1
|
Wang H, Yang J, Lee A, Phan J, Lim TY, Fuller CD, Han EY, Rhee DJ, Salzillo T, Zhao Y, Chopra N, Pham M, Castillo P, Sobremonte A, Moreno AC, Reddy JP, Rosenthal D, Garden AS, Wang X. MR-guided stereotactic radiation therapy for head and neck cancers. Clin Transl Radiat Oncol 2024; 46:100760. [PMID: 38510980 PMCID: PMC10950743 DOI: 10.1016/j.ctro.2024.100760] [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: 08/31/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT. Method Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were re-planned in the Monaco treatment planning system for Elekta Unity MR-Linac (MRL). The plan qualities, including target coverage, conformity, homogeneity, nearby critical organ doses, gradient index and low dose bath volume, were compared between VMAT and Monaco IMRT plans. Additionally, we evaluated the Unity adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) workflows using simulated setup errors for five patients and assessed the outcomes of our treated patients. Results Monaco IMRT plans achieved comparable results to VMAT plans in terms of target coverage, uniformity and homogeneity, with slightly higher target maximum and mean doses. The critical organ doses in Monaco IMRT plans all met clinical goals; however, the mean doses and low dose bath volumes were higher than in VMAT plans. The adaptive plans demonstrated that the ATP workflow may result in degraded target coverage and OAR doses for HN SBRT, while the ATS workflow can maintain the plan quality. Conclusion The use of Monaco treatment planning and online adaptation can achieve dosimetric results comparable to VMAT plans, with the additional benefits of real-time tracking of target volume and nearby critical structures. This offers the potential to treat aggressive and variable tumors in HN SBRT and improve local control and treatment toxicity.
Collapse
Affiliation(s)
- He Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Tze Yee Lim
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Eun Young Han
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Dong Joo Rhee
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Salzillo
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Zhao
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Nitish Chopra
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Pham
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Pam Castillo
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Sobremonte
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P. Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David Rosenthal
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
2
|
Heitkamp H, Heußner D, Rosenberger DC, Schnabel K, Rosenthal D, Bigalke S, Maeßen TV, Hohenschurz-Schmidt D, Liedgens H, Kaiser U, Pogatzki-Zahn EM. Systematic reviews and quality assessment of patient-reported outcome measures for physical function in comparative effectiveness studies regarding acute postoperative pain after total knee arthroplasty-Do we need to start all over again? Eur J Pain 2024. [PMID: 38623029 DOI: 10.1002/ejp.2272] [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] [Received: 08/17/2023] [Revised: 02/29/2024] [Accepted: 03/24/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND OBJECTIVE Recently, a consensus process specified a core outcome set (COS) of domains to be assessed in each comparative effectiveness research and clinical practice related to acute postoperative pain. Physical function (PF) was one of these domains. The aim of this review was to investigate which patient-reported outcome measures (PROMs) are used to assess PF after total knee arthroplasty (TKA) in clinical trials and if they fulfil basic requirements for a COS of PROMs based on their psychometric properties. METHODS A systematic review of randomized controlled trials and observational studies based on a search in MEDLINE, EMBASE and CENTRAL was undertaken. PROMs and performance measures were extracted and investigated, including evaluation of psychometric properties of PROMs based on COSMIN recommendations. RESULTS From initially 2896 identified records, 479 studies were included in the qualitative synthesis. Only 87 of these trials (18%) assessed PF using PROMs, whereas especially performance outcome measures were used in 470 studies (98%). Application of the 'COSMIN Risk-of-Bias-Box 1' to 13 of the 14 identified PROMs resulted in insufficient content validity of the included PROMs regarding the target population based on the inauguration or development articles. CONCLUSION Our data indicate that a patient-centred postoperative assessment of PF in pain-related clinical trials early after TKA is not common, even though patient-reported assessment is widely recommended. In addition, none of the applied PROMs shows content validity based on their inauguration or development articles for the assessment of postoperative pain-related PF after TKA. SIGNIFICANCE A systematic search for patient-reported outcome measures assessing postoperative, pain-related physical function after total knee arthroplasty in clinical trials and assessment of their content validity revealed none that fulfilled requirements based on COSMIN recommendations.
Collapse
Affiliation(s)
- H Heitkamp
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - D Heußner
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - D C Rosenberger
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - K Schnabel
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - D Rosenthal
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - S Bigalke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - T V Maeßen
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - D Hohenschurz-Schmidt
- Pain Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | | | - U Kaiser
- Clinic for Anaesthesiology and Intensive Care Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - E M Pogatzki-Zahn
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| |
Collapse
|
3
|
Abbas M, Nasar Z, Rosenthal D, Butts H, Fullilove R, Derose D, Moreau P, Ngyuen H, Law M. Addressing Food Insecurity Through Community Empowerment in a Staten Island (Richmond County) Neighborhood in New York City. J Community Health 2024:10.1007/s10900-024-01329-6. [PMID: 38466488 DOI: 10.1007/s10900-024-01329-6] [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] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
This study investigated community empowerment as a means of addressing food insecurity amongst underserved neighborhoods by increasing available and affordable food choices through Clementine Collective stands in Staten Island, New York (Richmond County), one of the 5 Boroughs of New York City. Given the growing complexity of food insecurity, inclusive and equitable action must be taken that incorporates the voices, perspectives and needs of those most impacted. Through methods of community engagement and empowerment, the Clementine Collective collaborates with local community residents to introduce sustainable solutions that address food insecurity. A survey (N = 132) was administered to customers of a Clementine Collective stand, located in Staten Island, that assessed customers' food habits and attitudes towards their food environment and solutions. The stand was placed in a local meat market grocery store. Descriptive statistics suggested that residents recognized gaps in their food environment and were empowered to advocate for solutions. Engaging residents from their food environment to advocate for local solutions, such as at community bodegas, or small grocery stores, may be an effective method of addressing food insecurity.
