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Liu DS, Wong DJ, Goh SK, Fayed A, Stevens S, Aly A, Bright T, Weinberg L, Watson DI. Quantifying Perioperative Risks for Antireflux and Hiatus Hernia Surgery: A Multicenter Cohort Study of 4301 Patients. Ann Surg 2024; 279:796-807. [PMID: 38318704 DOI: 10.1097/sla.0000000000006223] [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] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Using a comprehensive Australian cohort, we quantified the incidence and determined the independent predictors of intraoperative and postoperative complications associated with antireflux and hiatus hernia surgeries. In addition, we performed an in-depth analysis to understand the complication profiles associated with each independent risk factor. BACKGROUND Predicting perioperative risks for fundoplication and hiatus hernia repair will inform treatment decision-making, hospital resource allocation, and benchmarking. However, available risk calculators do not account for hernia anatomy or technical aspects of surgery in estimating perioperative risk. METHODS Retrospective analysis of all elective antireflux and hiatus hernia surgeries in 36 Australian hospitals over 10 years. Hierarchical multivariate logistic regression analyses were performed to determine the independent predictors of intraoperative and postoperative complications accounting for patient, surgical, anatomic, and perioperative factors. RESULTS A total of 4301 surgeries were analyzed. Of these, 1569 (36.5%) were large/giant hernias and 292 (6.8%) were revisional procedures. The incidence rates of intraoperative and postoperative complications were 12.6% and 13.3%, respectively. The Charlson Comorbidity Index, hernia size, revisional surgery, and baseline anticoagulant usage independently predicted both intraoperative and postoperative complications. These risk factors were associated with their own complication profiles. Finally, using risk matrices, we visualized the cumulative impact of these 4 risk factors on the development of intraoperative, overall postoperative, and major postoperative complications. CONCLUSIONS This study has improved our understanding of perioperative morbidity associated with antireflux and hiatus hernia surgery. Our findings group patients along a spectrum of perioperative risks that inform care at an individual and institutional level.
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Affiliation(s)
- David S Liu
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Victoria, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Victoria, Australia
| | - Darren J Wong
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Victoria, Australia
- Department of Gastroenterology, Austin Health, Victoria, Australia
| | - Su Kah Goh
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Victoria, Australia
| | - Aly Fayed
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Victoria, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Victoria, Australia
| | - Sean Stevens
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Victoria, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Victoria, Australia
| | - Ahmad Aly
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Victoria, Australia
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Victoria, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Morcos MM, Liu DS, Farid AR, See P, Hogue GD. Occipital condyle fracture in the pediatric population: A management algorithm and systematic review. J Child Orthop 2024; 18:216-228. [PMID: 38567039 PMCID: PMC10984159 DOI: 10.1177/18632521241229301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
Purpose This study aims to develop an accessible stepwise management algorithm for pediatric presentations of occipital condyle fractures (OCFs) based on a systematic review of the published literature regarding diagnostic evaluation, treatment, and outcomes. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric OCFs. Data extraction of clinical presentation, management strategies, imaging, and treatment outcome was performed. Results A total of 15 studies reporting on 38 patients aged 18 years and younger presenting with OCFs were identified. Loss of consciousness (LOC), depressed level of consciousness, neck pain, decreased neck range of motion (ROM), and cranial nerve injury were the most common presenting symptoms. Diagnostic imaging included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and functional radiographs to assess cervical stability. Treatment options varied and included soft collar, hard collar, and halo vest. All studies resulted in a complete healing of the OCF, with resolution of associated pain. Conclusion The proposed treatment algorithm suggests a framework for the management of pediatric OCFs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a stepwise approach should be utilized in the management of isolated pediatric OCFs.
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Affiliation(s)
- Mary M Morcos
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Boston, MA, USA
| | - David S Liu
- Harvard Medical School, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | | | - Pokmeng See
- Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, USA
| | - Grant D Hogue
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
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Hogue GD, Liu DS, Kaushal SG, Tavabi N, Feldman L, Stracciolini A, Shore B, Hedequist D, Bae D, Meehan W, Kim YJ, Kocher M, Murray MM, Kiapour AM. Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain. J Pediatr Orthop 2024:01241398-990000000-00518. [PMID: 38512171 DOI: 10.1097/bpo.0000000000002669] [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] [Indexed: 03/22/2024]
Abstract
BACKGROUND Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges. METHODS Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits). We evaluated the differences in rate of telehealth utilization, rate of patient adherence, disparities in care access and patient satisfaction, and technological issues. RESULTS Compared with in-person prepandemic visits, THVs had lower ratios of non-White patients (by 5.8%; P<0.001), Hispanic patients (by 2.8%; P<0.001) and patients with public insurance (by 1.8%; P<0.001), and a higher mean distance between the patient's residence and clinic (by 18.8 miles; P<0.001). There were minimal differences in median household income (average $2297 less in THV; P<0.001) and social vulnerability index (average 0.01 points lower in THV; P<0.001) between groups. THVs had comparable patient satisfaction to in-person visits. Non-White patients, Hispanics, and those with public insurance had lower ratings for both in-person visits and THVs and had more technical difficulties during their THV. CONCLUSIONS Telehealth is a viable method of care for a range of pediatric OSM conditions, providing a similar quality of care as in-person visits with a greater geographic reach. However, in its current format, reduced disparities were not observed in pediatric OSM THVs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Grant D Hogue
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Allan Z, Witts S, Wong DJ, Lee MM, Tie J, Tebbutt NC, Clemons NJ, Liu DS. Peritoneal Tumor DNA as a Prognostic Biomarker in Gastric Cancer: A Systematic Review and Meta-Analysis. JCO Precis Oncol 2024; 8:e2300546. [PMID: 38513167 DOI: 10.1200/po.23.00546] [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: 10/02/2023] [Revised: 12/07/2023] [Accepted: 01/30/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Gastric cancers commonly spread to the peritoneum. Its presence significantly alters patient prognosis and treatment-intent; however, current methods of peritoneal staging are inaccurate. Peritoneal tumor DNA (ptDNA) is tumor-derived DNA detectable in peritoneal lavage fluid. ptDNA positivity may indicate peritoneal micrometastasis and may be more sensitive than cytology in staging the peritoneum. In this meta-analysis, we evaluated the prognostic potential of ptDNA in gastric cancer. METHODS PubMed, Embase, Scopus, and Web of Science databases were searched using PRISMA guidelines. Studies published between January 1, 1990, and April 30, 2023, containing quantitative data relating to ptDNA in gastric cancer were meta-analyzed. RESULTS Six studies were analyzed. Of the total 757 patients with gastric adenocarcinoma, 318 (42.0%) were stage I, 311 (41.0%) were stage II/III, 116 (15.3%) were stage IV, and 22 (2.9%) were undetermined. Overall, ptDNA detected cytology-positive cases with a sensitivity and specificity of 85.2% (95% CI, 66.5 to 100.0) and 91.5% (95% CI, 86.5 to 96.6), respectively. Additionally, ptDNA was detected in 54 (8.5%) of 634 cytology-negative patients. The presence of ptDNA negatively correlated with pathological stage I (relative risk [RR], 0.29 [95% CI, 0.13 to 0.66]) and positively correlated with pathological stage IV (RR, 8.61 [95% CI, 1.86 to 39.89]) disease. Importantly, ptDNA positivity predicted an increased risk of peritoneal-specific metastasis (RR, 13.81 [95% CI, 8.11 to 23.53]) and reduced 3-year progression-free (RR, 5.37 [95% CI, 1.39 to 20.74]) and overall (hazard ratio, 4.13 [95% CI, 1.51 to 11.32]) survival. CONCLUSION ptDNA carries valuable prognostic information and can detect peritoneal micrometastases in patients with gastric cancer. Its clinical utility in peritoneal staging for gastric cancer deserves further investigation.
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Affiliation(s)
- Zexi Allan
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Sasha Witts
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Darren J Wong
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, VIC, Australia
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne Department of Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Margaret M Lee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
- Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Niall C Tebbutt
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Austin Health, Heidelberg, VIC, Australia
| | - Nicholas J Clemons
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - David S Liu
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne Department of Surgery, Austin Health, Heidelberg, VIC, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, VIC, Australia
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Liu DS, Farid AR, Linden GS, Cook D, Birch CM, Hresko MT, Hedequist DJ, Hogue GD. Utility of postoperative laboratory testing after posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2024; 12:375-381. [PMID: 37884756 DOI: 10.1007/s43390-023-00771-1] [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: 07/06/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE With advancements to blood management strategies, risk of perioperative transfusion following surgical treatment of adolescent idiopathic scoliosis (AIS) has diminished. We hypothesize that routine laboratory testing on postoperative-day 1 (POD1) and beyond is unnecessary. The purpose of this study is to determine necessity of POD1 labs, particularly hematocrit and hemoglobin levels, following surgical management of AIS. METHODS We performed a retrospective cohort study of consecutive AIS patients aged 11-19 who underwent posterior spinal fusion (PSF) at a single institution. Univariable logistic regression was utilized to determine factors associated with hematocrit ≤ 22% on POD1 or a postoperative transfusion. Firth's penalized logistic regression was used for any separation in data. Youden's index was utilized to determine the optimal point on the ROC curve that maximizes both sensitivity and specificity. RESULTS 527 patients qualified for this study. Among the eight total patients with POD1 hematocrit ≤ 22, none underwent transfusion. These patients had lower last intraoperative hematocrit levels compared to patients with POD1 hematocrit > 22% (24.1% vs 31.5%, p < 0.001), and these groups showed no difference in preoperative hematocrit levels (38.2% vs 39.8%, p = 0.11). Four patients underwent postoperative transfusion. Both preoperative hematocrit levels (34.0% vs 39.9%, p = 0.001) and last intraoperative hematocrit levels (25.1% vs 31.4%, p = 0.002) were lower compared to patients without transfusion. Intraoperative hematocrit < 26.2%, operative time of more than 35.8 min per level fused, or cell salvage > 241 cc were significant risk factors for postoperative transfusion. CONCLUSION Transfusion after PSF for AIS is exceedingly rare. POD1 labs should be considered when last intraoperative hematocrit < 26%, operative time per level fused > 35 min, or cell salvage amount > 241 cc. Otherwise, unless symptomatic, patients do not benefit from postoperative laboratory screening.
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Affiliation(s)
- David S Liu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Gabriel S Linden
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Craig M Birch
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - M Timothy Hresko
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel J Hedequist
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Grant D Hogue
- Harvard Medical School, Boston, MA, USA.
