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Caspase-8 activity mediates TNFα production and restricts Coxiella burnetii replication during murine macrophage infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.02.578698. [PMID: 38352389 PMCID: PMC10862817 DOI: 10.1101/2024.02.02.578698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Coxiella burnetii is an obligate intracellular bacteria which causes the global zoonotic disease Q Fever. Treatment options for infection are limited, and development of novel therapeutic strategies requires a greater understanding of how C. burnetii interacts with immune signaling. Cell death responses are known to be manipulated by C. burnetii, but the role of caspase-8, a central regulator of multiple cell death pathways, has not been investigated. In this research, we studied bacterial manipulation of caspase-8 signaling and the significance of caspase-8 to C. burnetii infection, examining bacterial replication, cell death induction, and cytokine signaling. We measured caspase, RIPK, and MLKL activation in C. burnetii-infected TNFα/CHX-treated THP-1 macrophage-like cells and TNFα/ZVAD-treated L929 cells to assess apoptosis and necroptosis signaling. Additionally, we measured C. burnetii replication, cell death, and TNFα induction over 12 days in RIPK1-kinase-dead, RIPK3-kinase-dead, or RIPK3-kinase-dead-caspase-8-/- BMDMs to understand the significance of caspase-8 and RIPK1/3 during infection. We found that caspase-8 is inhibited by C. burnetii, coinciding with inhibition of apoptosis and increased susceptibility to necroptosis. Furthermore, C. burnetii replication was increased in BMDMs lacking caspase-8, but not in those lacking RIPK1/3 kinase activity, corresponding with decreased TNFα production and reduced cell death. As TNFα is associated with the control of C. burnetii, this lack of a TNFα response may allow for the unchecked bacterial growth we saw in caspase-8-/- BMDMs. This research identifies and explores caspase-8 as a key regulator of C. burnetii infection, opening novel therapeutic doors.
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Radiosurgery Dose Reduction for Brain Metastases on Immunotherapy (RADREMI): One-Year Safety and Efficacy Outcomes from a Multicenter Phase I Trial. Int J Radiat Oncol Biol Phys 2023; 117:S172. [PMID: 37784430 DOI: 10.1016/j.ijrobp.2023.06.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The combination of immunotherapy and single-fraction stereotactic radiosurgery (SRS) for treatment of metastatic brain disease has yielded symptomatic radiation necrosis rates as high as 20% (PMID: 29327059). Consequently, the Radiosurgery Dose Reduction for Brain Metastases on Immunotherapy (RADREMI) multicenter phase I trial (registered at clinicaltrials.gov, NCT04047602) was created to address whether reduced-dose SRS can improve morbidity without compromising efficacy. In this report we present our one-year findings. MATERIALS/METHODS Eligibility for RADREMI enrollment required brain metastases patients with: a) Histologically-confirmed primary malignancy, b) Receipt of immunotherapy within 30 days of SRS, c) 1-10 MRI-visible brain metastases, d) Estimated median survival of at least 6 months (via disease-specific graded prognostic assessment), and e) No history of whole brain radiation therapy. Reduced-dose SRS utilized 18 Gy for lesions 0-2 cm, 14 Gy for lesions 2.1-3 cm, and 12 Gy for lesions 3.1-4 cm. Symptomatic radiation necrosis was defined as imaging findings consistent with radiation necrosis combined with clinical symptoms requiring steroid administration and/or operative intervention. Local control was defined by Response Assessment in Neuro-Oncology (RANO) criteria. RESULTS From December 18, 2019 to June 30, 2022, 54 lesions in 17 patients were treated on RADREMI with at least one-year of follow-up. One-year local control occurred in 52 of 54 lesions and in 15 of 17 patients, yielding control rates of 96% per lesion and 88% per patient. Radiographic radiation necrosis occurred in 2 of 54 lesions (4%). No symptomatic radiation necrosis occurred. CONCLUSION Our findings of concurrent immunotherapy + reduced-dose SRS at one-year post-treatment revealed excellent local control (96%) with no symptomatic radiation necrosis, and minimal radiographic radiation necrosis. These results attest to the durability of the safety and efficacy of reduced-dose SRS with immunotherapy for metastatic brain disease.
