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Liu HH, Ezekowitz MD, Columbo M, Khan O, Martin J, Spahr J, Yaron D, Cushinotto L, Kapelusznik L. The future is now: our experience starting a remote clinical trial during the beginning of the COVID-19 pandemic. Trials 2021; 22:603. [PMID: 34493311 PMCID: PMC8422835 DOI: 10.1186/s13063-021-05537-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background The World Health Organization declared the outbreak of SARS-CoV-2 a pandemic on February 11, 2020. This organism causes COVID-19 disease and the rapid rise in cases and geographic spread strained healthcare systems. Clinical research trials were hindered by infection control measures discouraging physical contact and diversion of resources to meet emergent requirements. The need for effective treatment and prevention of COVID-19 prompted an untested investigational response. Trial groups adapted approaches using remote enrolment and consenting, newly developed diagnostic tests, delivery of study medications and devices to participants’ homes, and remote monitoring to ensure investigator/enrollee safety while preserving ethical integrity, confidentiality, and data accuracy. Methods Clinical researchers at our community health system in the USA undertook an outpatient randomized open-label study of hydroxychloroquine (HCQ) prophylaxis versus observation of SARS-CoV-2 infection in household COVID-19 contacts. Designed in March 2020, challenges included COVID-19 infection in the research group, HCQ shortage, and lack of well-established home SARS-CoV-2 tests and remote ECG monitoring protocols in populations naive to these procedures. The study was written, funded, and received ethical committee approval in 4 months and was completed by September 2020 during a period of fluctuating infection rates and conflicting political opinions on HCQ use; results have been published. Singular methodology included the use of a new RNA PCR saliva SARS-CoV-2 home diagnostic test and a remote smartphone-based 6-lead ECG recording system. Results Of 483 households contacted regarding trial participation, 209 (43.3%) did not respond to telephone calls/e-mails and 90 (18.6%) declined; others were not eligible by inclusion or exclusion criteria. Ultimately, 54 individuals were enrolled and 42 completed the study. Numbers were too small to determine the efficacy of HCQ prophylaxis. No serious treatment-related adverse events were encountered. Conclusions Flexibility in design, a multidisciplinary research team, prompt cooperation among research, funding, ethics review groups, and finding innovative study approaches enabled this work. Concerns were balancing study recruitment against unduly influencing individuals anxious for protection from the pandemic and exclusion of groups based on lack of Internet access and technology. An issue to address going forward is establishing research cooperation across community health systems before emergencies develop. Trial registration ClinicalTrials.govNCT04652648. Registered on December 3, 2020.
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Affiliation(s)
- Hans H Liu
- Department of Medicine, Bryn Mawr Hospital, Bryn Mawr, PA, USA. .,The Sidney Kimmel Medical College, Philadelphia, PA, USA. .,, Bala Cynwyd, PA, USA.
| | - Michael D Ezekowitz
- Department of Medicine, Bryn Mawr Hospital, Bryn Mawr, PA, USA.,The Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Michele Columbo
- Department of Medicine, Bryn Mawr Hospital, Bryn Mawr, PA, USA
| | - Oneib Khan
- Lankenau Internal Medicine Residency Program, Lankenau Hospital, Main Line Health System, Wynnewood, PA, USA
| | - Jack Martin
- Department of Medicine, Bryn Mawr Hospital, Bryn Mawr, PA, USA
| | | | - David Yaron
- Bryn Mawr Family Practice Residency, Bryn Mawr Hospital, Bryn Mawr, PA, USA
| | - Lisa Cushinotto
- Department of Pharmacy, Bryn Mawr Hospital, Bryn Mawr, PA, USA
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Umemura A, Suto T, Fujiwara H, Sasaki A. Invention of novel scoring system for reduced port laparoscopic colorectal surgery to secure surgical safety and quality: A prospective clinical trial. Asian J Surg 2021; 44:1120-1122. [PMID: 34172382 DOI: 10.1016/j.asjsur.2021.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan.