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Tokhi A, George SV, Cabalag CS, Liu DS, Duong CP. Vagal sparing gastrectomy: A systematic review and meta-analysis. Dig Surg 2024:000536472. [PMID: 38412841 DOI: 10.1159/000536472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
Radical gastrectomy is associated with significant functional complications. In appropriate patients may be amenable to less invasive resection aimed at preserving the vagal trunks. The aim of this systematic review and meta-analysis is to assess the functional consequences and oncological safety of vagal sparing gastrectomy (VSG) compared to conventional non-vagal sparing gastrectomy (CG). A systematic review of four databases was undertaken for studies published between 1/11990 and 15/122021, comparing patients who underwent VSG to CG. We meta-analysed the following outcomes: operative time, blood loss, nodal yield, days to flatus, body weight changes, as well as the incidence of post-operative cholelithiasis, diarrhoea, delayed gastric emptying, and dumping syndrome. Thirty studies were included in the meta-analysis with a selection of studies qualitatively analysed. VSG was associated with a lower rate of cholelithiasis (OR 0.25, 95% CI 0.15-0.41, p<0.010) and early dumping syndrome (OR 0.42, 95% CI 0.21 - 0.86; p=0.02), less blood loss (MD -51 ml, 95% CI -89.11 to -12.81 ml, p=0.009), less long term weight loss (MD 2.03%, 95% CI 0.31-3.76%, p=0.02) and a faster time to flatus (MD -0.42 days, 95% CI -0.48 - 0.36, p<0.001). There was no significant difference in nodal harvest, overall survival, and all other endpoints. VSG significantly reduces the incidence of post-operative cholelithiasis and dumping syndrome, decreases weight loss and facilitates an earlier return of gut motility. Although technically more challenging, VSG should be considered for prophylactic surgery.
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Liu DS, Mazurek MH, Whitehead DC, Hood MC, Choi P, Gupte A, Ottensmeyer MP, Fintelmann FJ, Uppot RN, Andriole KP, Gee MS, Brink JA, Succi MD. A Novel Design-Thinking, Hospital Innovation Core Certificate Curriculum for Radiologists and Trainees: Creation, Implementation, and Multiyear Results. Acad Radiol 2024; 31:417-425. [PMID: 38401987 DOI: 10.1016/j.acra.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES Innovation is a crucial skill for physicians and researchers, yet traditional medical education does not provide instruction or experience to cultivate an innovative mindset. This study evaluates the effectiveness of a novel course implemented in an academic radiology department training program over a 5-year period designed to educate future radiologists on the fundamentals of medical innovation. MATERIALS AND METHODS A pre- and post-course survey and examination were administered to residents who participated in the innovation course (MESH Core) from 2018 to 2022. Respondents were first evaluated on their subjective comfort level, understanding, and beliefs on innovation-related topics using a 5-point Likert-scale survey. Respondents were also administered a 21-question multiple-choice exam to test their objective knowledge of innovation-related topics. RESULTS Thirty-eight residents participated in the survey (response rate 95%). Resident understanding, comfort and belief regarding innovation-related topics improved significantly (P < .0001) on all nine Likert-scale questions after the course. After the course, a significant majority of residents either agreed or strongly agreed that technological innovation should be a core competency for the residency curriculum, and that a workshop to prototype their ideas would be beneficial. Performance on the course exam showed significant improvement (48% vs 86%, P < .0001). The overall course experience was rated 5 out of 5 by all participants. CONCLUSION MESH Core demonstrates long-term success in educating future radiologists on the basic concepts of medical technological innovation. Years later, residents used the knowledge and experience gained from MESH Core to successfully pursue their own inventions and innovative projects. This innovation model may serve as an approach for other institutions to implement training in this domain.
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Affiliation(s)
- David S Liu
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Mercy H Mazurek
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - David C Whitehead
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Michael C Hood
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Peter Choi
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.)
| | - Anu Gupte
- Mass General Brigham Innovation, Boston, Massachusetts (A.G., M.D.S.)
| | - Mark P Ottensmeyer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Florian J Fintelmann
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Raul N Uppot
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Katherine P Andriole
- Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Data Science Office, Mass General Brigham, Boston, Massachusetts (K.P.A.)
| | - Michael S Gee
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - James A Brink
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Marc D Succi
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Mass General Brigham Innovation, Boston, Massachusetts (A.G., M.D.S.).
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8
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Allan Z, Liu DS, Lee MM, Tie J, Clemons NJ. A Practical Approach to Interpreting Circulating Tumor DNA in the Management of Gastrointestinal Cancers. Clin Chem 2024; 70:49-59. [PMID: 38175583 DOI: 10.1093/clinchem/hvad188] [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: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is accumulating evidence supporting the clinical use of circulating tumor DNA (ctDNA) in solid tumors, especially in different types of gastrointestinal cancer. As such, appraisal of the current and potential clinical utility of ctDNA is needed to guide clinicians in decision-making to facilitate its general applicability. CONTENT In this review, we firstly discuss considerations surrounding specimen collection, processing, storage, and analysis, which affect reporting and interpretation of results. Secondly, we evaluate a selection of studies on colorectal, esophago-gastric, and pancreatic cancer to determine the level of evidence for the use of ctDNA in disease screening, detection of molecular residual disease (MRD) and disease recurrence during surveillance, assessment of therapy response, and guiding targeted therapy. Lastly, we highlight current limitations in the clinical utility of ctDNA and future directions. SUMMARY Current evidence of ctDNA in gastrointestinal cancer is promising but varies depending on its specific clinical role and cancer type. Larger prospective trials are needed to validate different aspects of ctDNA clinical utility, and standardization of collection protocols, analytical assays, and reporting guidelines should be considered to facilitate its wider applicability.
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Affiliation(s)
- Zexi Allan
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - David S Liu
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Margaret M Lee
- Division of Personalised Oncology, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Division of Personalised Oncology, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Nicholas J Clemons
- Division of Cancer Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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9
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Liu DS, Miller P, Rothenberg A, Vuillermin C, Waters PM, Bauer AS. Early Elbow Flexion Contracture Predicts Shoulder Contracture in Infants with Brachial Plexus Birth Injury. J Pediatr 2024; 264:113739. [PMID: 37717907 DOI: 10.1016/j.jpeds.2023.113739] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/19/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To determine if children who present with an elbow flexion contracture (EFC) from brachial plexus birth injury (BPBI) are more likely to develop shoulder contracture and undergo surgical treatment. STUDY DESIGN Retrospective review of children <2 years of age with BPBI who presented to a single children's hospital from 1993 to 2020. Age, elbow and shoulder range of motion (ROM), imaging measurements, and surgical treatment and outcome were analyzed. Patients with an EFC of ≥10° were included in the study sample. Data from 2445 clinical evaluations (1190 patients) were assessed. The final study cohort included 72 EFC cases matched with 230 non-EFC controls. Three patients lacked sufficient follow-up data. RESULTS There were 299 included patients who showed no differences between study and control groups with respect to age, sex, race, ethnicity, or functional score. Patients with EFC had 12° less shoulder range of motion (95% CI, 5°-20°; P < .001) and had 2.5 times the odds of shoulder contracture (OR, 2.5; 95% CI, 1.3-4.7; P = .006). For each additional 5° of EFC, the odds of shoulder contracture increased by 50% (OR, 1.5; 95% CI, 1.2-1.8; P < .001) and odds of shoulder procedure increased by 62% (OR, 1.62; 95% CI, 1.04-2.53; P = .03). Sensitivity of EFC for predicting shoulder contracture was 49% and specificity was 82%. CONCLUSIONS In patients with BPBI <2 years of age, presence of EFC can be used as a screening tool in identifying shoulder contractures that may otherwise be difficult to assess. Prompt referral should be arranged for evaluation at a BPBI specialty clinic, because delayed presentation risks worsening shoulder contracture and potentially more complicated surgery.
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Affiliation(s)
- David S Liu
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Anna Rothenberg
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Peter M Waters
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC
| | - Andrea S Bauer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
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10
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Buchholz V, Hazard R, Lee DK, Liu DS, Zhang W, Chen S, Aly A, Barnett S, Le P, Weinberg L. Textbook outcomes after oesophagectomy: a single-centre observational study. BMC Surg 2023; 23:368. [PMID: 38066440 PMCID: PMC10704701 DOI: 10.1186/s12893-023-02253-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Textbook outcomes is a composite quality assurance tool assessing the ideal perioperative and postoperative course as a unified measure. Currently, its definition and application in the context of oesophagectomy in Australia is unknown. The aim of this study was to assess the textbook outcomes after oesophagectomy in a single referral centre of Australia and investigate the association between textbook outcomes and patient, tumour, and treatment characteristics. METHODS An observational study was retrospectively performed on patients undergoing open, laparoscopic, or hybrid oesophagectomy between January 2010 and December 2019 in a single cancer referral centre. A textbook outcome was defined as the fulfillment of 10 criteria: R0 resection, retrieval of at least 15 lymph nodes, no intraoperative complications, no postoperative complications greater than Clavien-Dindo grade III, no anastomotic leak, no readmission to the ICU, no hospital stay beyond 21 days, no mortality within 90 days, no readmission related to the surgical procedure within 30 days from admission and no reintervention related to the surgical procedure. The proportion of patients who met each criterion for textbook outcome was calculated and compared. Selected patient-related parameters (age, gender, BMI, ASA score, CCI score), tumour-related factors (tumour location, tumour histology, AJCC clinical T and N stage and treatment-related factor [neoadjuvant chemotherapy and surgical approach]) were assessed. Disease recurrence and one year survival were also evaluated. RESULTS 110 patients who underwent oesophagectomy were included. The overall textbook outcome rate was 24%. The difference in rates across the years was not statistically significant. The most achieved textbook outcome parameters were 'no mortality in 90 days' (96%) and 'R0 resection' (89%). The least frequently met textbook outcome parameter was 'no severe postoperative complications' (58%), followed by 'no hospital stays over 21 days' (61%). No significant association was found between patient, tumour and treatment characteristics and the rate of textbook outcome. Tumour recurrence rate and overall long term survival was similar between textbook outcome and non-textbook outcome groups. Patients with R0 resection, no intraoperative complication and a hospital stay less than 21 days had reduced mortality rates. CONCLUSIONS Textbook outcome is a clinically relevant indicator and was achieved in 24% of patients. Severe complications and a prolonged hospital stay were the key criteria that limited the achievement of a textbook outcome. These findings provide meticulous evaluation of oesophagectomy perioperative care and provide a direction for the utilisation of this concept in identifying and improving surgical and oncological care across multiple healthcare levels.
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Affiliation(s)
- Vered Buchholz
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia
| | - Riley Hazard
- Department of Anesthesia, Austin Health, Melbourne, VIC, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Austin, USA
- Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Precinct, VIC, Australia
| | - Wendell Zhang
- Department of Anesthesia, Austin Health, Melbourne, VIC, Australia
| | - Sharon Chen
- Department of Anesthesia, Austin Health, Melbourne, VIC, Australia
| | - Ahmed Aly
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia
| | - Stephen Barnett
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia
| | - Peter Le
- Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Precinct, VIC, Australia
| | - Laurence Weinberg
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Australia.