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PP01.64 A Safety and Efficacy Analysis Comparing Elderly vs Nonelderly Patients Treated with Consolidation Immunotherapy after Chemoradiation for stage III NSCLC from the BTCRC LUN 16-081 Clinical Trial. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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PP01.44 Long-Term Survival and Outcomes by Race from the Phase I/II trial of Carboplatin, Nab-paclitaxel, and Pembrolizumab for Advanced NSCLC: HCRN LUN13-175. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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MA06.05 Consolidation Nivolumab and Ipilimumab or Nivolumab Alone Following Concurrent Chemoradiation for Patients with Unresectable Stage III NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Can J Surg 2021; 64:S80-S159. [PMID: 35483046 PMCID: PMC8677574 DOI: 10.1503/cjs.021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Darier's disease (also known as keratosis follicularis or dyskeratosis follicularis) is an autosomal dominant inherited disorder which manifests as hyperkeratotic greasy papules in the first or second decade of life. Aside from symptom management and behavioral modifications to avoid triggers, there are currently no validated treatments for Darier's disease (DD). However, a variety of treatments have been proposed in the literature including retinoids, steroids, vitamin D analogs, photodynamic therapy, and surgical excision. The purpose of this review article is to identify therapeutic options for treating DD and to outline the evidence underlying these interventions. A search was conducted in Medline for English language articles from inception to July 4, 2020. Our search identified a total of 474 nonduplicate studies, which were screened by title and abstract. Of these, 155 full text articles were screened against inclusion/exclusion criteria, and 113 studies were included in our review. We identified Grade B evidence for the following treatments of DD: oral acitretin, oral isotretinoin, systemic Vitamin A, topical tretinoin, topical isotretinoin, topical adapalene gel, topical 5-flououracil, topical calciptriol and tacalcitol (with sunscreen), grenz ray radiation, and x-ray radiation. All other evidence for treatments of DD consisted of case reports or case series, which is considered grade C evidence. Considering the quality and quantity of evidence, clinicians may consider initiating a trial of select topical or oral retinoids first in patients with localized or generalized DD, respectively.
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Family history of aortic dissection is not a risk factor in Marfan syndrome with a FBN1 gene mutation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A history family of aortic dissection was considered as a risk factor for aortic dissection in patients with Marfan syndrome with a FBN1 mutation.
Objectives
Evaluate whether a family history of aortic dissection is a risk marker for dissection in this population
Methods
Retrospective study of patients coming to the reference centre between 1996 and 2018, carrying a FBN1 gene mutation. Pedigrees were obtained for each patient, and familial screening actively pursued. Patients with a family history of aortic dissection were compared with patients without family history of aortic dissection.
Results
1700 patients (age 33.2 (±17) years, 51% women) with a FBN1 gene mutation were included. 145 (8,5%) patients underwent aortic dissection at a mean age of 37.9 (±11.4) years and 323 (19%) patients had been operated at 33.8 (±13.9) years.
481 patients had a family history of aortic dissection, including 38 who dissected themselves, and 88 who underwent surgery. 1219 had no family history of aortic dissection, including 107 who dissected themselves, and 235 who underwent surgery.
Therefore, the personal risk for aortic dissection was similar in patients with and without a family history of aortic dissection (38/481, i.e. 7.9% vs 107/1219, i.e. 8.8%), as was the personal risk for prophylactic aortic surgery (88/481, i.e. 18.3% vs. 253/1219, i.e. 17.2%), and the risk for either aortic dissection or prophylactic aortic surgery (118/481, i.e. 24.5% vs. 328/1219, i.e. 26.9%).