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Japan
| | | | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
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Sharma S, Lee BK, Garg A, Peyton R, Schuler BT, Mason P, Delnoy PP, Gallagher MM, Hariharan R, Schaerf R, Du R, Serratore ND, Starck CT. Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, international clinical study. Heart Rhythm O2 2021; 2:113-21. [PMID: 34113913 DOI: 10.1016/j.hroo.2021.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Transvenous lead extraction (TLE) plays a critical role in managing patients with cardiovascular implantable electronic devices. Mechanical TLE tools, including rotational sheaths, are used to overcome fibrosis and calcification surrounding leads. Prospective clinical data are limited regarding the safety and effectiveness of use of mechanical TLE devices, especially rotational tools. Objective To prospectively investigate the safety and effectiveness of mechanical TLE in real-world usage. Methods Patients were enrolled at 10 sites in the United States and Europe to evaluate the use of mechanical TLE devices. Clinical success, complete procedural success, and complications were evaluated through follow-up (median, 29 days). Patient data were source verified and complications were adjudicated by an independent clinical events committee (CEC). Results Between October 2018 and January 2020, mechanical TLE tools, including rotational sheaths, were used to extract 460 leads with a median indwell time of 7.4 years from 230 patients (mean age 64.3 ± 14.4 years). Noninfectious indications for TLE were more common than infectious indications (61.5% vs 38.5%, respectively). The extracted leads included 305 pacemaker leads (66.3%) and 155 implantable cardioverter-defibrillator leads (33.7%), including 85 leads with passive fixation (18.5%). A bidirectional rotational sheath was needed for 368 leads (88.0%). Clinical success was obtained in 98.7% of procedures; complete procedural success was achieved for 96.3% of leads. CEC-adjudicated device-related major complications occurred in 6 of 230 (2.6%) procedures. No isolated superior vena cava injury or procedural death occurred. Conclusion This prospective clinical study demonstrates that use of mechanical TLE tools, especially bidirectional rotational sheaths, are effective and safe.
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Ito K, Sugita S, Nakajima Y, Hozumi T, Yamakawa K, Fujiwara M, Karasawa K. Electron beam intraoperative radiotherapy for metastatic epidural spinal cord compression: a prospective observational study. Clin Exp Metastasis 2021; 38:219-25. [PMID: 33629217 DOI: 10.1007/s10585-021-10078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
To assess the additional effects of intraoperative radiotherapy (IORT) with decompression surgery and adjuvant external beam radiotherapy (EBRT) for metastatic epidural spinal cord compression (MESCC). This single-arm institutional prospective observational study recruited patients between June 2017 and March 2020 and included those with symptoms of spinal cord compression owing to metastases, who were diagnosed using MRI. Patients with radiation-sensitive primary tumors and those who could not tolerate surgery were excluded. The treatment protocol comprised decompression surgery and electron beam IORT of 20 Gy in a single fraction followed by EBRT of 30 Gy in 10 fractions. The primary endpoints included the 1-year local failure rate and ambulatory functions. The study was closed in May 2019 owing to changes in treatment policies at our institution. Twenty patients were registered between June 2017 and May 2019. Although all patients completed surgery and IORT, 2 did not receive postoperative EBRT. Patients most commonly had colorectal cancer (4 patients), followed by thyroid cancer, renal cell carcinoma, lung cancer, breast cancer, sarcomas, and other cancers (3, 3, 2, 2, 2, and 4 patients, respectively). The median follow-up duration was 16 months (range 2-30 months); the 1-year local failure rate was 16%. On comparing ambulatory functions pre-treatment and at 1 year after treatment, improvement, no change, and worsening were observed in 3, 9, and 0 patients, respectively. This study's findings suggest that decompression surgery and IORT followed by EBRT are effective in achieving local control and maintaining ambulation in patients with MESCC.