- Department of Anesthesia, Austin Health, Melbourne, VIC, Australia.
- Department of Critical Care, University of Melbourne, Victoria, Australia.
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11
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Wartko PD, Bobb JF, Boudreau DM, Matthews AG, McCormack J, Lee AK, Qiu H, Yu O, Hyun N, Idu AE, Campbell CI, Saxon AJ, Liu DS, Altschuler A, Samet JH, Labelle CT, Zare-Mehrjerdi M, Stotts AL, Braciszewski JM, Murphy MT, Dryden D, Arnsten JH, Cunningham CO, Horigian VE, Szapocznik J, Glass JE, Caldeiro RM, Phillips RC, Shea M, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Lapham GT, Addis M, Bradley KA, Ghiroli MM, Hamilton LK, Hu Y, LaHue JS, Loree AM, Murphy SM, Northrup TF, Shmueli-Blumberg D, Silva AJ, Weinstein ZM, Wong MT, Burganowski RP. Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1343-1354. [PMID: 37902748 PMCID: PMC10616772 DOI: 10.1001/jamainternmed.2023.5701] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments. Objective To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization. Design, Setting, and Participants The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after. Intervention The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine. Main Outcomes and Measures The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up. Results During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70). Conclusions and Relevance The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD. Trial Registration ClinicalTrials.gov Identifier: NCT03407638.
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Affiliation(s)
- Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Genentech Inc, South San Francisco, California
| | | | | | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Kaiser Permanente Washington, Renton
| | - Hongxiang Qiu
- Kaiser Permanente Washington Health Research Institute, Seattle
- Now with Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
| | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, North Bethesda, Maryland
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jeffrey H Samet
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Colleen T Labelle
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
| | - Mohammad Zare-Mehrjerdi
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Angela L Stotts
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Douglas Dryden
- MultiCare Health System, Tacoma, Washington
- Now with Mosaic Medical, Bend, Oregon
| | - Julia H Arnsten
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Bronx, New York
- Now with New York State Office of Addiction Services and Supports, New York
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Ryan M Caldeiro
- Mental Health and Wellness Department, Kaiser Permanente Washington, Renton
| | | | - Mary Shea
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- University of Minnesota Medical School, Minneapolis
| | | | - Jennifer McNeely
- Department of Population Health, Grossman School of Medicine, New York University, New York
| | - Jane M Liebschutz
- Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Joseph O Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California
| | - Megan M Ghiroli
- Montefiore Medical Center, Bronx, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Yong Hu
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Thomas F Northrup
- Department of Family and Community Medicine, UTHealth Houston McGovern Medical School, Houston, Texas
| | | | | | - Zoe M Weinstein
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, Massachusetts
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12
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Buchholz V, Hazard R, Yin Z, Tran N, Yip SWS, Le P, Kioussis B, Hinton J, Liu DS, Lee DK, Weinberg L. The impact of intraoperative and postoperative fluid balance on complications for transthoracic esophagectomy: a retrospective analysis. BMC Res Notes 2023; 16:315. [PMID: 37932807 PMCID: PMC10629189 DOI: 10.1186/s13104-023-06574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE Transthoracic esophagectomy is associated with significant morbidity and mortality. Therefore, it is imperative to optimize perioperative management and minimize complications. In this retrospective analysis, we evaluated the association between fluid balance and esophagectomy complications at a tertiary hospital in Melbourne, Australia, with a particular focus on respiratory morbidity and anastomotic leaks. Cumulative fluid balance was calculated intraoperatively, postoperatively in recovery postoperative day (POD) 0, and on POD 1 and 2. High and low fluid balance was defined as greater than or less than the median fluid balance, respectively, and postoperative surgical complications were graded using the Clavien-Dindo classification. RESULTS In total, 109 patients, with an average age of 64 years, were included in this study. High fluid balance on POD 0, POD1 and POD 2 was associated with a higher incidence of anastomotic leak (OR 8.59; 95%CI: 2.64-39.0). High fluid balance on POD 2 was associated with more severe complications (of any type) (OR 3.33; 95%CI: 1.4-8.26) and severe pulmonary complications (OR 3.04; 95%CI: 1.27-7.67). For every 1 L extra cumulative fluid balance in POD 1, the odds of a major complication increase by 15%, while controlling for body mass index (BMI) and American Society of Anaesthesiologists (ASA) class. The results show that higher cumulative fluid balance is associated with worsening postoperative outcomes in patients undergoing transthoracic esophagectomy. Restricted fluid balance, especially postoperatively, may mitigate the risk of postoperative complications - however prospective trials are required to establish this definitively.
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Affiliation(s)
- Vered Buchholz
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia
| | - Riley Hazard
- Department of Anesthesia, Austin Health, Melbourne, Australia
| | - Zoe Yin
- Department of Anesthesia, Austin Health, Melbourne, Australia
| | - Nghiep Tran
- Department of Anesthesia, Austin Health, Melbourne, Australia
| | | | - Peter Le
- Department of Anesthesia, Austin Health, Melbourne, Australia
| | | | - Jake Hinton
- Department of Anesthesia, Austin Health, Melbourne, Australia
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia
- General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Melbourne, Australia.
- Department of Critical Care, University of Melbourne, Melbourne, Australia.
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13
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Weinberg L, Scurrah N, Neal-Williams T, Zhang W, Chen S, Slifirski H, Liu DS, Armellini A, Aly A, Clough A, Lee DK. The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study. BMC Surg 2023; 23:335. [PMID: 37924061 PMCID: PMC10625241 DOI: 10.1186/s12893-023-02246-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Antiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects. METHODS A retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications' administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated. RESULTS One hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310). CONCLUSIONS Preoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.
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Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Australia.
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
| | - Nick Scurrah
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | | | - Wendell Zhang
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Sharon Chen
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Hugh Slifirski
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
- General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | - Ahmad Aly
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Anthony Clough
- Department of Surgery, Box Hill Hospital, Box Hill, Australia
- Melbourne Centre for Bariatric Surgery, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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14
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Allan Z, Witts S, Tie J, Tebbutt N, Clemons NJ, Liu DS. The prognostic impact of peritoneal tumour DNA in gastrointestinal and gynaecological malignancies: a systematic review. Br J Cancer 2023; 129:1717-1726. [PMID: 37700064 PMCID: PMC10667497 DOI: 10.1038/s41416-023-02424-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Peritoneal metastases from various abdominal cancer types are common and carry poor prognosis. The presence of peritoneal disease upstages cancer diagnosis and alters disease trajectory and treatment pathway in many cancer types. Therefore, accurate and timely detection of peritoneal disease is crucial. The current practice of diagnostic laparoscopy and peritoneal lavage cytology (PLC) in detecting peritoneal disease has variable sensitivity. The significant proportion of peritoneal recurrence seen during follow-up in patients where initial PLC was negative indicates the ongoing need for a better diagnostic tool for detecting clinically occult peritoneal disease, especially peritoneal micro-metastases. Advancement in liquid biopsy has allowed the development and use of peritoneal tumour DNA (ptDNA) as a cancer-specific biomarker within the peritoneum, and the presence of ptDNA may be a surrogate marker for early peritoneal metastases. A growing body of literature on ptDNA in different cancer types portends promising results. Here, we conduct a systematic review to evaluate the prognostic impact of ptDNA in various cancer types and discuss its potential future clinical applications, with a focus on gastrointestinal and gynaecological malignancies.
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Affiliation(s)
- Zexi Allan
- Division of Cancer Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3000, Australia.
| | - Sasha Witts
- Division of Cancer Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3000, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
| | - Niall Tebbutt
- Department of Surgery, University of Melbourne, Grattan Street, Parkville, VIC, 3000, Australia
- Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Nicholas J Clemons
- Division of Cancer Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3000, Australia
| | - David S Liu
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Parkville, VIC, 3000, Australia
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
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15
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Kunz S, Ashraf H, Klonis C, Thompson SK, Aly A, Liu DS. Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis. Langenbecks Arch Surg 2023; 408:403. [PMID: 37843694 PMCID: PMC10579133 DOI: 10.1007/s00423-023-03143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. METHODS A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. RESULTS Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller's myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. CONCLUSION In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.
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Affiliation(s)
- Stephen Kunz
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
- General and Gastrointestinal Surgery Research and Trials Group, Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Hamza Ashraf
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Christopher Klonis
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - David S Liu
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
- General and Gastrointestinal Surgery Research and Trials Group, Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
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16
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Liu DS, Watkins IT, Adams T, Kramer DE, Watkins CJ. Posterior Tibiotalar Impingement After Pediatric Ankle Fracture Surgical Fixation: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00013. [PMID: 38126808 DOI: 10.2106/jbjs.cc.22.00629] [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] [Indexed: 12/23/2023]
Abstract
CASE A 13-year-old healthy, nearly skeletally mature, female patient presented to an outpatient clinic after sustaining a bimalleolar ankle fracture-dislocation, which was subsequently treated with open reduction and internal fixation and casting. Postoperatively, the patient had significant limitations to ankle range of motion. Imaging revealed posterior tibiotalar impingement. The patient underwent arthroscopic debridement and osteoplasty, and she was able to return to previous levels of activity. CONCLUSIONS Complications from pediatric ankle fractures are rare, so further diagnostic workup is warranted for patients with persistent pain and limitations.
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Affiliation(s)
- David S Liu
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Ian T Watkins
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Taylor Adams
- Boston Children's Hospital, Boston, Massachusetts
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17
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Farid AR, Liu DS, Morcos MM, Hogue GD. Spinal osteoid osteoma in the pediatric population: A management algorithm and systematic review. J Child Orthop 2023; 17:428-441. [PMID: 37799321 PMCID: PMC10549702 DOI: 10.1177/18632521231192477] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed. Results Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period. Conclusions The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs.