Collapse
Affiliation(s)
- Miral Abbas
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - Zainab Nasar
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - David Rosenthal
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - Heather Butts
- Columbia University Mailman School of Public Health, Columbia University, New York, USA.
| | - Robert Fullilove
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - Daphne Derose
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - Patrick Moreau
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
- Community Health Worker, Staten Island University Hospital, Staten Island, USA
| | - Hedda Ngyuen
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| | - Monica Law
- Columbia University Mailman School of Public Health, Columbia University, New York, USA
| |
Collapse
|
4
|
Nealon KA, Han EY, Kry SF, Nguyen C, Pham M, Reed VK, Rosenthal D, Simiele S, Court LE. Monitoring Variations in the Use of Automated Contouring Software. Pract Radiat Oncol 2024; 14:e75-e85. [PMID: 37797883 DOI: 10.1016/j.prro.2023.09.004] [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: 05/31/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Our purpose was to identify variations in the clinical use of automatically generated contours that could be attributed to software error, off-label use, or automation bias. METHODS AND MATERIALS For 500 head and neck patients who were contoured by an in-house automated contouring system, Dice similarity coefficient and added path length were calculated between the contours generated by the automated system and the final contours after editing for clinical use. Statistical process control was used and control charts were generated with control limits at 3 standard deviations. Contours that exceeded the thresholds were investigated to determine the cause. Moving mean control plots were then generated to identify dosimetrists who were editing less over time, which could be indicative of automation bias. RESULTS Major contouring edits were flagged for: 1.0% brain, 3.1% brain stem, 3.5% left cochlea, 2.9% right cochlea, 4.8% esophagus, 4.1% left eye, 4.0% right eye, 2.2% left lens, 4.9% right lens, 2.5% mandible, 11% left optic nerve, 6.1% right optic nerve, 3.8% left parotid, 5.9% right parotid, and 3.0% of spinal cord contours. Identified causes of editing included unexpected patient positioning, deviation from standard clinical practice, and disagreement between dosimetrist preference and automated contouring style. A statistically significant (P < .05) difference was identified between the contour editing practice of dosimetrists, with 1 dosimetrist editing more across all organs at risk. Eighteen percent (27/150) of moving mean control plots created for 5 dosimetrists indicated the amount of contour editing was decreasing over time, possibly corresponding to automation bias. CONCLUSIONS The developed system was used to detect statistically significant edits caused by software error, unexpected clinical use, and automation bias. The increased ability to detect systematic errors that occur when editing automatically generated contours will improve the safety of the automatic treatment planning workflow.
Collapse
Affiliation(s)
- Kelly A Nealon
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Eun Young Han
- Department of Radiation Physics - Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen F Kry
- Radiation Physics Outreach, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Callistus Nguyen
- Department of Radiation Physics - Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Pham
- Department of Radiation Physics - Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie K Reed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Simiele
- Department of Radiation Physics - Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics - Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
5
|
Ashfaq A, Lorts A, Rosenthal D, Adachi I, Rossano J, Davies R, Simpson KE, Maeda K, Wisotzkey B, Koehl D, Cantor RS, Jacobs JP, Peng D, Kirklin JK, Morales DLS. Survival in Pediatric Patients With Ventricular Assist Devices: A Special Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report. Ann Thorac Surg 2023; 116:972-979. [PMID: 37573991 DOI: 10.1016/j.athoracsur.2023.07.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) provides detailed understanding on pediatric patients supported with ventricular assist devices (VADs). We sought to identify important variables affecting mortality in pediatric VADs. METHODS Patients aged <19 years, from 2012 to 2021, were included. Survival analyses were performed using Kaplan-Meier. Parametric hazard modeling was used to identify risk factors for death. RESULTS Of the 1109 patients, the most common devices were implantable continuous (IC, 448 [40%]), followed by paracorporeal pulsatile (PP, 306 [28%]), paracorporeal continuous (PC, 293 [26%]), and percutaneous (58 [5%]). Patients with percutaneous device, infants, congenital heart disease, biventricular support, and Interagency Registry for Mechanically Assisted Circulatory Support profile 1 had worse overall survival at 6 months. Positive outcome was 83% at 6 months. Consistent with their cohort composition, device type positive outcomes at 6 months were IC, 92%; PP, 84%; and PC, 69%. Parametric hazard modeling for overall survival showed an early hazard for death with biventricular support, congenital heart disease (CHD), intubation before implantation, PC device, and renal impairment, whereas a constant hazard was associated with ascites. For patients <10 kg, parametric modeling showed an early hazard for CHD, intubation, and renal impairment. Modeling in CHD patients showed an early hazard for biventricular support, renal impairment, and use of PC/PP devices. CONCLUSIONS This multivariable analysis of the complete Pedimacs database demonstrates that illness at VAD implantation, diagnosis, and strategy of support affect survival and differ by device type. We hope this is the first step in creating a predictive tool to help providers and families have informed expectations.
Collapse
Affiliation(s)
- Awais Ashfaq
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Angela Lorts
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Rosenthal
- Department of Pediatric Cardiology, Lucile Salter Packard Children's Hospital, Palo Alto, California
| | - Iki Adachi
- Department of Pediatric Cardiac Surgery, Texas Children's Hospital, Houston, Texas
| | - Joseph Rossano
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ryan Davies
- Department of Pediatric Cardiac Surgery, UT Southwestern, Dallas, Texas
| | - Kathleen E Simpson
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora, Colorado
| | - Katsuhide Maeda
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bethany Wisotzkey
- Department of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - David Peng
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - David L S Morales
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|
6
|
Kaufman BD, Garcia A, He Z, Tesi-Rocha C, Buu M, Rosenthal D, Gordish-Dressman H, Almond CS, Duong T. Major Adverse Dystrophinopathy Events (MADE) Score as Marker of Cumulative Morbidity and Risk for Mortality in Boys with Duchenne Muscular Dystrophy. Prog Pediatr Cardiol 2023; 69:101639. [PMID: 37990740 PMCID: PMC10659574 DOI: 10.1016/j.ppedcard.2023.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background Overlapping symptoms from cardiomyopathy, respiratory insufficiency, and skeletal myopathy confound assessment of heart failure in Duchenne Muscular Dystrophy. We developed an ordinal scale of multiorgan clinical variables that reflect cumulative disease burden-the Major Adverse Dystrophinopathy Event (MADE) Score. We hypothesized that a higher MADE score would be associated with increased mortality in boys with Duchenne Muscular Dystrophy. The Cooperative International Neuromuscular Research Group Duchenne Natural History Study dataset was utilized for validation. Methods Duchenne Natural History Study variables were selected based on clinical relevance to prespecified domains: Cardiac, Pulmonary, Myopathy, Nutrition. Severity points (0-4) were assigned and summed for study visits. MADE score for cohorts defined by age, ambulatory status, and survival were compared at enrollment and longitudinally.Associations between MADE score and mortality were examined. Results Duchenne Natural History Study enrolled 440 males, 12.6 ±6.1 years old, with 3,559 visits over 4.6 ±2.8 years, 45 deaths. MADE score increased with age and nonambulatory status. Mean MADE score per visit was 19 ±10 for those who died vs. 9.8 ±9.3 in survivors p=0.03. Baseline MADE score >12 predicted mortality independent of age (78% sensitivity, CPE.70). Rising MADE score trajectory was associated with mortality in models adjusted for enrollment age, follow-up time, and ambulatory status, all p<.001. Conclusion A multiorgan severity score, MADE, was developed to track cumulative morbidities that impact heart failure in Duchenne muscular dystrophy. MADE score predicted Duchenne Natural History Study mortality. MADE score can be used for serial heart failure assessment in males and may serve as an endpoint for Duchenne muscular dystrophy clinical research.
