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Wong R, Martin J, Chong TWH. The swinging pendulum of risk management: is it time to reimagine risk in dementia care? Int Psychogeriatr 2024; 36:227-230. [PMID: 38389398 DOI: 10.1017/s1041610224000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Terence W H Chong
- St Vincent's Hospital Melbourne, Kew, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- Royal Melbourne Hospital, Parkville, Australia
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Baccili Cury Megid T, Baskurt Z, Ma LX, Barron CC, Farooq A, Saltiel MP, Wang X, Bach Y, Ayoama H, Jang RW, Chen E, Veit-Haibach P, Wang B, Kalimuthu S, Cotton J, Wong R, Mesci A, Elimova E. Leptomeningeal carcinomatosis and brain metastases in gastroesophageal carcinoma: a real-world analysis of clinical and pathologic characteristics and outcomes. J Neurooncol 2024; 167:111-122. [PMID: 38372902 PMCID: PMC10978709 DOI: 10.1007/s11060-024-04576-8] [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: 12/10/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Brain metastasis (BrM) and Leptomeningeal Carcinomatosis (LMC) are uncommon complications in gastroesophageal carcinoma (GEC) patients. These patients have a poor prognosis and are challenging to treat. We described the clinicopathologic features and outcomes in the largest cohort of Central Nervous System (CNS) metastasis in GEC patients. METHODS single-center retrospective study of GEC treated from 2007 to 2021. Clinicopathologic characteristics and treatment modalities were reviewed. Survival was calculated from the date of CNS diagnosis until date of death/last follow-up using the Kaplan-Meier method. A multivariable Cox proportional hazards regression model was used. RESULTS Of 3283 GEC patients, 100 (3.04%) were diagnosed with BrM and 20 with LMC (0.61%). Patients with known human epidermal growth factor receptor 2 (HER2) status (N = 48), 60% were HER2 positive (defined as IHC 3 + or IHC 2+/FISH+). Among LMC patients most were signet-ring subtype (85%), and only 15% (2/13) were HER2 positive. Median survival was 0.7; 3.8; and 7.7 months in BrM patients treated with best supportive care, radiation, and surgery, respectively (p < 0.001). In LMC, median survival was 0.7 month in patients who had best supportive care (7/19) and 2.8 months for those who had whole brain radiation therapy (p = 0.015). Multivariate analysis showed worse outcomes in ECOG ≥ 2 (p = 0.002), number of BrM ≥ 4 (p < 0.001) and number of metastatic sites (p = 0.009). CONCLUSION HER2 expression were enriched in patients with BrM, while it is uncommon in LMC. Patients treated with surgery followed by radiation had an improved OS in BrM and WBRT benefited patients with LMC.
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Affiliation(s)
| | - Zeynep Baskurt
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Lucy X Ma
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | - Carly C Barron
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | - Abdul Farooq
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Xin Wang
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | - Yvonne Bach
- Department of Medical Oncology and Hematology, University of Toronto, Toronto, Canada
| | - Hiroko Ayoama
- Department of Medical Oncology and Hematology, University of Toronto, Toronto, Canada
| | - Raymond W Jang
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | - Eric Chen
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada
| | - Patrick Veit-Haibach
- Toronto Joint Department Medical Imaging and University Health Network, Sinai Health System, University Medical Imaging Toronto, Women's College Hospital, Toronto, Canada
| | - Ben Wang
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - James Cotton
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Aruz Mesci
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Elena Elimova
- Medical Oncology and Hematology at Princess Margaret Cancer Centre, Toronto, Canada.