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Affiliation(s)
| | - David S Liu
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Mary M Morcos
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
| | - Grant D Hogue
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
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18
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Liu DS, Allan Z, Wong DJ, Goh SK, Stevens S, Aly A, Bright T, Watson DI. Pre-existing hiatal mesh increases morbidity during and after revisional antireflux surgery: A retrospective multicenter study. Surgery 2023; 174:549-557. [PMID: 37369605 DOI: 10.1016/j.surg.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Revisional antireflux surgery, including hiatus hernia repair, is increasingly common. Mesh-augmented hiatal closure at the time of index operation is controversial but commonly performed. Although a meta-analysis of randomized data has demonstrated no additional benefit of routine mesh placement, it is unclear whether this practice results in harm, particularly at the time of revisional antireflux surgery. We determined whether pre-existing mesh at the hiatus increases morbidity during and after revisional antireflux surgery. METHODS Analysis of prospectively-maintained databases of all elective revisional antireflux surgery cases in 36 hospitals across Australia took place over 10 years. Intraoperative and postoperative outcomes of patients with and without prior hiatal mesh were compared. Propensity score-matched analysis was used to validate primary findings. RESULTS A total of 346 revisional cases (35 with pre-existing mesh) were analyzed. The 2 groups had comparable baseline characteristics. In total, 77 (22.2%) patients had 148 intraoperative adverse events. Pre-existing mesh was associated with a higher risk of intraoperative complications (48.6% vs 22.5%, odds ratio 3.25, 95% confidence interval 1.63-6.38, P = .002), secondary to bleeding, and lacerations to pleura, lung, and liver. Overall, 63 (18.2%) patients developed postoperative complications. Pre-existing mesh was associated with increased postoperative morbidity (37.1% vs 16.1%, odds ratio 3.09, 95% confidence interval 1.50-6.43, P = .005), particularly due to bleeding and respiratory complications. Importantly, pre-existing mesh independently predicted the occurrence of intraoperative and postoperative complications. CONCLUSION Prior hiatal mesh significantly increases morbidity during and after revisional antireflux surgery. Given that revisional surgery is increasingly being performed, our findings discourage routine mesh use during primary antireflux surgery.
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Affiliation(s)
- David S Liu
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia.
| | - Zexi Allan
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Darren J Wong
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia; Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Su Kah Goh
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Sean Stevens
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Ahmad Aly
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia; Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia; Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
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19
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Liu DS, Fayed A, Evans P, Bright T, Aly A, Duong C, Spillane J, Weinberg L, Watson DI. Understanding Potentially Preventable Mortality Following Oesophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality. Ann Surg Oncol 2023; 30:4950-4961. [PMID: 37157003 PMCID: PMC10319683 DOI: 10.1245/s10434-023-13571-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION At a national level, understanding preventable mortality after oesophago-gastric cancer surgery can direct quality-improvement efforts. Accordingly, utilizing the Australian and New Zealand Audit of Surgical Mortality (ANZASM), we aimed to: (1) determine the causes of death following oesophago-gastric cancer resections in Australia, (2) quantify the proportion of potentially preventable deaths, and (3) identify clinical management issues contributing to preventable mortality. METHODS All in-hospital mortalities following oesophago-gastric cancer surgery from 1 January 2010 to 31 December 2020 were analysed using ANZASM data. Potentially preventable and non-preventable cases were compared. Thematic analysis with a data-driven approach was used to classify clinical management issues. RESULTS Overall, 636 complications and 123 clinical management issues were identified in 105 mortalities. The most common causes of death were cardio-respiratory in aetiology. Forty-nine (46.7%) deaths were potentially preventable. These cases were characterized by higher rates of sepsis (59.2% vs 33.9%, p = 0.011), multiorgan dysfunction syndrome (40.8% vs 25.0%, p = 0.042), re-operation (63.3% vs 41.1%, p = 0.031) and other complications compared with non-preventable mortality. Potentially preventable mortalities also had more clinical management issues per patient [median (IQR): 2 (1-3) vs 0 (0-1), p < 0.001), which adversely impacted preoperative (30.6% vs 7.1%, p = 0.002), intraoperative (18.4% vs 5.4%, p = 0.037) and postoperative (51.0% vs 17.9%, p < 0.001) care. Thematic analysis highlighted recurrent areas of deficiency with preoperative, intraoperative and postoperative patient management. CONCLUSIONS Almost 50% of deaths following oesophago-gastric cancer resections were potentially preventable. These were characterized by higher complication rates and clinical management issues. We highlight recurrent themes in patient management to improve future quality of care.
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Affiliation(s)
- David S Liu
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Health, Heidelberg, VIC, Australia.
| | - Aly Fayed
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC, Australia
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Penelope Evans
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA, Australia
| | - Tim Bright
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC, Australia
| | - Cuong Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - John Spillane
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, VIC, Australia
| | - David I Watson
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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20
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Liu DS, Fayed A, Evans P, Bright T, Aly A, Duong C, Spillane J, Weinberg L, Watson DI. ASO Visual Abstract: Understanding Potentially Preventable Mortality After Esophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality. Ann Surg Oncol 2023; 30:4964-4965. [PMID: 37191863 DOI: 10.1245/s10434-023-13639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- David S Liu
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, Victoria, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
- General and Gastrointestinal Surgery Research Group, Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
| | - Aly Fayed
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, Victoria, Australia
- General and Gastrointestinal Surgery Research Group, Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Penelope Evans
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, South Australia, Australia
| | - Tim Bright
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Cuong Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John Spillane
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - David I Watson
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Liu DS, Wang YX, Rexiti P. [Progress in minimally invasive surgery for adjacent segment disease after lumbar fusion]. Zhonghua Wai Ke Za Zhi 2023; 61:722-727. [PMID: 37400215 DOI: 10.3760/cma.j.cn112139-20230220-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Adjacent segment disease (ASDis) is a common complication of posterior lumbar spine fusion and often requires surgical treatment. In the treatment of ASDis, percutaneous spinal endoscopy can be used for simple decompression without removal of the original internal fixation, or for posterior fixation and fusion under the scope or in combination with other access fixation and fusion techniques, with the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Traditional trajectory screw technique is one of the risk factors for adjacent segment degeneration because of its tendency to cause damage to the adjacent synovial joint during surgery. In contrast, the cortical tone trajectory (CBT) screw placement technique not only reduces the damage to the articular joint during the screw placement process, but also preserves the original internal fixation in the treatment of ASDis, which significantly reduces the surgical trauma. Secondly, the implantation of CBT screws with the aid of digital technologies such as three-dimentinal printed guides, CT navigation, and robotics allows for more precise "double nailing" of ASDis patients to complete the fusion of adjacent segments, and is a minimally invasive procedure to be considered for patients who meet the clinical indications for fusion. This article reviews the literature on the use of percutaneous spinal endoscopy and CBT in the surgical management of ASDis.
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Affiliation(s)
- D S Liu
- Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Y X Wang
- Xinjiang Medical University, Urumqi 830054, China
| | - Paerhati Rexiti
- Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Liu DS, Bright T, Watson DI. ASO Author Reflections: Preventable Mortality Following Esophago-Gastric Cancer Resection. Ann Surg Oncol 2023; 30:4962-4963. [PMID: 37154969 PMCID: PMC10319652 DOI: 10.1245/s10434-023-13585-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Affiliation(s)
- David S Liu
- Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne Department of Surgery, Austin Health, Heidelberg, VIC, Australia.
- Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC, Australia.
| | - Tim Bright
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David I Watson
- Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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23
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Klonis C, Ashraf H, Cabalag CS, Wong DJ, Stevens SG, Liu DS. Optimal Timing of Perioperative Chemical Thromboprophylaxis in Elective Major Abdominal Surgery: A Systematic Review and Meta-analysis. Ann Surg 2023; 277:904-911. [PMID: 36538616 DOI: 10.1097/sla.0000000000005764] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the effect of the timing of chemoprophylaxis on venous thromboembolisms (VTEs) and bleeding rates in patients undergoing major abdominal surgery. BACKGROUND Postoperative bleeding and VTE incur significant morbidity, mortality, and health care costs. Chemoprophylaxis is used routinely to prevent VTEs but increases bleeding risk. The perioperative timing of chemoprophylaxis initiation may influence both VTE and bleeding risks. The optimal window for commencing chemoprophylaxis in the perioperative period is unclear. METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched using PRISMA guidelines. Randomized trials and cohort studies published between January 1, 2000 to May 10, 2022, which reported on chemoprophylaxis timing as well as the incidence of VTE and bleeding after elective abdominal surgery were meta-analyzed. RESULTS From 6175 studies, 14 (24,922 patients) were meta-analyzed. Bariatric (4 studies), antireflux (1 study), hepato-pancreatic-biliary (5 studies), colorectal (1 study), ventral hernia (1 study), and major intra-abdominal surgeries (2 studies) were included. Chemoprophylaxis was initiated before skin closure in 10,403 patients, and postoperatively in 14,519 patients. Both symptomatic [risk ratios (RR), 0.81; 95% CI, 0.45-1.43; P =0.460] and overall (RR, 0.74; 95% CI, 0.45-1.24; P =0.250) VTE rates were comparable between study groups. Compared with postoperative chemoprophylaxis, early usage increased the risk of all bleeding (RR, 1.56; 95% CI, 1.13-2.15; P =0.007), major bleeding (RR, 1.63; 95% CI, 1.16-2.28; P =0.005), blood transfusion (RR, 1.48; 95% CI, 1.24-1.76; P <0.001), and reintervention (RR, 1.94; 95% CI, 1.19-3.18; P =0.008). CONCLUSIONS Our findings advocate for initiating chemoprophylaxis postoperatively in elective abdominal surgery to minimize bleeding risk without compromising VTE protection.
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Affiliation(s)
- Christopher Klonis
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
| | - Hamza Ashraf
- Division of Surgery, Anesthesia, and Procedural Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Carlos S Cabalag
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
- Division of Surgery, Anesthesia, and Procedural Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
| | - Darren J Wong
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Sean G Stevens
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
- Division of Surgery, Anesthesia, and Procedural Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
| | - David S Liu
- Department of Surgery, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
- Division of Surgery, Anesthesia, and Procedural Medicine, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Austin Health, Heidelberg, VIC, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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24
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Downie E, May J, Stevens S, Liu DS. Towards standardized perioperative chemoprophylaxis in major elective abdominal surgery. ANZ J Surg 2023; 93:817-818. [PMID: 36869374 DOI: 10.1111/ans.18364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Emma Downie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James May
- Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sean Stevens
- Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Austin Precinct, Austin Health, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Melbourne, Victoria, Australia
| | - David S Liu
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Austin Precinct, Austin Health, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Melbourne, Victoria, Australia
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Grishin MY, Sdvizhenskii PA, Asyutin RD, Tretyakov RS, Stavertiy AY, Pershin SM, Liu DS, Lednev VN. Combining thermal imaging and spectral pyrometry for express temperature mapping in additive manufacturing. Appl Opt 2023; 62:335-341. [PMID: 36630231 DOI: 10.1364/ao.478113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
A compact and low-cost two-dimensional (2D) thermal imager was developed for real-time temperature mapping of a melt pool during coaxial laser cladding (the additive manufacturing technique). The device combines a color CMOS camera and a compact spectrometer. The spectrometer was utilized for internal calibration and validation of a 2D temperature map that was acquired by the CMOS camera. The remarkable feature of the thermal imager is that camera images are calibrated directly during the measurement process utilizing spectral pyrometry. Additionally, the spectrometer decreased a potential systematic error due to a spectrum contribution from atomic/ionic lines emission. The spectral pyrometry provided temperature accuracy measurements of ±23K while two-dimensional (2D) temperature mapping by two-color pyrometry accuracy was estimated as ±38K in the range of 1700-3500 K. The system has been installed at a coaxial laser cladding head for real-time temperature mapping. The system was developed for measuring a melt pool during laser cladding production of a high wear-resistant coating (tungsten carbide particles in a nickel matrix). Tungsten carbides powder flow rate has been changed sequentially from 5 to 27 g/min by powder feeder programming, which resulted in a variation of melt pool dimensions and temperature maps during the cladding process.