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Takahashi M, Ohtani S, Nagai SE, Takashima S, Yamaguchi M, Tsuneizumi M, Komoike Y, Osako T, Ito Y, Ikeda M, Ishida K, Nakayama T, Takashima T, Asakawa T, Matsumoto S, Shimizu D, Masuda N. The efficacy and safety of pertuzumab plus trastuzumab and docetaxel as a first-line therapy in Japanese patients with inoperable or recurrent HER2-positive breast cancer: the COMACHI study. Breast Cancer Res Treat 2021; 185:125-134. [PMID: 32920732 PMCID: PMC7843485 DOI: 10.1007/s10549-020-05921-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE In the CLEOPATRA study of patients with human epidermal growth factor receptor 2 (HER2)-positive recurrent or metastatic breast cancer, the Japanese patient subgroup did not demonstrate the improved progression-free survival (PFS) of pertuzumab plus trastuzumab and docetaxel vs. placebo that was seen in the overall population. Therefore, COMACHI was conducted to confirm the efficacy and safety of this treatment regimen in this patient subgroup. METHODS This was a phase IV study of pertuzumab plus trastuzumab and docetaxel in Japanese patients with histologically/cytologically confirmed inoperable or recurrent HER2-positive breast cancer. All patients received pertuzumab, trastuzumab, and docetaxel intravenously every 3 weeks until disease progression/unacceptable toxicity. The primary endpoint was investigator-assessed PFS. Secondary endpoints were overall survival (OS), investigator-assessed objective response rate, and duration of response (DoR). Safety was also assessed. RESULTS At final analysis, median investigator-assessed PFS was 22.8 months (95% CI 16.9-37.5). From first dose, OS rate at 1 year was 97.7%; and at 2 and 3 years were 88.5% and 79.1%, respectively. Of the 118 patients with measurable disease at baseline, response rate was 83.9% (95% CI 77.3-90.5) and median investigator-assessed DoR was 26.3 months (95% CI 17.1-not evaluable). Treatment was well tolerated, with no new safety signals detected. CONCLUSIONS Our results suggest similar efficacy and safety for pertuzumab plus trastuzumab and docetaxel in Japanese patients compared with the overall population of CLEOPATRA, providing further support for this combination therapy as standard of care for Japanese patients with inoperable or recurrent HER2-positive breast cancer.
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Affiliation(s)
- Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Shoichiro Ohtani
- Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Seiki Takashima
- Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Miki Yamaguchi
- Breast Surgery, JCHO Kurume General Hospital, 21 Kushihara-machi Kurume, Fukuoka, Japan
| | | | | | - Tomofumi Osako
- Breast Center, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Yoshinori Ito
- Breast Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Masahiko Ikeda
- Breast and Thyroid Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Kazushige Ishida
- Surgery, Iwate Medical University, 2-1-1, Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695 Japan
| | - Takahiro Nakayama
- Breast and Endocrine Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567 Japan
| | - Tsutomu Takashima
- Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 5458585 Japan
| | - Takashi Asakawa
- Clinical Information and Intelligence Department, Chugai Pharmaceutical Co., Ltd, 1-1 Nihonbashi-Muromachi 2-Chome, Chuo-ku, Tokyo, 103-8324 Japan
| | - Sho Matsumoto
- Clinical Study Management Department, Chugai Pharmaceutical Co., Ltd, 1-1 Nihonbashi-Muromachi 2-Chome, Chuo-ku, Tokyo, 103-8324 Japan
| | - Daisuke Shimizu
- Clinical Science and Strategy Department, Chugai Pharmaceutical Co., Ltd, 1-1 Nihonbashi-Muromachi 2-Chome, Chuo-ku, Tokyo, 103-8324 Japan
| | - Norikazu Masuda
- Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Gabardo M, Zielak J, Tórtora G, Gerber J, Meger M, Rebellato N, Küchler E, Scariot R. Impact of orthognathic surgery on quality of life: Predisposing clinical and genetic factors. J Craniomaxillofac Surg 2019; 47:1285-1291. [PMID: 31331851 DOI: 10.1016/j.jcms.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Dentofacial deformities have an impact on quality of life (QOL). Many factors can influence this perception, including genetic aspects. ANKK1 and DRD2 genes are associated with dopaminergic system and could modulate behavioral dysfunction. PURPOSE The impact of orthognathic surgery and associated factors on QOL of adults was evaluated. MATERIAL AND METHODS The abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was applied to patients from two surgery services one week before (T0) and six months after surgery (T1). The independent variables were age, sex, race, facial pattern, presence of jaw asymmetry and vertical deformities, and polymorphisms associated with ANKK1 and DRD2 genes. Descriptive and bivariate analyses were performed. RESULTS There was improvement in the perception of QOL from T0 to T1 in the general score, in the physical and psychological domains, and in the quality of life and general health perception (QOLGHP) (p < 0.001). In this interval, individuals aged ≥30 years reported positive impacts on all outcomes (p < 0.05), whereas in women this improvement did not occur only for the physical domain (p = 0.136). There was an association between the polymorphisms associated with the ANKK1 gene (rs1800497) and the perception of QOL in the social relationship's domain (p = 0.021) and QOLGHP (p = 0.042). The other clinical conditions were not associated with outcomes (p > 0.05). CONCLUSION Perception of QOL of patients improved following orthognathic surgery in physical, psychological, and QOLGHP domains. Aged ≥30 years, being women and polymorphisms associated with the ANKK1 gene were related to positive impacts.