Conclusions
In Marfan syndrome with a FBN1 gene mutation, a family history of aortic dissection is not a marker of aortic disease severity.
Funding Acknowledgement
Type of funding sources: None.
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Genotype-phenotype correlations in Marfan syndrome patients with FBN1 mutations: a cohort study on 1575 patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Marfan syndrome (MFS) is a connective tissue disorder in which several systems are affected with great phenotypic variability. Although known to be associated with pathogenic variants in the FBN1 gene, few genotype-phenotype correlations have been found in probands' studies only.
Purpose
The aim of this study is to provide survival curves and genotype-phenotype correlations in all patients with FBN1 mutations, probands and relatives.
Methods
We established survival curves and sought genotype–phenotype correlations in a population of 1575 consecutive MFS patients with pathogenic class 4 or 5 variants in the FBN1 gene. This population represents the most comprehensive clinical database worldwide on MFS.
Results
Global survival was 90% at 60 years. However, lifelong aortic event rate (either dissection or surgery) and survival were impacted by the genotype. Premature termination codons (PTC), resulting in haploinsufficiency, were associated with a shorter life expectancy and a high lifelong risk of an aortic event (83%). Interestingly, these variants were also associated with the highest risk of severe scoliosis (52%) and with a lower risk for ectopia lentis (EL) surgery (13%). Dominant negative in-frame pathogenic variants could be subdivided according to their impact on the cysteine content of fibrillin-1: cysteine loss (–Cys) was associated with high aortic risk (73%) and a higher frequency of EL surgery (43%); cysteine addition was associated with moderate aortic risk (29%) and the highest frequency of EL surgery (48%); unchanged cysteine content was associated with high aortic risk (61%) and lower frequency of EL surgery (23%). No gene-region effect was observed, except for a more severe phenotype for in-frame variants with cysteine loss within the “neonatal region”. Aortic risk was greater for males in all subgroups, and probands were more severely affected.
Conclusions
MFS genotype-phenotype correlations related to pathogenic FBN1 variants exist for aortic and extra-aortic features. This leads us to propose new tools to refine the prognosis in this population. Preventive therapy with β-blockers and restricted exercise should be proposed regardless of the aortic diameter in the high aortic risk groups (PTC and –Cys variants). These results have major consequences on genetic counseling and personalized medicine for patients carrying a FBN1 mutation. This study also improves the overall understanding of the role of FBN1 in various organs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation Coeur et Recherche, Paris, FranceFédération Française de Cardiologie, Paris, France Patients with PTC vs. in-frame mutationsDifferences within in-frame mutations
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141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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81 VIRTUAL: Virtual Interactive Surgical Skills Classroom – An Ongoing Randomized Controlled Trial. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.
Results
Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusions
To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol). Br J Surg 2021. [DOI: 10.1093/bjs/znab282.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.
Result
Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusion
This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.
Take-home Message
This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.
Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.
Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).
Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
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Clinical relevance of genotype–phenotype correlations beyond vascular events in a cohort study of 1500 Marfan syndrome patients with FBN1 pathogenic variants. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2021.04.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bridge to Remission in Biventricular Cardiogenic Shock Associated with Endocrine Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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P03.01 A Randomized Phase II Trial of Adjuvant Pembrolizumab vs Observation after Curative Resection for Stage I NSCLC with Primary Tumors Between 1-4 cm. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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FP01.04 BTCRC LUN19-396: Adjuvant Chemotherapy Plus Atezolizumab in Stage IB-IIIA Resected NSCLC and Clearance of ctDNA. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Electrocardiographic and echocardiographic abnormalities associated with mitral valve prolapse in patients with Marfan syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Marfan syndrome (MFS) is responsible for cardiovascular disorders such as aortic aneurism and mitral valve prolapse (MVP).
A malignant MVP phenotype combining clinical, electrical and morphological features has been described in symptomatic patients who have experienced sudden cardiac death or complex ventricular arrhythmias.