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Liu DS, Abu-Shaban K, Sugito HR, Kulkarni V, Kikyo F, Gupta Y, Elsamaloty H. Assessment of United States Radiology Residency Program Websites in the COVID-19 Era. J Am Coll Radiol 2022; 19:1170-1176. [PMID: 35709976 PMCID: PMC9167846 DOI: 10.1016/j.jacr.2022.05.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To provide an updated evaluation of radiology residency program websites in light of virtual interviewing during the COVID-19 pandemic and encourage programs to improve the quality of their online website presence. Methods We evaluated the websites of 197 US radiology residency programs between November and December 2021 for the presence or absence of 30 metrics. The metrics chosen are those considered important by applicants when choosing a program and have been used in other similar papers. Results Of the 197 programs, 192 (97.5%) had working websites. The average radiology residency website had 16 of 30 (54%) metrics listed on their websites. Five programs did not have accessible websites and were not included in the analysis. The most comprehensive website had 29 of 30 (97%) of metrics listed and the least comprehensive website had 2 of 30 (7%). There is a statistically significant difference in website comprehensiveness between top 20 and non–top 20 radiology program websites. Conclusion Although radiology residency program websites have generally become more comprehensive over time, there is still room for improvement, especially in times of virtual interviews when residency applicants are becoming more and more reliant on program websites to gain essential information about a program. Some key areas to include are diversity and inclusion initiatives, resident wellness, applicant information, program benefits, and showcase of people in the program.
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Affiliation(s)
- David S Liu
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.
| | - Kamil Abu-Shaban
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Harun R Sugito
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Fumitaka Kikyo
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Yasha Gupta
- Radiology Chief Resident (R4), Mount Auburn Hospital, Cambridge, Massachusetts; Vice Chair of the Resident & Fellow Section at ACR
| | - Haitham Elsamaloty
- Chair of Radiology Department, University of Toledo Medical Center, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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Aly A, Spiro C, Liu DS, Mori K, Lim HK, Blackham R, Erese RJ. Bariatric surgery in a public hospital: a 10-year experience. ANZ J Surg 2022; 92:2129-2136. [PMID: 35603768 PMCID: PMC9546354 DOI: 10.1111/ans.17768] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 12/31/2022]
Abstract
Introduction Obesity is common and adversely impacts quality‐of‐life and healthcare cost. In Australia, less than 10% of bariatric surgeries are performed in the public sector. This study reports our 10‐year experience from a high volume public bariatric service which delivers multi‐disciplinary care for primary and revisional procedures with mid‐ to long‐term follow‐up. Methods A prospectively maintained database of all patients who underwent bariatric surgery from January 2010 to January 2020 at a tertiary metropolitan hospital was analysed. We analysed patient demographics, comorbidities, perioperative outcomes, 2‐ and 5‐year weight loss as well as comorbidities reduction. Results A total of 995 patients underwent 1086 (674 primary and 412 revisional) bariatric procedures with mean age of 46.9 years, mean BMI of 49.6 ± 9.1 kg/m2 and 92% patients with ≥1 obesity‐related co‐morbidity. Length‐of‐stay was longer for revisional than primary surgery (5.6 vs. 3.5 days). Major complication rate was 4.2%. Overall, % Total body weight loss (%TBWL) for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At 2 years follow‐up, treatment was ceased or reduced in 65% of diabetics, 29% of hypertensive patients and 69% of sleep apnoea patients. Conclusion This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector.
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Affiliation(s)
- Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Calista Spiro
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - David S Liu
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,General and Gastrointestinal Surgery Research Group, The University of Melbourne Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Krinal Mori
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Hou K Lim
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ruth Blackham
- Department of Surgery, University Western Australia, Western Australia, Australia
| | - Raymund J Erese
- Section of Bariatric Surgery, The Medical City/Ateneo School of Medicine and Public Health, Pasig, Philippines
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Teng PK, Han XD, Liu YZ, Zhao WY, Liu DS, Liu XD. [Clinical characteristics and outcome analysis of COVID-19 patients with pulmonary tuberculosis]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:510-514. [PMID: 35527467 DOI: 10.3760/cma.j.cn112147-20220122-00416] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Coronavirus disease (COVID-19) and tuberculosis (TB) are two respiratory infectious diseases with a high incidence of transmission, mainly via respiratory droplets and both can weaken the immune system and lower the number of CD4+T cells in patients. COVID-19 can occur before, at the same time or after the diagnosis of TB. Patients with pulmonary TB are more likely to have co-infection when they have a history of epidemiological exposure to COVID-19. At present, many cases of nosocomial infection of COVID-19 caused by ineffective prevention and control measures in tuberculosis hospitals have been reported successively at domestic and overseas. Therefore, it is urgent to strengthen the prevention and control of nosocomial infections in tuberculosis hospitals. The superposition of the two diseases can lead to a worsening prognosis, aggravating the patient's condition and making treatment more difficult. In addition, in the context of the new coronavirus epidemic, early recognition of co-infection with new coronavirus should be made when TB patients in chest hospitals present with symptoms such as aggregated fever or progressive disease. At the same time, we should focus on identifying the clinical and imaging manifestations of TB and COVID-19 co-infection. At present, research on COVID-19 complicated with pulmonary TB is scarce, and there are disputes on many aspects. As a country with a high prevalence of tuberculosis, it is of great practical significance to identify the clinical characteristics, outcomes, and treatment of the two infectious diseases in China.
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Affiliation(s)
- P K Teng
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
| | - X D Han
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Y Z Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
| | - W Y Zhao
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
| | - D S Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
| | - X D Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao 266011, China
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Grisdela PT, Liu DS, Dyer GSM, Earp BE, Blazar P, Zhang D. Factors Associated With Implant Removal Following Plate-and-Screw Fixation of Isolated Metacarpal Fractures. J Hand Surg Am 2022:S0363-5023(22)00067-3. [PMID: 35305847 DOI: 10.1016/j.jhsa.2022.01.026] [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: 05/18/2021] [Revised: 12/09/2021] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The incidence of and associated risk factors for implant removal following the plate-and-screw fixation of metacarpal shaft fractures have not been well described. The primary objective of our study was to identify implant-related radiographic parameters associated with implant removal in patients treated with the plate-and-screw fixation of isolated, displaced metacarpal fractures at 2 years of follow-up. The secondary objective of our study was to identify patient-related factors associated with implant removal. METHODS A retrospective study of all patients who underwent open treatment of a metacarpal fracture with a plate-and-screw construct from January 1, 2000, to April 30, 2019, at 2 level-1 trauma centers was conducted. After the application of exclusion criteria, we identified 138 patients with a single isolated metacarpal fracture of a nonthumb digit treated with open reduction and internal fixation using a plate-and-screw construct. Our study endpoint was the removal of the plate-and-screw construct or a minimum of 2 years of follow-up without the removal of the hardware. Twenty-three patients achieved our study endpoint as determined using their electronic medical records, and 58 additional patients were reached via telephone to confirm their implant removal status. A bivariate analysis was used to screen for factors associated with implant removal, and variables significant in the bivariate screen were included in a multivariable stepwise logistic regression model. RESULTS Twenty-three out of 81 patients (28%) in our final cohort underwent implant removal by the final follow-up visit. In the logistic regression analysis, the distance between the plate and metacarpophalangeal joint, the distance between the plate and carpometacarpal joint, and active smoking were independently associated with implant removal. CONCLUSIONS The proximity of metacarpal plates to adjacent joints is associated with subsequent implant removal. Patients may be counseled about the higher risk of implant removal when periarticular metacarpal plating is performed. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis IV.
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Affiliation(s)
- Phillip T Grisdela
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - David S Liu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Petric J, Bright T, Liu DS, Wee Yun M, Watson DI. Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 2022; 275:e45-e51. [PMID: 33856379 DOI: 10.1097/sla.0000000000004902] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This meta-analysis systematically reviewed published randomized control trials comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life. SUMMARY BACKGROUND DATA Repair of large HHs is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or nonabsorbable) repair. METHODS A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science, and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. RESULTS Seven randomized control trials were found which compared mesh-augmented (nonabsorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6-12 months, 10.1% mesh vs 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3-5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time (P = 0.05, OR 2.33, 95% confidence interval 0.03-24.69). CONCLUSIONS Mesh repair for HH does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.
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Affiliation(s)
- Josipa Petric
- College of Medicine and Public Health, Flinders University, South Australia, Australia
- Department of Surgery, Flinders Medical Centre, South Australia, Australia
| | - Tim Bright
- Department of Surgery, Flinders Medical Centre, South Australia, Australia
| | - David S Liu
- Department of Surgery, Flinders Medical Centre, South Australia, Australia
- Department of Surgery, Austin Hospital, Victoria, Australia
| | - Melissa Wee Yun
- Department of Surgery, Flinders Medical Centre, South Australia, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University, South Australia, Australia
- Department of Surgery, Flinders Medical Centre, South Australia, Australia
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Cong JC, Cui MM, Liu DS, Zhang H, Chen CS. [Evaluation of anorectal function after transanal total mesorectal excision and discussion of related problems]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:1024-1027. [PMID: 34823304 DOI: 10.3760/cma.j.cn441530-20200824-00496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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32
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Allan Z, Wong DJ, Sweeney T, Liu DS. Congenital midgut malrotation predisposing to small bowel volvulus around left-sided feeding jejunostomy. ANZ J Surg 2021; 92:1896-1898. [PMID: 34738331 DOI: 10.1111/ans.17362] [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] [Received: 09/19/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Zexi Allan
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Darren J Wong
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Thomas Sweeney
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - David S Liu
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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Yahya Z, Liu DS, Foo G, Aly A. Transgastric laparoendoscopic approach to tumours of the stomach. ANZ J Surg 2021; 92:759-763. [PMID: 34704328 DOI: 10.1111/ans.17314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently limited data to reassure the technical efficacy, particularly in attaining clear margins, through a transgastric laparo-endoscopic approach to resecting tumours located near the gastroesophageal junction (GOJ) or the pylorus. METHODS Single institution retrospective analysis of all cases from 1 April 2008 to 31 Dec 2019. RESULTS Overall, 34 patients (38 tumours) underwent transgastric laparo-endoscopic resection. Of these, 27 (71.1%) and 5 (14.7%) cases were located close to the GOJ and pylorus respectively. Three (8.0%) cases were converted to conventional laparoscopic excision. No anatomical gastric resection was required. The mean (SD) operative time was 167.5 (64.2) minutes and reduced with increasing experience. The median (IQR) length-of-stay was 3.0 (3.0-4.5) days. Major post-operative complication (Clavian-Dindo ≥3) occurred in 1 (2.9%) patient, which required surgical control of staple line bleeding. The most common pathology was gastrointestinal stromal tumour (71.1%), followed by leiomyoma (10.5%), schwannoma (5.2%), dysplastic polyp (5.2%), and neuroendocrine tumour (2.6%). The mean (SD) tumour diameter was 3.9 (2.1) cm (largest 10.1 cm, 10 cases >5 cm). Resection margins were clear in all cases. We found no evidence of tumour recurrence or gastric stenosis at a median follow-up of 88 months. CONCLUSION Transgastric laparo-endoscopic resection of junctional and pyloric tumours with low metastatic potential is technically feasible. This approach achieved clear resection margins in all our cases, with acceptable perioperative and longer-term outcomes.