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Wong R, Soong D. Disparities in neighbourhood characteristics and 10-year dementia risk by nativity status. Epidemiol Psychiatr Sci 2024; 33:e7. [PMID: 38356391 PMCID: PMC10894703 DOI: 10.1017/s2045796024000076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/27/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
AIMS Prior research indicates that neighbourhood disadvantage increases dementia risk. There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment. To our knowledge, our study is the first to analyse how nativity and neighbourhood interact to influence dementia risk. METHODS Ten years of prospective cohort data (2011-2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+. Cox regression analysed time to dementia diagnosis using nativity status (foreign- or native-born) and composite scores for neighbourhood physical disorder (litter, graffiti and vacancies) and social cohesion (know, help and trust each other), after applying sampling weights and imputing missing data. RESULTS In a weighted sample representing 26.9 million older adults, about 9.5% (n = 2.5 million) identified as foreign-born and 24.4% (n = 6.5 million) had an incident dementia diagnosis. Average baseline neighbourhood physical disorder was 0.19 (range 0-9), and baseline social cohesion was 4.28 (range 0-6). Baseline neighbourhood physical disorder was significantly higher among foreign-born (mean = 0.28) compared to native-born (mean = 0.18) older adults (t = -2.4, p = .02). Baseline neighbourhood social cohesion was significantly lower for foreign-born (mean = 3.57) compared to native-born (mean = 4.33) older adults (t = 5.5, p < .001). After adjusting for sociodemographic, health and neighbourhood variables, foreign-born older adults had a 51% significantly higher dementia risk (adjusted hazard ratio = 1.51, 95% CI = 1.19-1.90, p < .01). There were no significant interactions for nativity with neighbourhood physical disorder or social cohesion. CONCLUSIONS Our findings suggest that foreign-born older adults have higher neighbourhood physical disorder and lower social cohesion compared to native-born older adults. Despite the higher dementia risk, we observed for foreign-born older adults, and this relationship was not moderated by either neighbourhood physical disorder or social cohesion. Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.
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Affiliation(s)
- R. Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - D. Soong
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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McCarthy B, Datta S, Sesa-Ashton G, Wong R, Dawood T, Macefield VG. Differential control of sympathetic outflow to muscle and skin during physical and cognitive stressors. Clin Auton Res 2024; 34:177-189. [PMID: 38308178 PMCID: PMC10944443 DOI: 10.1007/s10286-024-01015-6] [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: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Sympathetic nerve activity towards muscle (MSNA) and skin (SSNA) regulates various physiological parameters. MSNA primarily functions in blood pressure and flow, while SSNA operates in thermoregulation. Physical and cognitive stressors have been shown to have effects on both types of sympathetic activity, but there are inconsistencies as to what these effects are. This article aims to address the discrepancies in the literature and compare MSNA and SSNA responses. METHODS Microelectrode recordings were taken from the common peroneal nerve in 29 participants: MSNA (n = 21), SSNA (n = 16) and both MSNA and SSNA (n = 8). Participants were subjected to four different 2-min stressors: two physical (isometric handgrip task, cold pressor test) and two cognitive (mental arithmetic task, Stroop colour-word conflict test), the latter of which saw participants separated into responders and non-responders to the stressors. It was hypothesised that the physical stressors would have a greater effect on MSNA than SSNA, while the cognitive stressors would operate conversely. RESULTS Peristimulus time histogram (PSTH) analysis showed the mental arithmetic task to significantly increase both MSNA and SSNA; the isometric handgrip task and cold pressor test to increase MSNA, but not SSNA; and Stroop test to have no significant effects on changing MSNA or SSNA from baseline. Additionally, stress responses did not differ between MSNA and SSNA in participants who had both sets of data recorded. CONCLUSIONS This study has provided evidence to support the literature which claims cognitive stressors increase sympathetic activity, and provides much needed SSNA data in response to stressors.