Collapse
Affiliation(s)
- Beth D Kaufman
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Stanford University, Palo Alto, CA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Carolina Tesi-Rocha
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - MyMy Buu
- Department of Pediatrics (Pulmonary Medicine), Stanford University School of Medicine, Palo Alto, CA
| | - David Rosenthal
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA
| | | | - Christopher S Almond
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA
| | - Tina Duong
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
7
|
Profita E, Lee E, Ma M, Martin E, Hollander S, Rosenthal D, Almond C, Nasirov T. Use of the SherpaPak Cardiac Transport System for Infant and Pediatric Donor Hearts: An Initial Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1701] [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: 04/05/2023] Open
|
8
|
Rivera DT, Martin E, Ma M, Hollander S, Bensen R, Ebel N, Zhang K, Bonham A, Gallo A, Esquivel C, Navaratnam M, Rosenthal D, Chen S. The Intra-Operative “Gross Pathology”: An Approach to Determining Heart-Only Versus Heart-Liver Transplantation in Fontan Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.483] [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: 04/05/2023] Open
|
9
|
Niebler R, Lorts A, O'Connor M, Shezad M, Rosenthal D. Impact of Heartware Vad Discontinuation on the Pediatric Population-An Advanced Heart Failure Improving Outcomes (ACTION) Registry Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1693] [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: 04/05/2023] Open
|
10
|
Rangu S, Murray J, Shiu A, Martin E, Nasirov T, Bruzoni M, Chen S, Rosenthal D, Ma M, Dykes J. Colocutaneous Fistula Following Pediatric Bivad Implantation, A Rare but Serious Complication. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1246] [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: 04/05/2023] Open
|
11
|
So B, Lee J, Kidambi S, Dykes J, Rosenthal D, Ma M. Evaluating the Impact of Donor-Recipient Race Mismatch on Graft Survival in Infant Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.894] [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: 04/05/2023] Open
|
12
|
Chan E, Jacobs N, Lee J, Kidambi S, Zawadzki R, Kim E, Dykes J, Rosenthal D, Ma M. Racial Disparities in Pediatric Heart Transplantation: A National Registry Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.079] [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: 04/05/2023] Open
|
13
|
Ramirez CB, Shezad M, VanderPluym C, Bleiweis M, Tunuguntla H, Joong A, Rosenthal D, Lorts A, Auerbach S, Adachi I, Davies R, O'Connor M. Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Outcomes Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.025] [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: 04/05/2023] Open
|
14
|
Hollander SA, Wujcik K, Schmidt J, Liu E, Lin A, Dykes J, Good J, Brown M, Rosenthal D. Home Milrinone in Pediatric Hospice Care of Children with Heart Failure. J Pain Symptom Manage 2023; 65:216-221. [PMID: 36417945 DOI: 10.1016/j.jpainsymman.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT The symptom profile of children dying from cardiac disease, especially heart failure, differs from those with cancer and other non-cardiac conditions. Treatment with vasoactive infusions at home may be a superior therapy for symptom control for these patients, rather than traditional pain and anxiety management with morphine and benzodiazepines. OBJECTIVES We report our experience using outpatient milrinone in children receiving hospice care for end-stage heart failure. METHODS Retrospective review of a contemporary cohort of all patients at Lucile Packard Children's Hospital, Stanford who were discharged on intravenous milrinone and hospice care between 2008 and 2021. Clinical data, including cardiac diagnosis, milrinone dose and route of administration, total milrinone days, symptoms reported, rehospitalization rates, concurrent therapies and complications were analyzed. RESULTS Among 8 patients, median duration of home milrinone infusion was 191 (33, 572) days with the longest support duration 1,054 days. All (100%) patients were also receiving diuretics at the time of death. Five (63%) were receiving no other pain control medications until the active phase of dying. From milrinone initiation to last outpatient assessment, a reduction in the number of patients reporting respiratory discomfort, abdominal pain, weight loss/lack of appetite, and fatigue was observed. Six (75%) died at home. CONCLUSION We used milrinone with oral diuretics effectively for symptom control in children with heart failure on palliative care. Our experience was that this combination can be used safely in the outpatient setting for long-term use without the addition of opiates, benzodiazepines, or supplemental oxygen in most cases.
Collapse
Affiliation(s)
- Seth A Hollander
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA.
| | - Kari Wujcik
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - Julie Schmidt
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - Esther Liu
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - Aileen Lin
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - John Dykes
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - Julie Good
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - Michelle Brown
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| | - David Rosenthal
- Department of Pediatrics (Cardiology) (S.A.H., J.D., D.R.), Stanford University, Palo Alto, California, USA; Solid Organ Transplant Services (K.W., J.S.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pediatric Pulmonary Hypertension Service (E.L.), Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA; Pulmonary Hypertension Service (A.L.), Stanford University, Palo Alto, California, USA; Department of Anesthesiology (J.G.), Perioperative and Pain Medicine (and by courtesy, Pediatrics), Stanford University, Palo Alto, California, USA; Departments of Psychiatry & Palliative Care (M.B.), Stanford University/, Palo Alto, California, USA
| |
Collapse
|
15
|
Ahmed H, Lee J, Bernstein D, Rosenthal D, Dykes J, Lee D, Barkoff L, Weinberg K, Hollander SA, Chen S. Increased risk of infections in pediatric Fontan patients after heart transplantation. Pediatr Transplant 2023; 27:e14421. [PMID: 36303275 DOI: 10.1111/petr.14421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infectious complications are a major cause of morbidity and mortality after HT. Fontan patients may be more susceptible to post-HT infections. METHODS This was a single-center, retrospective cohort analysis of pediatric patients undergoing HT for FF physiology or DCM, who underwent induction with ATG. The primary endpoint was an infection in the first 180 days post-HT, defined as positive (1) blood/urine/respiratory culture; (2) viral PCR; (3) skin or wound infection; and/or (4) culture-negative infection if ≥5 days of antibiotics were completed. Secondary endpoints included (1) cell counts after ATG; (2) PTLD; and (3) rejection (≥Grade 2R ACR or pAMR2) in the first 180 days post-HT. RESULTS A total of 59 patients (26 FF, 33 DCM) underwent HT at 14.7 (IQR 10.6, 19.5) and 11.7 (IQR 1.4, 13.6) years of age, respectively. The median total ATG received was 7.4 (IQR 4.9, 7.7) vs 7.5 (IQR 7.3, 7.6) mg/kg (p = NS) for FF and DCM patients, respectively. Twenty-three patients (39%) developed an infection 180 days post-HT, with a higher rate of infection in FF patients (54% vs 27%, p = .03). Adjusted for pre-transplant absolute lymphocyte count, FF patients had a higher risk of infection at 30 days post-HT (OR 7.62, 95% CI 1.13-51.48, p = .04). There was no difference in the incidence of PTLD (12% vs 0%; p = .08) or rejection (12% vs 21%; p = .49). CONCLUSION Compared to DCM patients, FF patients have a higher risk of infection. Modifications to induction therapy for FF patients should be considered.
