overall accuracy. The use of [(99m)Tc]tilmanocept for SLNB in select patients may be appropriate and may obviate the need to perform more extensive procedures such as END.
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Affiliation(s)
- Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Francisco J Civantos
- Department of Otolaryngology, University of Miami Hospital and Clinics/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Kevin T Brumund
- Division of Head and Neck Surgery, Department of Surgery, Moores UCSD Cancer Center and Veteran Affairs San Diego Medical Center, San Diego, CA, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Nathan C Hall
- Division of Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William R Carroll
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell B Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, MO, USA
| | - Walter T Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ryan M, Crow J, Kahmke R, Fisher SR, Su Z, Lee WT. FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients. Am J Otolaryngol 2014; 35:689-94. [PMID: 25212103 DOI: 10.1016/j.amjoto.2014.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/20/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE 1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence. STUDY DESIGN Retrospective cohort study. METHODS Patients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend. RESULTS Fifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p=0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p=0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p=0.02). CONCLUSION FoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.
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Lee WT. The promise of a profession lies within us. Bull Am Coll Surg 2014; 99:30-31. [PMID: 25345219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hu F, Vishwanath K, Beumer HW, Puscas L, Afshari HR, Esclamado RM, Scher R, Fisher S, Lo J, Mulvey C, Ramanujam N, Lee WT. Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma. Oral Oncol 2014; 50:848-856. [PMID: 25037162 DOI: 10.1016/j.oraloncology.2014.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 05/22/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We propose the use of morphological optical biomarkers for rapid detection of human head and neck squamous cell carcinoma (HNSCC) by leveraging the underlying tissue characteristics in aerodigestive tracts. MATERIALS AND METHODS Diffuse reflectance spectra were obtained from malignant and contra-lateral normal tissues of 57 patients undergoing panendoscopy and biopsy. Oxygen saturation, total hemoglobin concentration, and the reduced scattering coefficient were extracted. Differences in malignant and normal tissues were examined based on two different groupings: anatomical site and morphological tissue type. RESULTS AND CONCLUSIONS Measurements were acquired from 252 sites, of which 51 were pathologically classified as SCC. Optical biomarkers exhibited statistical differences between malignant and normal samples. Contrast was enhanced when parsing tissues by morphological classification rather than anatomical subtype for unpaired comparisons. Corresponding linear discriminant models using multiple optical biomarkers showed improved predictive ability when accounting for morphological classification, particularly in node-positive lesions. The false-positive rate was retrospectively found to decrease by 34.2% in morphologically- vs. anatomically-derived predictive models. In glottic tissue, the surgeon exhibited a false-positive rate of 45.7% while the device showed a lower false-positive rate of 12.4%. Additionally, comparisons of optical parameters were made to further understand the physiology of tumor staging and potential causes of high surgeon false-positive rates. Optical spectroscopy is a user-friendly, non-invasive tool capable of providing quantitative information to discriminate malignant from normal head and neck tissues. Predictive models demonstrated promising results for real-time diagnostics. Furthermore, the strategy described appears to be well suited to reduce the clinical false-positive rate.
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Affiliation(s)
- Fangyao Hu
- Duke University, Biomedical Engineering Department, Durham, NC, USA
| | | | - H Wolfgang Beumer
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Liana Puscas
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA.,Section of Otolaryngology - Head and Neck Surgery, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Hamid R Afshari
- Dental Service, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Ramon M Esclamado
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard Scher
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel Fisher
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Lo
- Duke University, Biomedical Engineering Department, Durham, NC, USA
| | - Christine Mulvey
- Duke University, Biomedical Engineering Department, Durham, NC, USA
| | | | - Walter T Lee
- Division of Otolaryngology - Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA.,Section of Otolaryngology - Head and Neck Surgery, Durham Veterans Administration Medical Center, Durham, NC, USA
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Rocke DJ, Beumer HW, Taylor DH, Thomas S, Puscas L, Lee WT. Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer. JAMA Otolaryngol Head Neck Surg 2014; 140:497-503. [PMID: 24763550 DOI: 10.1001/jamaoto.2014.494] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions. OBJECTIVE To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. DESIGN, SETTING, AND PARTICIPANTS Otolaryngology-head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers. INTERVENTIONS Participation in online assessment exercise. MAIN OUTCOMES AND MEASURES Medicare resource allocation. RESULTS Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048). CONCLUSIONS AND RELEVANCE Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.
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Affiliation(s)
- Daniel J Rocke
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Halton W Beumer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina2now with Medical Corps, US Air Force, Joint Base Langley-Eustis, Virginia
| | - Donald H Taylor
- Duke Sanford School of Public Policy, Durham, North Carolina4Community and Family Medicine and Nursing, Duke University Medical Center, Durham, North Carolina
| | - Steven Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina6Section of Otolaryngology, Durham VA Medical Center, Durham, North Carolina
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