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Affiliation(s)
- Brendan McCarthy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sudipta Datta
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Rebecca Wong
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tye Dawood
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
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Zingeta GT, Worku YT, Awol M, Woldetsadik ES, Assefa M, Chama TZ, Feyisa JD, Bedada HF, Adem MI, Mengesha T, Wong R. Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study. JCO Glob Oncol 2024; 10:e2300253. [PMID: 38181315 DOI: 10.1200/go.23.00253] [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: 07/26/2023] [Revised: 10/11/2023] [Accepted: 11/02/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Head and neck cancers (HNCs) are the third most commonly treated cancer with radiation in Ethiopia. Most patients present with advanced stage and are not candidates for curative treatment. The objective of our study is to assess the outcome of hypofractionated palliative radiotherapy (RT) for advanced HNCs in a resource-limited setting. MATERIALS AND METHODS Patients with histology-proven advanced HNC candidates for hypofractionated palliative RT were enrolled. Three regimens were allowed: 44.4 Gy in 12 fractions, 30 Gy in 10 fractions, and 20 Gy in five fractions. Response to treatment was assessed at baseline and at 4 weeks after treatment completion. The Kaplan-Meier curve was used to measure the survival. RESULTS Between January 2022 and January 2023, 52 patients were enrolled and 25 patients were eligible for outcome assessment. Index symptoms include pain, bleeding, dysphagia, respiratory distress, and others in 25, 13, 10, 6, and 17 patients, respectively. Complete relief of the top three symptoms include pain in 52% of patients, hemostasis in 84% of patients, and dysphagia in 30% of patients. Objectively, 64% of patients attained partial response. For 48% of patients, their quality of life (QoL) improved in one parameter of the physical scores. Moreover, 64% of patients showed improvement in three parameters. The global functional score improved in 80% of patients. One patient had grade 3 xerostomia. At the end of the study period, 44% of patients died. The median survival after radiation was 9 months (95% CI, 7.2 to 10.8). CONCLUSION All palliative hypofractionated regimens used were effective in terms of symptom control, tumor response rate, and QoL, and were well tolerated. This makes it appropriate for our setup because the majority of patients require palliation.
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Affiliation(s)
- Girum Tessema Zingeta
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Tesfaye Worku
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Munir Awol
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Edom Seife Woldetsadik
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsion Zebdios Chama
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jilcha Diribi Feyisa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Lebanon, NH
| | - Hawi Furgassa Bedada
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Oncology, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mohammed Ibrahim Adem
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Oncology, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Rebecca Wong
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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McCarthy B, Datta S, Sesa-Ashton G, Wong R, Henderson LA, Dawood T, Macefield VG. Top-down control of vestibular inputs by the dorsolateral prefrontal cortex. Exp Brain Res 2023; 241:2845-2853. [PMID: 37902866 PMCID: PMC10635918 DOI: 10.1007/s00221-023-06722-6] [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: 06/13/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023]
Abstract
The vestibular apparatus provides spatial information on the position of the head in space and with respect to gravity. Low-frequency sinusoidal galvanic vestibular stimulation (sGVS), a means of selectively changing the firing of vestibular afferents, induces a frequency-dependent perception of sway and, in some individuals, induces nausea. Given that vestibular afferents project to the insular cortex-which forms part of the vestibular cortex-and that the insula receives inputs from the dorsolateral prefrontal cortex (dlPFC), we tested the hypothesis that electrical stimulation of the dlPFC can modulate vestibular inputs. Sinusoidal electrical stimulation (± 2 mA, 0.08 Hz, 100 cycles) was delivered via surface electrodes over (1) the mastoid processes alone (sGVS), (2) electroencephalogram (EEG) site F4 (right dlPFC) and the nasion or (3) to each site concurrently (sGVS + dlPFC) in 23 participants. The same stimulation protocol was used in a separate study to investigate EEG site F3 (left dlPFC) instead of F4 in 13 participants. During sGVS, all participants reported perceptions of sway and 13 participants also reported nausea, neither sensation of which occurred as a result of dlPFC stimulation. Interestingly, when sGVS and dlPFC stimulations were delivered concurrently, vestibular perceptions and sensations of nausea were almost completely abolished. We conclude that the dlPFC provides top-down control of vestibular inputs and further suggests that dlPFC stimulation may provide a novel means of controlling nausea.
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Affiliation(s)
- Brendan McCarthy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sudipta Datta
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Rebecca Wong
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Luke A Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Tye Dawood
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
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Lalor A, Callaway L, Koritsas S, Curran-Bennett A, Wong R, Zannier R, Hill K. Interventions to reduce falls in community-dwelling adults with intellectual disability: a systematic review. J Intellect Disabil Res 2023; 67:1073-1095. [PMID: 37435852 DOI: 10.1111/jir.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND People with intellectual disability have a high risk of falls and falls-related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community-dwelling adults with intellectual disability and the quality of this evidence. METHOD Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18 years or over, at least 50% of study participants had intellectual disability, participants were community-dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4 years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes. CONCLUSION This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large-scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability.