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Affiliation(s)
- Marilisa Gabardo
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
| | - João Zielak
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil.
| | - Gabriela Tórtora
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Jennifer Gerber
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Michelle Meger
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Nelson Rebellato
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, Avenida Prefeito Lothário Meissner 632, Curitiba, Paraná 80210-170, Brazil
| | - Erika Küchler
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Rafaela Scariot
- School of Health Sciences, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza 5300, Curitiba, Paraná, 81280-330, Brazil
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Kirzioğlu Z, Çiftçi ZZ, Yetiş CÇ. Clinical Success of Fiber-reinforced Composite Resin as a Space Maintainer. J Contemp Dent Pract 2017; 18:188-193. [PMID: 28258262] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The early loss of deciduous molars is a frequently encountered problem in dentistry. Various space maintainer designs were developed to prevent the loss of the space. The aim of this study was to evaluate long-term clinical performance and survival rates of fiber-reinforced composite resin (FRCR) as a space maintainer clinically. MATERIALS AND METHODS This study was designed on 44 children who had early missed deciduous molars. Space maintainers were prepared on plaster models of patients and fixed directly to the adjacent teeth. Survival rate and whether it causes any damage to adjacent teeth were examined clinically and radio-graphically for 24 months or until failure. Kaplan-Meier survival analysis was used for the statistical analyses. RESULTS Overall, 16.2% of space maintainers were dislodged and accepted to be failed at the end of 12 months. At the 24-month control, 52.2% success was stated with the FRCR space maintainer and because of permanent tooth eruption, 31.8% of space maintainer were taken out. The mean duration of space maintainers was measured to be 14.8 ± 3.48 months. There was no statistical significance between survival time and gender, tooth number, localization, and measured space (p > 0.05). CONCLUSION After all 24 months follow-up, as well as esthetic properties of FRCR space maintainer, their applicability in a single seance and strength against the forces are determined as the advantages of the technique. CLINICAL SIGNIFICANCE The FRCR space maintainers can be thought of as alternatives to metal space maintainers.
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Affiliation(s)
- Zuhal Kirzioğlu
- Department of Pediatric Dentistry, Faculty of Dentistry Suleyman Demirel University, Isparta, Turkey
| | - Z Zahit Çiftçi
- Department of Pediatric Dentistry, Faculty of Dentistry, Akdeniz University, Antalya, Turkey, Phone: +902422274400, e-mail:
| | - Ceylan Ç Yetiş
- Department of Pediatric Dentistry, Faculty of Dentistry Suleyman Demirel University, Isparta, Turkey
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Zhu M, Wijeyakumar W, Syed AR, Joachim N, Hong T, Broadhead GK, Li H, Luo K, Chang A. Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2016; 255:475-484. [PMID: 27572301 DOI: 10.1007/s00417-016-3477-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess changes in vision-related quality of life (VR-QoL) among patients with treatment-resistant neovascular age-related macular degeneration (nAMD) following intravitreal aflibercept treatment over 48 weeks. METHODS We conducted a prospective study in which 49 patients with nAMD resistant to anti-vascular endothelial growth factor therapy were switched to intravitreal aflibercept. Patients were treated with three loading doses every 4 weeks followed by injections every 8 weeks, for a total of 48 weeks. Ophthalmic examinations performed at each visit included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurement. The National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess VR-QoL at baseline and weeks 24 and 48. Changes in NEI VFQ-25 composite and subscale scores were analyzed using paired t tests. The relationship between the change in VR-QoL and changes in BCVA and CMT, and the impact of the better-seeing eye (BSE, defined as the eye reading the greater number of letters at baseline) vs. the worse-seeing eye (WSE, the fellow eye to the BSE) were assessed. RESULTS Mean NEI VFQ-25 composite scores improved significantly at weeks 24 and 48 compared to baseline (4.5 ± 9.2 and 4.4 ± 11.8, respectively, all p < 0.01). Among subscales, general vision and near and distance activities showed significant improvements at weeks 24 and 48 (all p < 0.05). Improvement in the NEI VFQ-25 composite score was significantly associated with increased BCVA at week 48 (β coefficient = 0.43, p = 0.029), but not with change in CMT (β coefficient = -0.007, p = 0.631). There was no association between VR-QoL changes and BSE or WSE. CONCLUSION Despite previous anti-VEGF treatment in this cohort, overall VR-QoL improved following aflibercept therapy over 48 weeks. This improvement was related to improved vision in treatment eyes regardless of whether they were the BSE or WSE.