Collapse
Affiliation(s)
- Humera Ahmed
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Joanne Lee
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Daniel Bernstein
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Rosenthal
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Dykes
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Lee
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lynsey Barkoff
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kenneth Weinberg
- Division of Hematology-Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Seth A Hollander
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
16
|
Tsai J, Havlik J, Howell BA, Johnson E, Rosenthal D. Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model. J Gen Intern Med 2023; 38:765-783. [PMID: 36443628 PMCID: PMC9971390 DOI: 10.1007/s11606-022-07970-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.
Collapse
Affiliation(s)
- Jack Tsai
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA.
- University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John Havlik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin A Howell
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Erin Johnson
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA
| | - David Rosenthal
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- 4Catalyzer Inc., CT, Guilford, USA
| |
Collapse
|
17
|
Odegaard B, Lee A, Sans A, Lee I, Ng L, Haun A, Chesney D, Rosenthal D, Fallon F. Detecting changes in visual scenes during saccades: Replicating and extending John Grimes's experiments. J Vis 2022. [DOI: 10.1167/jov.22.14.4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
18
|
Bearl DW, Jeewa A, Auerbach SR, Azeka E, Phelps C, Sacks LD, Rosenthal D, Conway J. Clinical approach to mechanical circulatory support in the transplant patient from the Pediatric Heart Transplant Society. Pediatr Transplant 2022; 26:e14391. [PMID: 36377328 DOI: 10.1111/petr.14391] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
The use of mechanical circulatory support (MCS) for pediatric patients who have undergone heart transplant has grown rapidly in the past decade. This includes support in the immediate post-transplant period and "rescue" therapy for patient later in their transplant course. Extracorporeal membrane oxygenation (ECMO) remains a standard modality of support for intraoperative concerns and for acute decompensation in the immediate post-transplant period. However, both pulsatile and continuous flow ventricular assist devices (VADs) have been used with increasing success in transplant patients for longer durations of support. Centers participating in the Pediatric Heart Transplant Society (PHTS) were queried to provide their internal protocols and rationale for mechanical circulatory support following heart transplant. These protocols coupled with evidence-based literature were used to provide the following description of clinical approaches to MCS in the transplant patient highlighting areas of both broad consensus and significant practice variation.
Collapse
Affiliation(s)
- David W Bearl
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA
| | - Aamir Jeewa
- Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Scott R Auerbach
- Pediatrics, Division of Cardiology, Denver Anschutz Medical Campus, Children's Hospital Colorado Aurora, University of Colorado, Aurora, Colorado, USA
| | - Estela Azeka
- Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Christina Phelps
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Loren D Sacks
- Pediatric Cardiology, Stanford Univeristy School of Medicine, Palo Alto, California, USA
| | - David Rosenthal
- Pediatric Cardiology, Stanford Univeristy School of Medicine, Palo Alto, California, USA
| | - Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
19
|
Crawford TC, Kron J, Gu X, Afzal MR, Chicos AB, Roukoz H, Zimetbaum PJ, Murgatroyd FD, Martin K, Torosoff M, Steckman DA, Platonov PG, Bhan AK, Rosenfeld LE, De Lurgio DB, Garlitski AC, Vedantham V, Soejima K, Appelbaum J, Dickfeld TM, Ortman ML, Kaitani K, Nishiuchi S, Narasimhan C, Patton KK, Rosenthal D, Nour K, Mukerji SS, Zeppenfeld K, Zipse MM, Judson M, Judson M, Sauer WH, Ellenbogen KA, Froehlich J, Eagle KA, Bogun FM. CE-522-04 MORTALITY AND MORBIDITY OF CARDIAC SARCOIDOSIS: AN INTERNATIONAL REGISTRY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
20
|
Oh B, Boyle F, Pavlakis N, Clarke S, Guminski A, Eade T, Lamoury G, Carroll S, Morgia M, Kneebone A, Hruby G, Stevens M, Liu W, Corless B, Molloy M, Libermann T, Rosenthal D, Back M. Emerging Evidence of the Gut Microbiome in Chemotherapy: A Clinical Review. Front Oncol 2021; 11:706331. [PMID: 34604043 PMCID: PMC8481611 DOI: 10.3389/fonc.2021.706331] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/25/2021] [Indexed: 01/28/2023] Open
Abstract
Increasing evidence suggests that the gut microbiome is associated with both cancer chemotherapy (CTX) outcomes and adverse events (AEs). This review examines the relationship between the gut microbiome and CTX as well as the impact of CTX on the gut microbiome. A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for "cancer" and "chemotherapy" and "microbiome/microbiota". The relevant literature was selected for use in this article. Seventeen studies were selected on participants with colorectal cancer (CRC; n=5), Acute Myeloid Leukemia (AML; n=3), Non-Hodgkin's lymphoma (n=2), breast cancer (BCa; n=1), lung cancer (n=1), ovarian cancer (n=1), liver cancer (n=1), and various other types of cancers (n=3). Seven studies assessed the relationship between the gut microbiome and CTX with faecal samples collected prior to (n=3) and following CTX (n=4) showing that the gut microbiome is associated with both CTX efficacy and toxicity. Ten other prospective studies assessed the impact of CTX during treatment and found that CTX modulates the gut microbiome of people with cancer and that dysbiosis induced by the CTX is related to AEs. CTX adversely impacts the gut microbiome, inducing dysbiosis and is associated with CTX outcomes and AEs. Current evidence provides insights into the gut microbiome for clinicians, cancer survivors and the general public. More research is required to better understand and modify the impact of CTX on the gut microbiome.