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Affiliation(s)
- A Lalor
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - L Callaway
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - S Koritsas
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - A Curran-Bennett
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - R Wong
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
- IDEAS Therapy Services, Victoria, Australia
| | - R Zannier
- Department of Strategy and Transformation, Scope, Melbourne, Australia, Australia
| | - K Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Krishna S, Sertic A, Liu Z(A, Liu Z, Darling GE, Yeung J, Wong R, Chen EX, Kalimuthu S, Allen MJ, Suzuki C, Panov E, Ma LX, Bach Y, Jang RW, Swallow CJ, Brar S, Elimova E, Veit-Haibach P. Combination of clinical, radiomic, and "delta" radiomic features in survival prediction of metastatic gastroesophageal adenocarcinoma. Front Oncol 2023; 13:892393. [PMID: 37645426 PMCID: PMC10461093 DOI: 10.3389/fonc.2023.892393] [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: 03/09/2022] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
Objectives To identify combined clinical, radiomic, and delta-radiomic features in metastatic gastroesophageal adenocarcinomas (GEAs) that may predict survival outcomes. Methods A total of 166 patients with metastatic GEAs on palliative chemotherapy with baseline and treatment/follow-up (8-12 weeks) contrast-enhanced CT were retrospectively identified. Demographic and clinical data were collected. Three-dimensional whole-lesional radiomic analysis was performed on the treatment/follow-up scans. "Delta" radiomic features were calculated based on the change in radiomic parameters compared to the baseline. The univariable analysis (UVA) Cox proportional hazards model was used to select clinical variables predictive of overall survival (OS) and progression-free survival (PFS) (p-value <0.05). The radiomic and "delta" features were then assessed in a multivariable analysis (MVA) Cox model in combination with clinical features identified on UVA. Features with a p-value <0.01 in the MVA models were selected to assess their pairwise correlation. Only non-highly correlated features (Pearson's correlation coefficient <0.7) were included in the final model. Leave-one-out cross-validation method was used, and the 1-year area under the receiver operating characteristic curve (AUC) was calculated for PFS and OS. Results Of the 166 patients (median age of 59.8 years), 114 (69%) were male, 139 (84%) were non-Asian, and 147 (89%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. The median PFS and OS on treatment were 3.6 months (95% CI 2.86, 4.63) and 9 months (95% CI 7.49, 11.04), respectively. On UVA, the number of chemotherapy cycles and number of lesions at the end of treatment were associated with both PFS and OS (p < 0.001). ECOG status was associated with OS (p = 0.0063), but not PFS (p = 0.054). Of the delta-radiomic features, delta conventional HUmin, delta gray-level zone length matrix (GLZLM) GLNU, and delta GLZLM LGZE were incorporated into the model for PFS, and delta shape compacity was incorporated in the model for OS. Of the treatment/follow-up radiomic features, shape compacity and neighborhood gray-level dependence matrix (NGLDM) contrast were used in both models. The combined 1-year AUC (Kaplan-Meier estimator) was 0.82 and 0.81 for PFS and OS, respectively. Conclusions A combination of clinical, radiomics, and delta-radiomic features may predict PFS and OS in GEAs with reasonable accuracy.
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Affiliation(s)
- Satheesh Krishna
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andrew Sertic
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zhihui (Amy) Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zijin Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gail E. Darling
- Division of Thoracic Oncology, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Jonathon Yeung
- Division of Thoracic Oncology, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Rebecca Wong
- Division of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Eric X. Chen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sangeetha Kalimuthu
- Division of Pathology, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Michael J. Allen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Chihiro Suzuki
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elan Panov
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lucy X. Ma
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yvonne Bach
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Raymond W. Jang
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Carol J. Swallow
- Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Savtaj Brar
- Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elena Elimova
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Wong R, Sesa-Ashton G, Datta S, McCarthy B, Henderson LA, Dawood T, Macefield VG. The role of the dorsolateral prefrontal cortex in control of skin sympathetic nerve activity in humans. Cereb Cortex 2023; 33:8265-8272. [PMID: 37143172 PMCID: PMC10558060 DOI: 10.1093/cercor/bhad112] [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: 01/17/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/06/2023] Open
Abstract
The dorsolateral prefrontal cortex (dlPFC) is primarily involved in higher order executive functions, with there being evidence of lateralization. Brain imaging studies have revealed its link to the generation of skin sympathetic nerve activity (SSNA), which is elevated in states of emotional arousal or anxiety. However, no studies have directly explored dlPFC influences on SSNA. Transcranial alternating current stimulation (-2 to 2 mA, 0.08 Hz, 100 cycles) was applied between the left or right dlPFC and nasion via surface electrodes. Spontaneous bursts of SSNA were recorded from the common peroneal nerve via a tungsten microelectrode in 21 healthy participants. The modulation index was calculated for each stimulation paradigm by constructing cross-correlation histograms between SSNA and the sinusoidal stimulus. Stimulation of the dlPFC caused significant modulation of SSNA, but there was no significant difference in the median modulation index across sides. Stimulation also caused cyclic modulation of skin blood flow and sweat release. We have shown for the first time that stimulation of the dlPFC causes modulation of SSNA, also reflected in the effector-organ responses. This supports a role for the dlPFC in the control of SSNA, which likely contributes to the ability of emotions to bring about cutaneous vasoconstriction and sweat release.