We have taken advantage of the high prevalence of MVP in MFS patient to study the clinical, electrical and echocardiographic abnormalities associated with MVP.
Purpose
The aim of this study is to describe the clinical, electrical and morphological cardiac abnormalities associated with MVP in a cohort of MFS patients with FBN1 mutations with a high prevalence of MVP and who did not suffer from severe ventricular arrhythmias.
Methods
All consecutive patients coming to the National Reference Center for Marfan syndrome were evaluated prospectively i.e. clinical examination, 12-lead electrocardiogram, standard transthoracic echocardiography study and molecular genetic screening.
Results
352 consecutive patients were included from April 2015 to October 2016 [250 FBN1 mutation carriers (MFS) and 102 healthy relatives (HR)]. None of the patients had a history of sudden cardiac death or complex ventricular arrhythmia.
MFS vs HR: MFS patients were younger (33 vs 41yo p<0.001) and 2/3 were women in both groups. In the MFS group, abnormal T waves repolarization in lateral leads were more common [172 MFS (70.2%) vs. 87 HR (86.14%) p<0,0012], as was MVP [38.37% vs 1.96%; p<0,0001], and diastolic hypertrophy of the basal segment of the inferolateral wall (thickness >11mm) [22.31% vs. 9.18%; p<0.0001].
In MFS, MVP affected either one valve (21.22%), or both (17.14%), and was not associated with electric abnormalities. However, diastolic basal inferolateral wall hypertrophy was associated with mitral valve prolapse (p<0,0001), QTc interval prolongation (p<0.0229), abnormal T waves repolarization in the inferior leads (p=0.004), and higher aortic Z-Score (p=0.274).
Conclusion
In MFS patients, the prevalence of MVP is high and no significant association between MVP and electrical abnormalities was found. In contrast, basal inferolateral wall hypertrophy is associated with MVP and repolarization disorders in inferior leads and QTc interval prolongation, i.e, electrocardiographic abnormalities described in malignant MVP.
QTc and basal inferolateral hypertrophy
Funding Acknowledgement
Type of funding source: None
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Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Clinical, electrical and morphological cardiac disorders in Marfan patients with FBN1 mutations. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2020. [DOI: 10.1016/j.acvdsp.2019.09.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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P1.01-67 Ph I/II Carboplatin, Nab-Paclitaxel and Pembrolizumab for Advanced NSCLC (HCRN LUN13-175): Outcomes by Nab-Paclitaxel Dose. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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P2.14-24 An Open-Label Randomized Phase II Study of Combining Osimertinib With and Without Ramucirumab in TKI-Naïve EGFR-Mutant Metastatic NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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P6497Loeys-Dietz syndrome-5: phenotypic spectrum of TGFB3 mutations in an international cohort and first report of a homozygous patient. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mutations in TGFB3 cause Loeys-Dietz syndrome-5 (LDS5), an autosomal dominantly inherited connective tissue disorder. LDS5 is characterized by aortic aneurysms and dissections associated with systemic features mainly involving the ocular and skeletal systems. Precise delineation of LDS5 phenotype is difficult because of the small number of identified cases.
Purpose
The purpose of this study was to further define LDS5 with an emphasis on cardiologic features by describing the genotype and phenotype in an international cohort of patients.
Methods
We performed a retrospective cross-sectional multicentre study. Genetic testing was performed as a part of standard medical care. Clinical data were collected by means of an anonymized questionnaire, which was sent to the referent physicians.