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Affiliation(s)
- Zarif Yahya
- Department of Surgery, Upper GI Surgery Unit, Austin Health, Heidelberg, Victoria, Australia
| | - David S Liu
- Department of Surgery, Upper GI Surgery Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Gary Foo
- Department of Surgery, Upper GI Surgery Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Ahmad Aly
- Department of Surgery, Upper GI Surgery Unit, Austin Health, Heidelberg, Victoria, Australia
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Guerra GR, Kong JC, Millen RM, Read M, Liu DS, Roth S, Sampurno S, Sia J, Bernardi MP, Chittleborough TJ, Behrenbruch CC, Teh J, Xu H, Haynes NM, Yu J, Lupat R, Hawkes D, Di Costanzo N, Tothill RW, Mitchell C, Ngan SY, Heriot AG, Ramsay RG, Phillips WA. Molecular and genomic characterisation of a panel of human anal cancer cell lines. Cell Death Dis 2021; 12:959. [PMID: 34663790 PMCID: PMC8523722 DOI: 10.1038/s41419-021-04141-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022]
Abstract
Anal cancer is a rare disease that has doubled in incidence over the last four decades. Current treatment and survival of patients with this disease has not changed substantially over this period of time, due, in part, to a paucity of preclinical models to assess new therapeutic options. To address this hiatus, we set-out to establish, validate and characterise a panel of human anal squamous cell carcinoma (ASCC) cell lines by employing an explant technique using fresh human ASCC tumour tissue. The panel of five human ASCC cell lines were validated to confirm their origin, squamous features and tumourigenicity, followed by molecular and genomic (whole-exome sequencing) characterisation. This panel recapitulates the genetic and molecular characteristics previously described in ASCC including phosphoinositide-3-kinase (PI3K) mutations in three of the human papillomavirus (HPV) positive lines and TP53 mutations in the HPV negative line. The cell lines demonstrate the ability to form tumouroids and retain their tumourigenic potential upon xenotransplantation, with varied inducible expression of major histocompatibility complex class I (MHC class I) and Programmed cell death ligand 1 (PD-L1). We observed differential responses to standard chemotherapy, radiotherapy and a PI3K specific molecular targeted agent in vitro, which correlated with the clinical response of the patient tumours from which they were derived. We anticipate this novel panel of human ASCC cell lines will form a valuable resource for future studies into the biology and therapeutics of this rare disease.
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Affiliation(s)
- Glen R Guerra
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Joseph C Kong
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Rosemary M Millen
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Matthew Read
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - David S Liu
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- UGI Surgery Unit, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Sara Roth
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Shienny Sampurno
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Joseph Sia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Maria-Pia Bernardi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Timothy J Chittleborough
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Corina C Behrenbruch
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jiasian Teh
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Huiling Xu
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Nicole M Haynes
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jiaan Yu
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Richard Lupat
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - David Hawkes
- Department of Biochemistry and Pharmacology, The University of Melbourne, Parkville, VIC, 3010, Australia
- VCS Foundation, Carlton, VIC, 3053, Australia
- Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - Natasha Di Costanzo
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Richard W Tothill
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Centre for Cancer Research, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Samuel Y Ngan
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Alexander G Heriot
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Robert G Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Wayne A Phillips
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia.
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia.
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Hii A, Liu DS, Kholmurodova F, Irvine T, Bright T, Watson DI, Thompson SK. Partial Fundoplication is Effective Treatment for Female Patients with Gastroesophageal Reflux and Scleroderma: A Multicenter Comparative Cohort Study. World J Surg 2021; 46:147-153. [PMID: 34590163 DOI: 10.1007/s00268-021-06326-7] [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] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with scleroderma often suffer from dysphagia and gastroesophageal reflux disease (GERD). Partial fundoplication is a validated anti-reflux procedure for GERD but may worsen dysphagia in scleroderma patients. Its utility in these patients is unknown. Here, we evaluate the efficacy and acceptability of partial fundoplication for the treatment of medically refractory GERD in patients with scleroderma. METHODS Analysis of a prospectively maintained database of patients who underwent fundoplication across 14 hospitals between 1991 and 2019. Perioperative outcomes, reintervention rates, heartburn, dysphagia, and patient satisfaction were assessed at 3 months, 1- and 3-years post-surgery. RESULTS A total of 17 patients with scleroderma were propensity score matched to 526 non-scleroderma controls. All underwent a partial fundoplication. Perioperative outcomes including complication rate, length of stay, and need for reoperation were similar between the two groups. Compared to baseline, both groups reported significantly improved heartburn at 3 months, 1- and 3-years following partial fundoplication. Surgery was equally effective at controlling heartburn across all follow-up timepoints in patients with or without scleroderma. Dysphagia to solids was more common in patients with scleroderma than controls at 3-months post-surgery, but was not significantly different to controls at 1- and 3-year follow-up. Satisfaction scores were high and comparable between both groups across all postoperative timepoints, with 100% of patients with scleroderma reporting that their initial choice to undergo surgery was correct. CONCLUSIONS Partial fundoplication controls reflux and is associated with a transient period of dysphagia to solids in patients with scleroderma. This approach is safe, effective and acceptable for patients with scleroderma and medically refractory GERD.
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Affiliation(s)
- Amanda Hii
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David S Liu
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia. .,Department of Surgery, Austin Hospital, Heidelberg, VIC, 3084, Australia.
| | - Feruza Kholmurodova
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Tanya Irvine
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Sarah K Thompson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
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Fujihara KM, Corrales Benitez M, Cabalag CS, Zhang BZ, Ko HS, Liu DS, Simpson KJ, Haupt Y, Lipton L, Haupt S, Phillips WA, Clemons NJ. SLC7A11 Is a Superior Determinant of APR-246 (Eprenetapopt) Response than TP53 Mutation Status. Mol Cancer Ther 2021; 20:1858-1867. [PMID: 34315763 DOI: 10.1158/1535-7163.mct-21-0067] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/24/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
APR-246 (eprenetapopt) is in clinical development with a focus on hematologic malignancies and is promoted as a mutant-p53 reactivation therapy. Currently, the detection of at least one TP53 mutation is an inclusion criterion for patient selection into most APR-246 clinical trials. Preliminary results from our phase Ib/II clinical trial investigating APR-246 combined with doublet chemotherapy [cisplatin and 5-fluorouracil (5-FU)] in metastatic esophageal cancer, together with previous preclinical studies, indicate that TP53 mutation status alone may not be a sufficient biomarker for APR-246 response. This study aims to identify a robust biomarker for response to APR-246. Correlation analysis of the PRIMA-1 activity (lead compound to APR-246) with mutational status, gene expression, protein expression, and metabolite abundance across over 700 cancer cell lines (CCL) was performed. Functional validation and a boutique siRNA screen of over 850 redox-related genes were also conducted. TP53 mutation status was not consistently predictive of response to APR-246. The expression of SLC7A11, the cystine/glutamate transporter, was identified as a superior determinant of response to APR-246. Genetic regulators of SLC7A11, including ATF4, MDM2, wild-type p53, and c-Myc, were confirmed to also regulate cancer-cell sensitivity to APR-246. In conclusion, SLC7A11 expression is a broadly applicable determinant of sensitivity to APR-246 across cancer and should be utilized as the key predictive biomarker to stratify patients for future clinical investigation of APR-246.
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Affiliation(s)
- Kenji M Fujihara
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Carlos S Cabalag
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bonnie Z Zhang
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Hyun S Ko
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David S Liu
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,HPB Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Kaylene J Simpson
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ygal Haupt
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Therapeutics Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Pathology, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Lara Lipton
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sue Haupt
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Cancer Therapeutics Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Pathology, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Wayne A Phillips
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Surgery at St. Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas J Clemons
- Gastrointestinal Cancer Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Gandhi SD, Liu DS, Sheha ED, Colman MW. Prone transpsoas lumbar corpectomy: simultaneous posterior and lateral lumbar access for difficult clinical scenarios. J Neurosurg Spine 2021:1-8. [PMID: 34171838 DOI: 10.3171/2020.12.spine201913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lateral lumbar corpectomy with interbody fusion has been well described via a transpsoas approach in the lateral position, as has lumbar interbody fusion with posterior fixation in the prone position. However, no previous report has described the use of both an open posterior approach and a lateral transpsoas approach simultaneously in the prone position. Here, the authors describe their technique of performing transpsoas lumbar corpectomy in the prone position in order to have simultaneous posterior and lateral access for difficult clinical scenarios, and they report their early clinical experience. METHODS The surgical technique for simultaneous posterior and lateral transpsoas access to the lumbar spine was reviewed and described in detail. The cases of 2 patients who underwent simultaneous posterior and lateral access in the prone position for complex lumbar pathology were retrospectively reviewed. Clinical presentation, preoperative radiographs, postoperative course, and postoperative radiographs were reviewed. RESULTS The first patient presented after previous transforaminal lumbar interbody fusion that was complicated by significant subsidence of the intervertebral cage, vertebral body split fracture, rotational instability, and resulting spinal stenosis. A simultaneous posterior and lateral transpsoas approach in the prone position allowed for removal of the previous cage, lumbar corpectomy, and rigid posterior fixation with direct decompression. The second patient had a significant pathologic burst fracture secondary to a plasmacytoma with retropulsion, resulting in vertebra plana and significant canal stenosis. Simultaneous approaches allowed for complete resection of the plasmacytoma, restoration of lumbar alignment, rigid fixation, and direct posterior decompression. There were no short-term complications, and both patients had resolution of their preoperative symptoms. CONCLUSIONS Simultaneous posterior and lateral transpsoas access to the lumbar spine in the prone position is a previously unreported technique that allows a safe surgical approach to difficult clinical scenarios.