Collapse
Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,University of Kansas Medical Center, Kansas City, KS, United States
| | - Frances Boyle
- Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Alex Guminski
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Towia Libermann
- Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | | | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Cancer Care Service, Mater Hospital, North Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
21
|
Oh B, Boyle F, Pavlakis N, Clarke S, Eade T, Hruby G, Lamoury G, Carroll S, Morgia M, Kneebone A, Stevens M, Liu W, Corless B, Molloy M, Kong B, Libermann T, Rosenthal D, Back M. The Gut Microbiome and Cancer Immunotherapy: Can We Use the Gut Microbiome as a Predictive Biomarker for Clinical Response in Cancer Immunotherapy? Cancers (Basel) 2021; 13:cancers13194824. [PMID: 34638308 PMCID: PMC8508052 DOI: 10.3390/cancers13194824] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The current review assessed the effects of the gut microbiome on clinical outcomes of immunotherapy and related adverse events (AEs) in cancer patients. Studies (n = 10) consistently reported that the gut microbiome prior to administering immune checkpoint inhibitors (ICIs) was associated with enhanced efficacy of ICIs and reduced AEs. Recent fecal microbiome transplant (FMT) studies demonstrated the modulatory effects of FMT on the composition and diversity of the gut microbiome in patients with refractory cancers and the potential to improve the efficacy of ICIs. Abstract Background: Emerging evidence suggests that gut microbiota influences the clinical response to immunotherapy. This review of clinical studies examines the relationship between gut microbiota and immunotherapy outcomes. Method: A literature search was conducted in electronic databases Medline, PubMed and ScienceDirect, with searches for “cancer” and “immunotherapy/immune checkpoint inhibitor” and “microbiome/microbiota” and/or “fecal microbiome transplant FMT”. The relevant literature was selected for this article. Results: Ten studies examined patients diagnosed with advanced metastatic melanoma (n = 6), hepatocellular carcinoma (HCC) (n = 2), non-small cell lung carcinoma (NSCLC) (n = 1) and one study examined combination both NSCLC and renal cell carcinoma (RCC) (n = 1). These studies consistently reported that the gut microbiome profile prior to administering immune checkpoint inhibitors (ICIs) was related to clinical response as measured by progression-free survival (PFS) and overall survival (OS). Two studies reported that a low abundance of Bacteroidetes was associated with colitis. Two studies showed that patients with anti-PD-1 refractory metastatic melanoma experienced improved response rates and no added toxicity when receiving fecal microbiota transplant (FMT) from patients with anti-PD-1 responsive disease. Conclusions: Overall, significant differences in the diversity and composition of the gut microbiome were identified in ICIs responders and non-responders. Our findings provide new insights into the value of assessing the gut microbiome in immunotherapy. Further robust randomized controlled trials (RCTs) examining the modulatory effects of the gut microbiome and FMT on ICIs in patients not responding to immunotherapy are warranted.
Collapse
Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
- Correspondence:
| | - Frances Boyle
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
| | - Wen Liu
- University of Kansas Medical Center, Kansas City, KS 66160-7601, USA;
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
| | - Mark Molloy
- Bowel Cancer and Biomarker Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Benjamin Kong
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Towia Libermann
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
- BIDMC Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - David Rosenthal
- Harvard Medical School, Boston, MA 02115, USA; (T.L.); (D.R.)
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (N.P.); (S.C.); (T.E.); (G.H.); (G.L.); (S.C.); (M.M.); (A.K.); (M.S.); (B.C.); (B.K.); (M.B.)
- The Mater Hospital, North Sydney, NSW 2065, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| |
Collapse
|
22
|
Khoury M, Wittekind S, Lal AK, Conway J, Bansal N, Lorts A, Rosenthal D, Burstein D. Significant Variation in Exercise Recommendations for Youth With Cardiomyopathies or Fontan Circulation: An Advanced Cardiac Therapies Improving Outcomes Network Learning Survey. Circ Heart Fail 2021; 14:e008738. [PMID: 34517722 DOI: 10.1161/circheartfailure.121.008738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Canada (M.K., J.C.)
| | - Samuel Wittekind
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (S.W., A.L.)
| | - Ashwin K Lal
- Division of Pediatric Cardiology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City (A.K.L.)
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Canada (M.K., J.C.)
| | - Neha Bansal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY (N.B.)
| | - Angela Lorts
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH (S.W., A.L.)
| | - David Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford University, Palo Alto, CA (D.R.)
| | - Danielle Burstein
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, PA (D.B.)
| |
Collapse
|
23
|
Lee J, Kidambi S, Rosenthal D, Nasirov T, Dykes J, Ma M. Weight Matching in Infant Heart Transplantation: Analysis of the United Network for Organ Sharing Database. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
24
|
Barkoff L, Dykes J, Maeda K, Hollander S, Rosenthal D, Kaufman B, Profita E, Wujcik K, Almond C. Taking a Closer Look at Distance: Does Increasing the Maximal Donor Distance Range Shorten Waitlist Times in Pediatric Heart Transplant Candidates? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
25
|
Murray J, Rosenthal D, Zafar F, Lorts A, Connelly C, Krack P, Vanderpluym C, Hawkins B, Niebler R, Mehegan M, Gajarski R, Sutcliffe D, Villa C. The ABC's of Stroke Prevention: Reduction in Stroke Frequency Following a Quality Improvement Intervention by the Action Learning Network. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
26
|
Lee J, Kidambi S, Rosenthal D, Nasirov T, Dykes J, Ma M. Evaluating Matching by Predicted Heart Mass in Adolescent Heart Transplantation: Analysis of the United Network for Organ Sharing Database. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
27
|
Shezad M, Rosenthal D, Larkins C, Heile T, Zafar F, Jeewa A, Barnes A, Lorts A, Joong A, Kwiatkowski D, Sutcliffe D, Sparks J, Simpson K, Ploutz M, Ghanayem N, Niebler R, Davies R, Auerbach S. The Adjudication Process at ACTION - Providing Real-World High-Quality Data. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
28
|
Tam S, Yao CMKL, Amit M, Gajera M, Luo X, Treistman R, Khanna A, Aashiq M, Nagarajan P, Bell D, El-Naggar A, Migden M, Wong M, Glisson B, Ferrarotto R, Esmaeli B, Rosenthal D, Li G, Weber RS, Myers JN, Gross ND. Association of Immunosuppression With Outcomes of Patients With Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Otolaryngol Head Neck Surg 2021; 146:128-135. [PMID: 31804658 DOI: 10.1001/jamaoto.2019.3751] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Patients with immunosuppression have a higher incidence of cutaneous squamous cell carcinoma (cSCC) and often present with more aggressive, multifocal disease. Objectives To determine the risks for mortality in patients with cSCC and immunosuppression compared with nonimmunosuppression and to compare the difference in mortality risk based on the cause of immunocompromise. Design, Setting, and Participants This retrospective cohort study of patients with cSCC of the head and neck recruited participants from a tertiary cancer care center. Patients who underwent no treatment, wide local excision, or biopsy of the lesions were eligible for inclusion from January 1, 1995, to September 30, 2015. Data were analyzed from March 21, 2018, to April 4, 2019. Exposures Immunocompromise, defined as having solid organ transplant, stem cell transplant, hematopoetic malignant disease, autoimmune disease requiring treatment with immunosuppressive therapy, type 1 or 2 diabetes treated with insulin, HIV or AIDS, or other hematoproliferative disorder. Main Outcomes and Measures Patients were divided into 2 groups according to their immune status (immunosuppression vs no immunosuppression). The primary outcome measure was disease-specific survival. A Cox proportional hazards regression model was used to determine the association of immune status with disease outcome. Results A total of 796 patients (680 men [85.4%]; median age, 69 [range, 27-98] years), including 147 with and 649 without immunosuppression (IS and non-IS groups, respectively), constituted the final cohort. In the IS group, 77 (52.4%) had diabetes, 39 (26.5%) had lymphoma or leukemia, 25 (17.0%) had an organ or stem cell transplant, and 3 (2.0%) had HIV. Five-year disease-specific survival was 68.2% in the IS group compared with 84.1% in the non-IS group (difference, 15.9%; 95% CI, 3.5%-27.4%). Immunosuppression was independently associated with worse disease-specific survival (hazard ratio, 2.32; 95% CI, 1.53-3.50). Conclusions and Relevance This study's findings suggest that immunosuppression is independently associated with a worse outcome in cSCC, with a 2.32 times increased risk of disease-specific death after adjusting for age, history of skin cancer, recurrent or persistent disease status, disease stage, and treatment.