Results
Ten (7 novel) TGFB3 mutations were identified in 31 patients (16 index patients). The mean age at last evaluation was 32 years (range 4–60 years). Aortic root dilatation, varices, and mitral valve insufficiency were the most common cardiovascular findings, reported in 28%, 22%, and 21% of patients, respectively. Higher incidences (40%, 29%, and 25%) of these findings were observed in the index patients. Four patients (8%) underwent aortic surgery, all after age 40. Abdominal aortic aneurysms were reported in 2/26 (8%) patients. Extra aortic artery disease included iliac artery aneurysm (one index patient) and tortuosity of the internal carotid and vertebral arteries (one index patient and one relative). The most frequently reported systemic features were high-arched palate, arachnodactyly, pes planus, pectus deformity, and joint hypermobility. Interestingly, we identified an homozygous TGFB3 mutation in a patient who presented with aortic dilatation at age 17, splenic torsion, severe myopia, cleft palate, and other skeletal features. Her heterozygous parents, brother, and sister displayed signs of the disease, but to a milder degree. To the best of our knowledge, this is the first identification of homozygous TGFB3 mutation.
Conclusions
Our data are in line with previous research, showing that aortic root dilatation is the main cardiovascular feature of LDS5. No deaths related to cardiovascular events were reported in any of the presented families. The cardiovascular phenotype of LDS5 appears to be milder compared to other vascular connective tissue disorder, such as Marfan syndrome, although our findings suggest that homozygosity is associated with a more severe and early-onset phenotype.
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Spatially Fractionated GRID Radiotherapy (SFGRT) in Conjunction with Standard Neoadjuvant Radiotherapy for Very High-Risk Soft Tissue and Osteo- Sarcomas: Promising Pathologic Response with Safe Dose-Escalation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Radiation Therapy Current Practice Capacity and Needs Assessment in Africa. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Re-Irradiation for Rectal Cancer: A Single Institution Experience Utilizing Photons and Protons. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reply to the letter to the editor ‘A centralised multidisciplinary clinic approach for germ cell tumours’ by Crawford. Ann Oncol 2018; 29:2264-2265. [DOI: 10.1093/annonc/mdy418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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P1.16-01 Prognostic Variables Associated with Improved Outcomes in Stage III NSCLC Patients Treated with Consolidation Pembrolizumab. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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OA01.07 Updated Results of a Phase II Trial of Concurrent Chemoradiation with Consolidation Pembrolizumab in Patients with Unresectable Stage III NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Diagnostic accuracy of a calibrated abdominal compression to predict fluid responsiveness in children. Br J Anaesth 2018; 121:1323-1331. [PMID: 30442260 DOI: 10.1016/j.bja.2018.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children. METHODS Patients younger than 8 yr with acute circulatory failure, regardless of their ventilation status, were selected. SVi, calculated as the average of five velocity-time integrals multiplied by the left ventricular outflow tract surface area, was recorded at four different steps: baseline, after an abdominal compression with a calibrated pressure of 25 mm Hg, after return to baseline, and then after a volume expansion (VE) of 10 ml kg-1 lactated Ringer solution over 10 min. Patients were classified as responders if SVi variation after volume expansion (ΔSVi-VE) increased by at least 15%. RESULTS The 39 children included had a median [inter-quartile range (IQR)] age of 9 [5-31] months. Twenty patients were fluid responders and 19 were non-responders. ΔSVi-CAC correlated with ΔSVi-VE (r=0.829; P<0.001). The area under the receiver operating characteristic curve (ROCAUC) was 0.94 [95% confidence interval (CI), 0.85-0.99]. The best threshold for ΔSVi-CAC was 11% with a specificity of 95% [95% CI, 84-100] and a sensitivity of 75% [95% CI, 55-95]. ROCAUC of respiratory variation of IVC diameter (ΔIVC) was 0.53 [95% CI, 0.32-0.72]. CONCLUSION ΔSVi-CAC during abdominal compression was a reliable method to predict fluid responsiveness in children with acute circulatory failure regardless of their ventilation status. CLINICAL TRIALS REGISTRATION CPP Lyon sud est II: n° ANSM 2015-A00388-41 Clinicaltrial.gov: NCT02505646.