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Affiliation(s)
- Sapan D Gandhi
- 1Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David S Liu
- 1Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Evan D Sheha
- 2Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; and
| | - Matthew W Colman
- 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Eichelmann AK, Mayne GC, Chiam K, Due SL, Bastian I, Butz F, Wang T, Sykes PJ, Clemons NJ, Liu DS, Michael MZ, Karapetis CS, Hummel R, Watson DI, Hussey DJ. Mutant p53 Mediates Sensitivity to Cancer Treatment Agents in Oesophageal Adenocarcinoma Associated with MicroRNA and SLC7A11 Expression. Int J Mol Sci 2021; 22:ijms22115547. [PMID: 34074015 PMCID: PMC8197322 DOI: 10.3390/ijms22115547] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
TP53 gene mutations occur in 70% of oesophageal adenocarcinomas (OACs). Given the central role of p53 in controlling cellular response to therapy we investigated the role of mutant (mut-) p53 and SLC7A11 in a CRISPR-mediated JH-EsoAd1 TP53 knockout model. Response to 2 Gy irradiation, cisplatin, 5-FU, 4-hydroxytamoxifen, and endoxifen was assessed, followed by a TaqMan OpenArray qPCR screening for differences in miRNA expression. Knockout of mut-p53 resulted in increased chemo- and radioresistance (2 Gy survival fraction: 38% vs. 56%, p < 0.0001) and in altered miRNA expression levels. Target mRNA pathways analyses indicated several potential mechanisms of treatment resistance. SLC7A11 knockdown restored radiosensitivity (2 Gy SF: 46% vs. 73%; p = 0.0239), possibly via enhanced sensitivity to oxidative stress. Pathway analysis of the mRNA targets of differentially expressed miRNAs indicated potential involvement in several pathways associated with apoptosis, ribosomes, and p53 signaling pathways. The data suggest that mut-p53 in JH-EsoAd1, despite being classified as non-functional, has some function related to radio- and chemoresistance. The results also highlight the important role of SLC7A11 in cancer metabolism and redox balance and the influence of p53 on these processes. Inhibition of the SLC7A11-glutathione axis may represent a promising approach to overcome resistance associated with mut-p53.
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Affiliation(s)
- Ann-Kathrin Eichelmann
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of General, Visceral and Transplant Surgery, University Hospital of Münster, Waldeyerstrasse 1, 48149 Münster, Germany
- Correspondence: (A.-K.E.); (D.J.H.)
| | - George C. Mayne
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| | - Karen Chiam
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Steven L. Due
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Isabell Bastian
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Frederike Butz
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Tingting Wang
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Pamela J. Sykes
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
| | - Nicholas J. Clemons
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; (N.J.C.); (D.S.L.)
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - David S. Liu
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; (N.J.C.); (D.S.L.)
- Department of Surgery, Austin Health, Heidelberg, VIC 3084, Australia
| | - Michael Z. Michael
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of Gastroenterology, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| | - Christos S. Karapetis
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| | - Richard Hummel
- Department of Surgery, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - David I. Watson
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| | - Damian J. Hussey
- Flinders Health and Medical Research Institute—Cancer Program, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; (G.C.M.); (K.C.); (S.L.D.); (I.B.); (F.B.); (T.W.); (P.J.S.); (M.Z.M.); (C.S.K.); (D.I.W.)
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
- Correspondence: (A.-K.E.); (D.J.H.)
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Liu DS, Wong E, Fong J, Stevens S, Mori K. Perioperative thromboprophylaxis is highly variable in general surgery: results from a multicentre survey. ANZ J Surg 2021; 90:2401-2403. [PMID: 33336486 DOI: 10.1111/ans.16223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David S Liu
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Flinders Drive, Adelaide, South Australia, Australia
| | - Enoch Wong
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Jonathan Fong
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Sean Stevens
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Krinal Mori
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, Northern Health, Melbourne, Victoria, Australia
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40
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Campbell CI, Saxon AJ, Boudreau DM, Wartko PD, Bobb JF, Lee AK, Matthews AG, McCormack J, Liu DS, Addis M, Altschuler A, Samet JH, LaBelle CT, Arnsten J, Caldeiro RM, Borst DT, Stotts AL, Braciszewski JM, Szapocznik J, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Glass JE, Lapham GT, Murphy SM, Weinstein ZM, Yarborough BJH, Bradley KA. PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment. Addict Sci Clin Pract 2021; 16:9. [PMID: 33517894 PMCID: PMC7849121 DOI: 10.1186/s13722-021-00218-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use Disorders treatment (PROUD) trial tests whether implementation of a collaborative care model (Massachusetts Model) using a nurse care manager (NCM) to support medication treatment of OUD in primary care increases OUD treatment and improves outcomes. Specifically, it tests whether implementation of collaborative care, compared to usual primary care, increases the number of days of medication for OUD (implementation objective) and reduces acute health care utilization (effectiveness objective). The protocol for the PROUD trial is presented here. Methods PROUD is a hybrid type III cluster-randomized implementation trial in six health care systems. The intervention consists of three implementation strategies: salary for a full-time NCM, training and technical assistance for the NCM, and requiring that three primary care providers have DEA waivers to prescribe buprenorphine. Within each health system, two primary care clinics are randomized: one to the intervention and one to Usual Primary Care. The sample includes all patients age 16–90 who visited the randomized primary care clinics from 3 years before to 2 years after randomization (anticipated to be > 170,000). Quantitative data are derived from existing health system administrative data, electronic medical records, and/or health insurance claims (“electronic health records,” [EHRs]). Anonymous staff surveys, stakeholder debriefs, and observations from site visits, trainings and technical assistance provide qualitative data to assess barriers and facilitators to implementation. The outcome for the implementation objective (primary outcome) is a clinic-level measure of the number of patient days of medication treatment of OUD over the 2 years post-randomization. The patient-level outcome for the effectiveness objective (secondary outcome) is days of acute care utilization [e.g. urgent care, emergency department (ED) and/or hospitalizations] over 2 years post-randomization among patients with documented OUD prior to randomization. Discussion The PROUD trial provides information for clinical leaders and policy makers regarding potential benefits for patients and health systems of a collaborative care model for management of OUD in primary care, tested in real-world diverse primary care settings. Trial registration # NCT03407638 (February 28, 2018); CTN-0074 https://clinicaltrials.gov/ct2/show/NCT03407638?term=CTN-0074&draw=2&rank=1
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Affiliation(s)
- Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA.
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | | | | | - David S Liu
- National Institute on Drug Abuse Center for Clinical Trials Network, Three White Flint North, 11601 Landsdown Street, North Bethesda, MD, 20852, USA
| | - Megan Addis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Jeffrey H Samet
- Boston Medical Center/Boston University School of Medicine: Clinical Addiction Research & Education (CARE) Unit Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Colleen T LaBelle
- Boston Medical Center/Boston University School of Medicine: Clinical Addiction Research & Education (CARE) Unit Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine, Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington, 9800 4th Ave. N.E., Seattle, WA, 98115, USA
| | - Douglas T Borst
- Kootenai Clinic Family Medicine, 1919 Lincoln Way, Suite 315, Coeur d Alene, ID, 83814, USA
| | - Angela L Stotts
- Department of Family & Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston School, 7000 Fannin Street, Houston, TX, 77030, USA
| | - Jordan M Braciszewski
- Department of Psychiatry, Center for Health Policy and Health Services Research, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor, Miami, FL, 33136, USA
| | - Gavin Bart
- University of Minnesota/Hennepin Healthcare, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201, USA
| | - Jennifer McNeely
- NYU Grossman School of Medicine, 180 Madison Ave., New York, NY, 10016, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh School of Medicine, 200 Lothrop Street, 933West, Pittsburgh, PA, 15213, USA
| | - Judith I Tsui
- University of Washington/Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Joseph O Merrill
- University of Washington/Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Sean M Murphy
- Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | - Zoe M Weinstein
- Clinical Addiction Research & Education (CARE) Unit, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
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41
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Goh SK, Dudi-Venkata NN, Zhou B, Ng D, Liu DS, Fong J, Low N, Lau L, Mori K, Sidhu A, Stevens S, Muralidharan V. Surgical Outpatient Study: characterizing the educational experience of outpatient clinics for surgical trainees. ANZ J Surg 2020; 90:2166-2167. [PMID: 33200522 DOI: 10.1111/ans.16269] [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] [Received: 04/26/2020] [Revised: 07/26/2020] [Accepted: 08/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Su Kah Goh
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Nagendra N Dudi-Venkata
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Bob Zhou
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Daniel Ng
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - David S Liu
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Jonathan Fong
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Nicholas Low
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Lawrence Lau
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Krinal Mori
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Ankur Sidhu
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Sean Stevens
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia
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42
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Liu DS, Bright T, Thompson SK, Irvine T, Watson DI, Aly A. Patients with Delayed Gastric Emptying Following Laparoscopic Repair of Large Hiatus Hernias Regain Long-Term Quality of Life. J Gastrointest Surg 2020; 24:2654-2657. [PMID: 32671804 DOI: 10.1007/s11605-020-04733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/14/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- David S Liu
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia. .,Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Tim Bright
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Sarah K Thompson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Tanya Irvine
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David I Watson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Ahmad Aly
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia.,University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia
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43
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Liu DS, Stevens S, Wong E, Fong J, Mori K, Fleming N, Beh PS, Crowe A, Howard T, Slevin M, Jain A, Gill AS, Lee S, Jamel W, Bennet S, Chung C, Ward S, Muralidharan V. Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries. ANZ J Surg 2020; 90:2441-2448. [PMID: 33124123 DOI: 10.1111/ans.16374] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism. METHODS Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted. RESULTS A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago-gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago-gastric, liver, pancreas and colon cancer resections had the highest bleeding risk. CONCLUSION Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients.
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Affiliation(s)
- David S Liu
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sean Stevens
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Enoch Wong
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jonathan Fong
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Krinal Mori
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,Northern Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola Fleming
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Pith Soh Beh
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Amy Crowe
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Tess Howard
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Maeve Slevin
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Anshini Jain
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Anna Sonia Gill
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Sharon Lee
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Wael Jamel
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Simon Bennet
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Chi Chung
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Salena Ward
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | -
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
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44
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Cheng C, Strugnell N, Liu DS. Prophylactic negative pressure dressings for closed emergency laparotomy incisions: where is the evidence? ANZ J Surg 2020; 90:1542-1544. [PMID: 32924304 DOI: 10.1111/ans.15881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Chao Cheng
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia
| | - David S Liu
- Department of Surgery, Northern Health, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
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45
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Azar WJ, Christie EL, Mitchell C, Liu DS, Au-Yeung G, Bowtell DDL. Noncanonical IL6 Signaling-Mediated Activation of YAP Regulates Cell Migration and Invasion in Ovarian Clear Cell Cancer. Cancer Res 2020; 80:4960-4971. [PMID: 32917727 DOI: 10.1158/0008-5472.can-19-3044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/21/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
Ovarian clear cell adenocarcinoma (OCCA) is characterized by a particularly poor response to conventional chemotherapy and a short overall survival time in women with established disease. The development of targeted treatments for OCCA relies on a better understanding of its molecular characteristics. IL6 is strongly expressed in OCCA and may therefore provide a novel therapeutic target. Here we use CRISPR/Cas9 and conditional short hairpin interfering RNA to perform loss-of-function studies in human OCCA cell lines to explore the requirement for IL6 in vitro and in vivo. While reduction of IL6 expression exerted limited effects in vitro, its attenuation significantly impaired tumor growth and neovascularization in vivo. In contrast to typical signaling via STAT3, IL6 in OCCA signaled via a noncanonical pathway involving gp130, Src, and the Hippo pathway protein YAP. A high-throughput combination drug screen identified agents that enhanced cell killing following reduction of IL6 signaling. Intersection of screen hits obtained from two cell lines and orthogonal approaches to attenuation of IL6 yielded AKT and EGFR inhibitors as enhancers of the inhibitory monoclonal IL6 receptor antibody tocilizumab. This study defines for the first time the requirements for, and mechanisms of, signaling by IL6 in human OCCA cell lines and identifies potential combinatory therapeutic approaches. Given the molecular diversity of OCCA, further in vitro and in vivo studies are warranted to determine whether such approaches will overcome the limited efficacy of tocilizumab observed in ovarian cancer to date. SIGNIFICANCE: This study defines the requirements for and mechanisms of noncanonical signaling by IL6 in human ovarian clear cell adenocarcinoma cell lines and identifies combinatory therapeutic approaches to be explored clinically.