Collapse
Affiliation(s)
- Samantha Tam
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Christopher M K L Yao
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Moran Amit
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Mona Gajera
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Xiaoning Luo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Rachel Treistman
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Anshu Khanna
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Mohamed Aashiq
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Priyadharsini Nagarajan
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Diana Bell
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Adel El-Naggar
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael Migden
- Division of Internal Medicine, Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael Wong
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bonnie Glisson
- Division of Cancer Medicine, Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Renata Ferrarotto
- Division of Cancer Medicine, Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Division of Surgery, Department of Plastic Surgery, Ophthalmic Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Rosenthal
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Guojun Li
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Randal S Weber
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey N Myers
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Neil D Gross
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
29
|
Abstract
COVID-19 has presented with a variety of manifestations including peripheral neurological symptoms. The most commonly associated peripheral neuropathies described with COVID-19 are Guillain-Barre syndrome and its variants as well as critical illness polyneuropathy. We report in this paper the distinct MRI findings of an unusual case of peripheral neuropathy associated with COVID-19. These findings are similar to those seen in Guillain-Barre syndrome or one of its variants, although differing from the classic condition in certain key clinical and radiological features.
Collapse
Affiliation(s)
- S. Bahouth
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6048, Boston, MA 02114 USA
| | - K. Chuang
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - L. Olson
- Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - D. Rosenthal
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6048, Boston, MA 02114 USA
| |
Collapse
|
30
|
Talhami A, Swed A, Hess S, Ovadia O, Greenberg S, Schumacher-Klinger A, Rosenthal D, Shalev DE, Hurevich M, Lazarovici P, Hoffman A, Gilon C. Cyclizing Painkillers: Development of Backbone-Cyclic TAPS Analogs. Front Chem 2020; 8:532577. [PMID: 33282822 PMCID: PMC7689096 DOI: 10.3389/fchem.2020.532577] [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: 02/04/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022] Open
Abstract
Painkillers are commonly used medications. Native peptide painkillers suffer from various pharmacological disadvantages, while small molecule painkillers like morphine are highly addictive. We present a general approach aimed to use backbone-cyclization to develop a peptidomimetic painkiller. Backbone-cyclization was applied to transform the linear peptide Tyr-Arg-Phe-Sar (TAPS) into an active backbone-cyclic peptide with improved drug properties. We designed and synthesized a focused backbone-cyclic TAPS library with conformational diversity, in which the members of the library have the generic name TAPS c(n-m) where n and m represent the lengths of the alkyl chains on the nitrogens of Gly and Arg, respectively. We used a combined screening approach to evaluate the pharmacological properties and the potency of the TAPS c(n-m) library. We focused on an in vivo active compound, TAPS c(2-6), which is metabolically stable and has the potential to become a peripheral painkiller being a full μ opioid receptor functional agonist. To prepare a large quantity of TAPS c(2-6), we optimized the conditions of the on-resin reductive alkylation step to increase the efficiency of its SPPS. NMR was used to determine the solution conformation of the peptide lead TAPS c(2-6).
Collapse
Affiliation(s)
- Alaa Talhami
- Department of Organic Chemistry, Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Swed
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shmuel Hess
- Meytav Technologies Incubator, Kiryat Shmona, Israel
| | - Oded Ovadia
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarit Greenberg
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Schumacher-Klinger
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Rosenthal
- Department of Organic Chemistry, Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Deborah E Shalev
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, Jerusalem, Israel.,Wolfson Centre for Applied Structural Biology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mattan Hurevich
- Department of Organic Chemistry, Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Philip Lazarovici
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amnon Hoffman
- School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chaim Gilon
- Department of Organic Chemistry, Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
31
|
Abstract
I raise concerns about Doerig et al.'s general project, about three of their criteria, and about their treatment of higher-order-thought theory.
Collapse
Affiliation(s)
- David Rosenthal
- Philosophy and Cognitive Science, Graduate Center, City University of New York
| |
Collapse
|
32
|
Coyle T, Kaplan B, Rosenthal D, McInerney A. M276 A CASE OF ROSAI-DORFMAN DISEASE IN AN INFANT. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Ng S, Cardenas C, Bahig H, Elgohari B, Moreno A, Shah S, Garden A, Phan J, Gunn G, Frank S, Rosenthal D, Morrison W, Wang J, Fuller C. PO-1691: Apparent diffusion coefficient changes in weekly MRI during radiotherapy in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Palacio MN, Gonzalez-Mosquera L, Rosenthal D, Kunar S, Tao Q, Gebre W, Liao H. Epidermal inclusion cyst in the thyroid gland. Stem Cell Investig 2020; 7:18. [PMID: 33209917 DOI: 10.21037/sci-2020-021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022]
Abstract
Epidermal inclusion cysts (EIC) are common benign lesions of the skin, ovaries, and testicles. However, their occurrence in thyroid gland is rare. We reported a case in which a 57-year-old male patient with history of nontoxic uninodular goiter presented with dysphonia and dysphagia. The cytology of ultrasound guided fine needle aspiration of the thyroid nodule revealed epidermal cyst. Despite the benign presentation. The patient underwent lobectomy to relieve his clinical symptoms and the surgical pathology exam confirmed the diagnosis of benign thyroid cyst, consistent with EIC of the thyroid.