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Abstract
CONTEXT Testicular germ-cell tumors (GCT) are highly curable. A multidisciplinary approach, including cisplatin-based chemotherapy has resulted in cure in the majority of patients with GCT. Thus, the life expectancy of survivors will extend to many decades post-diagnosis. Late treatment toxicities associated with cisplatin-based chemotherapy may impact their future health. OBJECTIVE To systematically evaluate evidence regarding the long-term toxicity of cisplatin in GCT survivors. EVIDENCE ACQUISITION We carried out a critical review of PubMed/Medline in February 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) criteria. Eighty-three publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS Included reports evaluated long-term toxicities of cisplatin-based chemotherapy in GCT survivors. Studies reporting neuro- and ototoxicity, secondary malignancies, cardiovascular, renal and pulmonary toxicities, hypogonadism and infertility were found. Seven studies (8%) reported genetic underpinnings of long-term toxicities and 3 (4%) and 14 (19%) studies correlated long-term toxicities with circulating platinum levels and cumulative dose of cisplatin, respectively. Significant risks for long-term toxicities associated with cisplatin and platinum-based regimens were reported. The cumulative dose of cisplatin and circulating platinum were reported as risk factors. Several single-nucleotide polymorphisms identified patients susceptible to cisplatin compared with wild-type individuals. CONCLUSIONS GCT survivors cured with cisplatin-based chemotherapy are at risk for long-term side-effects. Detection of single-nucleotide polymorphisms could be a valuable tool for predicting long-term toxicities. PATIENT SUMMARY Herein, this article summarizes the available evidence of long-term toxicity of cisplatin-based chemotherapy in GCT survivors and provide insights from Indiana University.
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Development of a prognostic system to predict the response to treatment of neutropenic fever. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adjuvant Whole-Pelvic Radiation Therapy (WPRT) for Endometrioid Adenocarcinoma (EA): 45 Gy or 50/50.4 Gy? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adjuvant Therapy for Locoregionally Advanced Endometrioid Adenocarcinoma (EA): Upfront Chemotherapy (UC) or Upfront Radiation Therapy (UR)? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Overall Survival After Endoscopic Surgery Versus Radiation as the Initial Treatment in Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Clinical Outcomes for Esophageal Cancer Patients Treated With Intensity Modulated Radiation Therapy Compared to 3-D Conformal Radiation Therapy: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Radiation Therapy Versus Chemotherapy Impact on Mature and Immature Neural Spine Density, In Addition to Neuronal Architecture, in the Hippocampus. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rare cases of nevoid basal cell carcinoma syndrome without basal cell carcinoma in Omani population. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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PD-019 What effect does pre-operative Enhanced Recovery Protocol counselling have on post-operative length of stay after colorectal resections? Ann Oncol 2015. [DOI: 10.1093/annonc/mdv234.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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SU-E-T-216: Comparison of Volumetrically Modulated Arc Therapy Treatment Using Flattening Filter Free Beams Vs. Flattened Beams for Partial Brain Irradiation. Med Phys 2015. [DOI: 10.1118/1.4924577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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SU-C-210-06: Quantitative Evaluation of Dosimetric Effects Resulting From Positional Variations of Pancreatic Tumor Volumes. Med Phys 2015. [DOI: 10.1118/1.4923851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Surgical safety checklist? Not for me, thanks. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Use of “Virtual” High-Dose-Rate (HDR) Brachytherapy via Spatially Fractionated GRID Radiation Therapy (SFGRT) as Part of Neoadjuvant Therapy in Poor Prognosis, Bulky Sarcomas. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Radiographic Tumor Volume Change as a Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer Patients Who Received Selective Internal Radiation Therapy to the Liver Using Yttrium-90 Resin Microspheres. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Target: a Randomized, Phase Ii Trial Comparing Vintafolide Versus Vintafolide Plus Docetaxel, Versus Docetaxel Alone in Second-Line Treatment of Folate-Receptor-Positive Non-Small Cell Lung Cancer (Nsclc) Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Multi-drug resistance and reduced susceptibility to ciprofloxacin among Salmonella enterica serovar Typhi isolates from the Middle East and Central Asia. New Microbes New Infect 2014; 2:88-92. [PMID: 25356352 PMCID: PMC4184576 DOI: 10.1002/nmi2.46] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/16/2014] [Accepted: 04/18/2014] [Indexed: 12/03/2022] Open