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Affiliation(s)
- Meidong Zhu
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Wijeyanthy Wijeyakumar
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Adil R Syed
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Nichole Joachim
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Thomas Hong
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Geoffrey K Broadhead
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Haitao Li
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Kehui Luo
- Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Andrew Chang
- Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.
- Sydney Institute of Vision Science, Sydney, Australia.
- Save Sight Institute, The University of Sydney, Sydney, Australia.
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Rutherford T, Orr J, Grendys E, Edwards R, Krivak TC, Holloway R, Moore RG, Puls L, Tillmanns T, Schink JC, Brower SL, Tian C, Herzog TJ. A prospective study evaluating the clinical relevance of a chemoresponse assay for treatment of patients with persistent or recurrent ovarian cancer. Gynecol Oncol 2013; 131:362-7. [PMID: 23954900 DOI: 10.1016/j.ygyno.2013.08.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/31/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Use of in vitro chemoresponse assays for informing effective treatment selection is a compelling clinical question and a topic of debate among oncologists. A prospective study was conducted evaluating the use of a chemoresponse assay in recurrent ovarian cancer patients. METHODS Women with persistent or recurrent ovarian cancer were enrolled under an IRB-approved protocol, and fresh tissue samples were collected for chemoresponse testing. Patients were treated with one of 15 protocol-designated treatments empirically selected by the oncologist, blinded to the assay results. Each treatment was classified by the assay as: sensitive (S), intermediate (I), or resistant (R). Patients were prospectively monitored for progression-free survival (PFS) and overall survival (OS). Associations of assay response for the physician-selected treatment with PFS and OS were analyzed. RESULTS A total of 262 evaluable patients were enrolled. Patients treated with an assay-sensitive regimen demonstrated significantly improved PFS and OS while there was no difference in clinical outcomes between I and R groups. Median PFS was 8.8 months for S vs. 5.9 months for I+R (hazard ratio [HR]=0.67, p=0.009). The association with assay response was consistent in both platinum-sensitive and platinum-resistant tumors (HR: 0.71 vs. 0.66) and was independent of other covariates in multivariate analysis (HR=0.66, p=0.020). A statistically significant14-month improvement in mean OS (37.5 months for S vs. 23.9 months for I+R, HR=0.61, p=0.010) was demonstrated. CONCLUSIONS This prospective study demonstrated improved PFS and OS for patients with either platinum-sensitive or platinum-resistant recurrent ovarian cancer treated with assay-sensitive agents.
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Pimenta L, Springmuller R, Lee CK, Oliveira L, Roth SE, Ogilvie WF. Clinical performance of an elastomeric lumbar disc replacement: Minimum 12 months follow-up. SAS J 2010; 4:16-25. [PMID: 25802645 DOI: 10.1016/j.esas.2009.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Elastomeric disc replacements have been developed to restore normal shock absorption and physiologic centers of rotation to the degenerated disc. The Physio-L Artificial Lumbar Disc is an elastomeric disc which uses a compliant polycarbonate-polyurethane core with enhanced endurance properties. The objective of this study was to evaluate the safety and efficacy of the Physio-L through a 12-month follow-up period in a prospective, nonrandomized clinical trial. Methods Twelve patients who met the inclusion/exclusion criteria were enrolled in the study. Eight patients received a single implant (L5-S1) and 4 received a 2-level implantation (L4-5 and L5-S1). Patients were assessed preoperatively and postoperatively at 6 weeks and 3, 6, and 12 months. Primary outcomes included the VAS, ODI, a radiographic analysis of implant condition, incidence of major complications, and reoperations. Secondary outcomes included SF-36, ROM at index and adjacent levels and disc height. Results All patients completed the 12-month follow-up evaluations. Through 12 months, the Physio-L devices have remained intact with no evidence of subsidence, migration, or expulsion. VAS low-back pain and ODI scores improved significantly at all follow-up periods compared to preoperative scores. The range of motion of 13.3° ± 5.5° at the index level was considered normal. Overall, patients were satisfied with an average score of 83.5 ± 26.8 mm. When comparing the device to other artificial discs, the current device showed a clinically relevant improvement in both ODI and VAS scores at all follow-up time points. Statistically significant improvements in both scores were observed at 12 months (P < .05). Conclusion The Physio-L is safe and efficacious, as demonstrated by improved pain relief and functional recovery without any implant failures, significant device related complications, or adverse incidents. The clinical results for VAS and ODI were superior to other marketed artificial lumbar discs such as the Charité and ProDisc-L at the same follow-up timeframes.
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