Collapse
Affiliation(s)
- Maria Naranjo Palacio
- Division of Endocrinology, Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | | | - David Rosenthal
- Division of Endocrinology, Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Salini Kunar
- Division of Endocrinology, Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Qi Tao
- Department of Pathology, Nassau University Medical Center, East Meadow, NY, USA
| | - Wondwossen Gebre
- Department of Pathology, Nassau University Medical Center, East Meadow, NY, USA
| | - Huijuan Liao
- Division of Endocrinology, Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA
| |
Collapse
|
35
|
Pasalic D, Ludmir E, Thaker N, Gunn B, Hanna E, Su S, Ferrarotto R, Glisson B, Reddy J, Fuller C, Phan J, Rosenthal D, Morrison W, Garden A, Frank S. Prospective Patient-Reported Outcomes, Physician-Assessed Toxicities, and Treatment Outcomes in Sinonasal Malignancies Following Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
36
|
Sosa A, Wang C, Nguyen T, Reddy J, Moreno A, Garden A, Rosenthal D, Frank S, Fuller C, Shah S, Morrison W, Gunn B, Su S, Phan J. Gamma Knife Boost for Head and Neck Cancers with Skull Base Extension: A Case Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Bocchese M, Rosenthal D, Haddad A, Rosenfeld B, Chen C, Basil A, Gangireddy C, Cooper J, Cronin E, Vedantham V, Gupta R, Whitman I. PATIENT CHARACTERISTICS ASSOCIATED WITH VENTRICULAR ARRHYTHMIAS, HEART BLOCK, AND HEART FAILURE IN CARDIAC SARCOIDOSIS PATIENTS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
38
|
Bocchese M, Rosenthal D, Haddad A, Rosenfeld B, Chen C, Basil A, Gangireddy C, Cooper J, Cronin E, Vedantham V, Whitman I, Gupta R. ASSESSING RACIAL DIFFERENCE IN PULMONARY PRESSURES IN CARDIAC SARCOIDOSIS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
39
|
Kormos RL, Antonides CF, Goldstein DJ, Cowger JA, Starling RC, Kirklin JK, Rame JE, Rosenthal D, Mooney ML, Caliskan K, Messe SR, Teuteberg JJ, Mohacsi P, Slaughter MS, Potapov EV, Rao V, Schima H, Stehlik J, Joseph S, Koenig SC, Pagani FD. Updated definitions of adverse events for trials and registries of mechanical circulatory support: A consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transplant 2020; 39:735-750. [DOI: 10.1016/j.healun.2020.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022] Open
|
40
|
Oh B, Bae K, Lamoury G, Eade T, Boyle F, Corless B, Clarke S, Yeung A, Rosenthal D, Schapira L, Back M. The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis. Medicines (Basel) 2020; 7:E39. [PMID: 32629903 PMCID: PMC7400467 DOI: 10.3390/medicines7070039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/13/2022]
Abstract
Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: "Tai Chi or Qigong" and "immune system, immune function, immunity, Immun*, inflammation and cytokines". Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, -0.15; 95% CI, -0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.
Collapse
Affiliation(s)
- Byeongsang Oh
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Kyeore Bae
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- Center for Immunity and Pain, Kwanghye Hospital, Seoul 06174, Korea
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Frances Boyle
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Brian Corless
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
| | - Stephen Clarke
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| | - Albert Yeung
- Harvard Medical School, Boston, MA 02115, USA; (A.Y.); (D.R.)
| | - David Rosenthal
- Harvard Medical School, Boston, MA 02115, USA; (A.Y.); (D.R.)
| | - Lidia Schapira
- Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards NSW 2065 Australia; (K.B.); (G.L.); (T.E.); (B.C.); (S.C.); (M.B.)
- The Mater Hospital, North Sydney NSW 2060, Australia;
- Sydney Medical School, University of Sydney, Sydney NSW 2060, Australia
| |
Collapse
|
41
|
Sen Gupta T, Campbell D, Chater AB, Rosenthal D, Saul L, Connaughton K, Cowie M. Fellowship of the Australian College of Rural & Remote Medicine (FACRRM) Assessment: a review of the first 12 years. MedEdPublish (2016) 2020; 9:100. [PMID: 38090052 PMCID: PMC10712634 DOI: 10.15694/mep.2020.000100.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. This paper provides an overview of the first 12 years of the formal assessment program of the Australian College of Rural and Remote Medicine (ACRRM). The ACRRM Fellowship represents the world's first and only Fellowship exam in Rural Medicine. The ACRRM assessment program is mapped to its Rural Generalist curriculum, based on the principles of programmatic assessment. ACRRM offers candidates the opportunity to participate in assessment in or close to their home location. The ACRRM Rural Generalist Curriculum defines the scope and standards for independent general practice anywhere in Australia, with a focus on rural and remote settings. The program was initially developed in 2006 and has evolved during delivery from 2008 onwards, utilising the following modalities: •Multi Source Feedback (MSF)•Multiple Choice Questions (MCQ)•Mini Clinical Evaluation Exercise (Mini-CEX)•Case Based Discussion (CBD)•Procedural Skills Logbook•Structured Assessment using Multiple Patient Scenarios (StAMPS) StAMPS is a unique examination, blending the formats of an Objective Structured Clinical Examination and a traditional viva vocè. The program has an emphasis on formative assessment. Over the past 12 years there has been considerable work in developing resources for candidates, governance structures and quality assurance processes. ACRRM's Fellowship requirements represent a customised bespoke assessment tailored to ACRRM's curriculum and the Australian rural and remote context. ACRRM's assessment program has grown substantially with 649 Fellowships being awarded from 2008 - 2019, with considerable experience gained in rural and remote assessment. It now represents a mature firmly-established process as a vocational endpoint in Rural and Remote Medicine. ACRRM has continued to offer its 'tele-assessment' program throughout the COVID-19 pandemic, with candidates and examiners participating in assessment by use of distance technology while remaining in or near their home community. This model may provide some insights for other medical Colleges and educational institutions facing challenges in the current environment.