Abstract
Typhoid fever is common in developing countries, with an estimated 120 million infections and 700 000 annual deaths, worldwide. Fluoroquinolones have been the treatment of choice for infection with multidrug-resistant (MDR) Salmonella enterica serovar Typhi (S. Typhi). However, alarming reports of fluoroquinolone-resistance and failure of typhoid fever treatment have recently been published. To determine the proportion of S. Typhi isolates with reduced susceptibility to ciprofloxacin (RSC) from six countries in the Middle East and Central Asia, 968 S. Typhi isolates collected between 2002 and 2007 from Egypt, Uzbekistan, Pakistan, Qatar, Jordan and Iraq were tested for antibiotic susceptibility to five antibiotics using the disc-diffusion method. MDR was defined as resistance to amicillin, chloramphenicol and trimethoprim-sulfamethoxazole. The E-test was employed to determine the MIC of ciprofloxacin only. Nalidixic acid resistance was evaluated as a marker for RSC. Interpretations were made according to CLSI guidelines. MDR strains were considerably more prevalent in Iraq (83%) and Pakistan (52%) compared with the other countries studied (13–52%). Nearly all isolates were susceptible (99.7%) to ceftriaxone. RSC was detected in a total of 218 isolates (22%), mostly from Iraq (54/59, 92%), Uzbekistan (98/123, 80%), Qatar (23/43, 54%) and Pakistan (31/65, 47%). Many of these (21%) were also MDR. Use of nalidixic acid resistance as an indicator for RSC was 99% sensitive and 98% specific. This study reinforces the need for routine antimicrobial susceptibility surveillance of enteric fever isolates and close review of current therapeutic policies in the region.
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Carbon monoxide attenuates bacteria-induced Endothelin-1 expression in second trimester placental explants. Placenta 2014; 35:351-8. [DOI: 10.1016/j.placenta.2014.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 02/01/2023]
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The Brucella suis IbpA heat-shock chaperone is not required for virulence or for expression of the VirB type IV secretion system VirB8 protein. Lett Appl Microbiol 2014; 58:564-8. [PMID: 24517122 DOI: 10.1111/lam.12231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Brucella suis, facultative intracellular bacterial pathogen of mammals, and Agrobacterium tumefaciens, a plant pathogen, both use a VirB type IV secretion system (T4SS) to translocate effector molecules into host cells. HspL, an α-crystalline-type small heat-shock protein, acts as a chaperone for the Agrobacterium VirB8 protein, an essential component of the VirB system. An Agrobacterium mutant lacking hspL is attenuated due to a misfunctional T4SS. We have investigated whether IbpA (BRA0051), the Brucella HspL homologue, plays a similar role. Unlike HspL, IbpA does not interact with VirB8, and an IbpA mutant shows full virulence and no defect in VirB expression. These data show that the Brucella α-crystalline-type small heat-shock protein IbpA is not required for Brucella virulence. SIGNIFICANCE AND IMPACT OF STUDY Many bacteria use type IV secretion systems (T4SS), multi-protein machines, to translocate DNA and protein substrates across their envelope. Understanding how T4SS function is important as they play major roles in the spread of plasmids carrying antibiotic resistance and in pathogenicity. In the plant pathogen Agrobacterium tumefaciens, HspL, an α-crystalline-type small heat-shock protein, acts as a chaperone for the essential type IV secretion system component VirB8. Here, we show that this is not the case for all T4SS; in the zoonotic pathogen Brucella suis, IbpA, the protein most related to HspL, does not play this role.
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Relationship of Osteoradionecrosis of the Mandible to Radiation Dose, Dmax, and Age in Oropharyngeal Cancer Patients. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2013.11.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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