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Affiliation(s)
- Walid J Azar
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Elizabeth L Christie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Chris Mitchell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David S Liu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - George Au-Yeung
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David D L Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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46
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Wee M, Liu DS, Thompson SK. Acute gastric dilatation: a life-threatening early complication following laparoscopic hiatus hernia repair. ANZ J Surg 2020; 91:755-757. [PMID: 32820843 DOI: 10.1111/ans.16267] [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] [Received: 06/06/2020] [Revised: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Melissa Wee
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David S Liu
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia
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47
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Liu DS, Stevens S, Wong E, Fong J, Mori K, Ward S, Lee S, Howard T, Jain A, Gill AS, Beh PS, Slevin M, Jamel W, Fleming N, Bennet S, Chung C, Crowe A, Muralidharan V. Pre‐operative and intra‐operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (
PROTECTinG
) study. ANZ J Surg 2020; 90:2449-2455. [DOI: 10.1111/ans.15998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 01/05/2023]
Affiliation(s)
- David S. Liu
- Department of Surgery Austin Health Melbourne Victoria Australia
- Department of Surgery Northern Health Melbourne Victoria Australia
- Department of Surgery and Perioperative Medicine Flinders Medical Centre Adelaide South Australia Australia
| | - Sean Stevens
- Department of Surgery Austin Health Melbourne Victoria Australia
- The University of Melbourne Department of Surgery Austin Health Melbourne Victoria Australia
| | - Enoch Wong
- Department of Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Jonathan Fong
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Krinal Mori
- Department of Surgery Austin Health Melbourne Victoria Australia
- Department of Surgery Northern Health Melbourne Victoria Australia
- The University of Melbourne Department of Surgery Northern Health Melbourne Victoria Australia
| | - Salena Ward
- Department of Surgery Box Hill Hospital Melbourne Victoria Australia
- Eastern Health Clinical School Monash University Melbourne Victoria Australia
| | - Sharon Lee
- Department of Surgery Northern Health Melbourne Victoria Australia
| | - Tess Howard
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Anshini Jain
- Department of Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Anna S. Gill
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Pith S. Beh
- Department of Surgery Northern Health Melbourne Victoria Australia
| | - Maeve Slevin
- Department of Surgery Northern Health Melbourne Victoria Australia
| | - Wael Jamel
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Nicola Fleming
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Simon Bennet
- Department of Surgery Austin Health Melbourne Victoria Australia
| | - Chi Chung
- Department of Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Amy Crowe
- Department of Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery Austin Health Melbourne Victoria Australia
- The University of Melbourne Department of Surgery Austin Health Melbourne Victoria Australia
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48
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Zhang LX, Lemire G, Gonzaga-Jauregui C, Molidperee S, Galaz-Montoya C, Liu DS, Verloes A, Shillington AG, Izumi K, Ritter AL, Keena B, Zackai E, Li D, Bhoj E, Tarpinian JM, Bedoukian E, Kukolich MK, Innes AM, Ediae GU, Sawyer SL, Nair KM, Soumya PC, Subbaraman KR, Probst FJ, Bassetti JA, Sutton RV, Gibbs RA, Brown C, Boone PM, Holm IA, Tartaglia M, Ferrero GB, Niceta M, Dentici ML, Radio FC, Keren B, Wells CF, Coubes C, Laquerrière A, Aziza J, Dubucs C, Nampoothiri S, Mowat D, Patel MS, Bracho A, Cammarata-Scalisi F, Gezdirici A, Fernandez-Jaen A, Hauser N, Zarate YA, Bosanko KA, Dieterich K, Carey JC, Chong JX, Nickerson DA, Bamshad MJ, Lee BH, Yang XJ, Lupski JR, Campeau PM. Further delineation of the clinical spectrum of KAT6B disorders and allelic series of pathogenic variants. Genet Med 2020; 22:1338-1347. [PMID: 32424177 DOI: 10.1038/s41436-020-0811-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/30/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Genitopatellar syndrome and Say-Barber-Biesecker-Young-Simpson syndrome are caused by variants in the KAT6B gene and are part of a broad clinical spectrum called KAT6B disorders, whose variable expressivity is increasingly being recognized. METHODS We herein present the phenotypes of 32 previously unreported individuals with a molecularly confirmed diagnosis of a KAT6B disorder, report 24 new pathogenic KAT6B variants, and review phenotypic information available on all published individuals with this condition. We also suggest a classification of clinical subtypes within the KAT6B disorder spectrum. RESULTS We demonstrate that cerebral anomalies, optic nerve hypoplasia, neurobehavioral difficulties, and distal limb anomalies other than long thumbs and great toes, such as polydactyly, are more frequently observed than initially reported. Intestinal malrotation and its serious consequences can be present in affected individuals. Additionally, we identified four children with Pierre Robin sequence, four individuals who had increased nuchal translucency/cystic hygroma prenatally, and two fetuses with severe renal anomalies leading to renal failure. We also report an individual in which a pathogenic variant was inherited from a mildly affected parent. CONCLUSION Our work provides a comprehensive review and expansion of the genotypic and phenotypic spectrum of KAT6B disorders that will assist clinicians in the assessment, counseling, and management of affected individuals.
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Affiliation(s)
- Li Xin Zhang
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Lemire
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Sirinart Molidperee
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Carolina Galaz-Montoya
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - David S Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Alain Verloes
- Department of Genetics and INSERM UMR1141, APHP-Nord Université de Paris, Robert DEBRE Hospital, Paris and ERN-ITHACA, Paris, France
| | - Amelle G Shillington
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kosuke Izumi
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alyssa L Ritter
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Beth Keena
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elaine Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Bhoj
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer M Tarpinian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emma Bedoukian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Grace U Ediae
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sarah L Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Para Chottil Soumya
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | | | - Frank J Probst
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Jennifer A Bassetti
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Reid V Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Chester Brown
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Philip M Boone
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Boris Keren
- Genetic department, AP-HP, Sorbonne Université, Paris, France
| | - Constance F Wells
- Service de Génétique Clinique, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU de Montpellier, Montpellier, France
| | - Christine Coubes
- Service de Génétique Clinique, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU de Montpellier, Montpellier, France
| | - Annie Laquerrière
- Department of Pathology, Centre for Genomic and Personalized Medicine, UNIROUEN Normandie University, Inserm U1245, Normandy, Rouen, France
| | - Jacqueline Aziza
- Département anatomie et cytologie pathologiques, CHU Toulouse, Toulouse, France
| | - Charlotte Dubucs
- Département anatomie et cytologie pathologiques, CHU Toulouse, Toulouse, France
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Millan S Patel
- BC Children's Hospital Research Institute and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Ana Bracho
- Genetic Research Institute, University of Zulia, Maracaibo, Venezuela
| | | | - Alper Gezdirici
- Department of Medical Genetics, Istanbul Health Science University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Alberto Fernandez-Jaen
- Department of Pediatric Neurology, Hospital Quirónsalud School of Medicine, Universidad Europea, Madrid, Spain
| | | | - Yuri A Zarate
- Department of Pediatrics, Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Katherine A Bosanko
- Department of Pediatrics, Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Klaus Dieterich
- Medical Genetics, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm, U1216, GIN, Grenoble, France
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Jessica X Chong
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Deborah A Nickerson
- Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA.,Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Brotman-Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Xiang-Jiao Yang
- Goodman Cancer Center, Department of Medicine, McGill University, Montreal, QC, Canada
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Philippe M Campeau
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
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49
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Abstract
Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Prompt investigation and definitive surgical treatment are required when pregnant women present with bilious vomiting and new-onset abdominal or back pain especially beyond the first trimester.
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Affiliation(s)
- Eelyn Chong
- Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, Victoria, Australia
| | - David S Liu
- Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia
| | - Vishnupriya Rajagopal
- Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, Victoria, Australia
| | - Neil Strugnell
- Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia
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50
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Liu DS, Zhang H. [Problem of the carbon dioxide embolism during the procedure of transanal total mesorectal excision]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:1110-1114. [PMID: 31874524 DOI: 10.3760/cma.j.issn.1671-0274.2019.12.003] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Carbon dioxide embolization is a special complication of laparoscopic colorectal surgery. It is rarely reported in conventional laparoscopic colorectal surgery, and has not been well recognized by surgeons. Transanal total mesorectal excision (taTME) is an increasingly popular sphincter-preserving surgery for low rectal cancer in recent years. Although the number of cases worldwide is not large, carbon dioxide embolization after operation has been reported successively. Once serious carbon dioxide embolization occurs, the mortality is extremely high. The main related factors of carbon dioxide embolization in taTME include high pressure of pneumoperitoneum, narrow space, abundant blood supply of prostate and vaginal wall, Trendelenburg position, etc. The key of prevention and treatment is to pay attention to the control of related risk factors, identify the early signs of carbon dioxide embolism, and take active and effective symptomatic treatment. Reducing the pressure of pneumoperitoneum perfusion can reduce the occurrence of CO2 embolism. Transesophageal echocardiography is the most sensitive way to monitor intravenously CO2, but it is difficult to carry out in clinical practice. The sudden decrease of end expiratory CO2 partial pressure is an important sign of early detection of CO2 embolism. If there is a suspicious lacuna in the operation, it is possible to reduce or stop the pneumoperitoneum when it is unable to distinguish between normal tissue gap or vascular lumen. If the "bubble sign" is observed, CO2 may enter the vein. The risk of venous embolism should be considered.
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Affiliation(s)
- D S Liu
- Department of Colorectal Tumor Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
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