Collapse
Affiliation(s)
- Tarun Sen Gupta
- James Cook University and Australian College of Rural and Remote Medicine
| | | | | | | | - Lynn Saul
- Australian College of Rural and Remote Medicine
| | | | | |
Collapse
|
42
|
Lorts A, Zafar F, VanderPluym C, Lantz J, Bleiweis M, Maeda K, Simpson K, Ploutz M, Jeewa A, Morales D, Rosenthal D. Contemporary Berlin Heart EXCOR Outcomes in North America: Report from the ACTION Registry. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
43
|
Burstein D, McBride M, Lorts A, Rosenthal D, Peng D, Lantz J, Tunuguntla H, Zinn M, Curran T, Wittekind S. Variation in Cardiac Rehabilitation for Pediatric Ventricular Assist Device Recipients across North America: An ACTION Network Survey. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
44
|
Barkoff L, Dykes J, Maeda K, Hollander S, Rosenthal D, Kaufman B, Profita E, Wujcik K, Almond C. Taking a Closer Look at Distance: Does Increasing the Maximal Donor Distance Range Shorten Waitlist Times in Pediatric Heart Transplant Candidates? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.307] [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: 11/26/2022] Open
|
45
|
Chen CY, Chen SF, Hollander SA, Rosenthal D, Maeda K, Burgart A, Almond CS, Chen S. Donor heart selection during the COVID-19 pandemic: A case study. J Heart Lung Transplant 2020; 39:497-498. [PMID: 32362395 PMCID: PMC7193142 DOI: 10.1016/j.healun.2020.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/21/2020] [Accepted: 03/21/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chiu-Yu Chen
- Department of Pediatrics, Divisions of Pediatric Cardiology
| | | | | | | | | | - Alyssa Burgart
- Department of Anesthesia, Stanford University School of Medicine, Palo Alto, California
| | | | - Sharon Chen
- Department of Pediatrics, Divisions of Pediatric Cardiology
| |
Collapse
|
46
|
Affiliation(s)
- David Rosenthal
- Philosophy and Concentration in Cognitive Science, Graduate Center, City University of New York, New York, NY, USA
| |
Collapse
|
47
|
Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
Collapse
Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
| |
Collapse
|
48
|
Gross N, Ferrarotto R, Nagarajan P, Bell D, El-Naggar A, Johnson J, Yuan Y, Glisson B, Wong M, Rosenthal D, Esmaeli B, Migden M, Wargo J, Weber R, Myers J. Phase II study of neoadjuvant cemiplimab prior to surgery in patients with stage III/IV (M0) cutaneous squamous cell carcinoma of the head and neck (CSCC-HN). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Eldridge RC, Pugh SL, Trotti A, Hu K, Spencer S, Yom SS, Rosenthal D, Read N, Desai A, Gore E, Shenouda G, Mishra MV, Bruner D, Xiao C. Changing functional status within 6 months posttreatment is prognostic of overall survival in patients with head and neck cancer: NRG Oncology Study. Head Neck 2019; 41:3924-3932. [PMID: 31435980 DOI: 10.1002/hed.25922] [Citation(s) in RCA: 5] [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: 05/07/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Is posttreatment functional status prognostic of overall survival in patients with head and neck cancer (HNC). METHODS In an HNC clinical trial, 495 patients had two posttreatment functional assessments measuring diet, public eating, and speech within 6 months. Patients were grouped by impairment (highly, moderately, modestly, or not impaired) and determined if they improved, declined, or did not change from the first assessment to the second. Multivariable Cox models estimated overall mortality. RESULTS Across all three scales, the change in posttreatment patient function strongly predicted overall survival. In diet, patients who declined to highly impaired had three times the mortality of patients who were not impaired at both assessments (hazard ratio [HR] = 3.60; 95% confidence interval, 2.02-6.42). For patients improving from highly impaired, mortality was statistically similar to patients with no impairment (HR = 1.38; 95% CI, 0.82-2.31). CONCLUSIONS Posttreatment functional status is a strong prognostic marker of survival in patients with HNC.
Collapse
Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Pittsburgh, Pennsylvania
| | | | - Kenneth Hu
- Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, New York
| | - Sharon Spencer
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Sue S Yom
- UCSF Medical Center-Mount Zion, San Francisco, California
| | - David Rosenthal
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Read
- London Regional Cancer Program, London, Ontario, Canada
| | | | - Elizabeth Gore
- Zablocki VA Medical Center (Accruals under Froedtert and the Medical College of Wisconsin), Milwaukee, Wisconsin
| | | | - Mark V Mishra
- University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland
| | - Deborah Bruner
- Emory University/Winship Cancer Center, Atlanta, Georgia
| | - Canhua Xiao
- Emory University/Winship Cancer Center, Atlanta, Georgia
| |
Collapse
|
50
|
Zhong H, Men K, Wang J, van Soest J, Rosenthal D, Dekker A, Zhang Z, Xiao Y. The Impact of Clinical Trial Quality Assurance on Outcome in Head and Neck Radiotherapy Treatment. Front Oncol 2019; 9:792. [PMID: 31497534 PMCID: PMC6712430 DOI: 10.3389/fonc.2019.00792] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose: To investigate the impact of radiation treatment quality assurance (RTQA) on treatment outcomes in a phase III trial for advanced head and neck cancer. Materials and Methods: A total of 767 patients from NRG/RTOG 0522 were included in this study. The contours of target volume (TV) and organ at risk (OAR), and dose-volume coverage of targets were reviewed and scored (per-protocol, variation-acceptable and deviation-unacceptable) according to the protocol. We performed log-rank tests for RTQA scores with patients' outcomes, including local control (LC), distant control (DC) and overall survival (OS). Cox models with and without RTQA score data were established. To obtain a more reasonable model, per-protocol and variation acceptable were combined into a single acceptable score. Results: The log-rank test showed that all RTQA scores correlated with LC, which was significantly different between the per-protocol and variation-acceptable patients in target and OAR contouring (p-value = 0.004 and 0.043). For dose-volume score, the per-protocol and variation-acceptable patients were significantly different from unacceptable patients in the LC, with a p-value = 0.020 and 0.006, respectively. The DC of patients with variation-acceptable was significantly different than that of the unacceptable patients (p-value = 0.043). There were no correlations between RTQA scores with other outcomes. By incorporating RTQA scores into outcome modeling, the performance of LC model can be improved from 0.62 to 0.63 (c-index). The RTQA scores had no impact on DC and OS. Conclusion: RTQA scores are related to patients' local control rates in head and neck cancer radiotherapy.
Collapse
Affiliation(s)
- Haoyu Zhong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kuo Men
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States.,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiazhou Wang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | | | - Zhen Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|