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Affiliation(s)
- Rebecca Wong
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, Australia
| | | | - Sudipta Datta
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, Australia
| | - Brendan McCarthy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, Australia
| | - Luke A Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, The University of Sydney, NSW, Australia
| | - Tye Dawood
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, Australia
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, Australia
- Department of Anatomy and Physiology, The University of Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, VIC, Australia
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Jaswa EG, Pasch LA, McGough A, Wong R, Corley J, Cedars MI, Huddleston HG. Decision regret among women considering planned oocyte cryopreservation: a prospective cohort study. J Assist Reprod Genet 2023:10.1007/s10815-023-02789-w. [PMID: 37058259 DOI: 10.1007/s10815-023-02789-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE To (1) prospectively characterize the incidence of decision regret among women considering planned oocyte cryopreservation (planned OC), comparing those who pursued treatment vs those who did not freeze eggs, and (2) to identify baseline predictors for future decision regret. METHODS A total of 173 women seen in consultation for planned OC were followed prospectively. Surveys were administered at (1) baseline (< 1 week after initial consultation) and (2) follow-up, 6 months after planned OC among participants who froze eggs or 6 months following consultation in the absence of further communication to pursue treatment. The primary outcome was the incidence of moderate-to-severe decision regret, indicated by a Decision Regret Scale score > 25. We also examined predictors of regret. RESULTS The incidence of moderate-to-severe regret over the decision to freeze eggs was 9% compared to 51% over the decision not to pursue treatment. Among women who froze eggs, adequacy of information at baseline to decide about treatment (aOR 0.16, 95% CI 0.03, 0.87) and emphasis on future parenthood (aOR 0.80, 95% CI 0.66, 0.99) were associated with reduced odds of regret. Forty-six percent of women who froze eggs regretted not doing so earlier. Among women who did not freeze eggs, the primary reasons were financial and time constraints, correlating with increased odds of decision regret in an exploratory analysis. CONCLUSIONS Among women undergoing planned OC, the incidence of decision regret is low compared to the regret confronting women seen in consultation for planned OC but who do not pursue treatment. Provider counseling is key to offset the regret risk.
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Affiliation(s)
- Eleni G Jaswa
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | - Lauri A Pasch
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Alexandra McGough
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Rebecca Wong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Jamie Corley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Marcelle I Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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Munisteri M, Wong R, Loza L, Scott LLF, Keyser EA, Gonzalez-Brown V. Resident Trainee Access and Barriers to Routine Health Services in the Military Health System. J Surg Educ 2023; 80:581-587. [PMID: 36933931 DOI: 10.1016/j.jsurg.2023.01.005] [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] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Resident physician wellness has been a highly contentious topic in graduate medical education over the past 2 decades. Physicians, including residents and attending physicians, are more likely than other professionals to work through illness and delay necessary healthcare screening appointments. Potential reasons for underutilization of health care include-unpredictable work hours, limited time, concerns about confidentiality, poor support from training programs, and apprehension about the impact on their peers. The goal of this study was to evaluate access to health care amongst resident physicians within a large military training facility. DESIGN This is an observational study using Department of Defense approved software to distribute an anonymous ten question survey on routine health care practices of residents. The survey was distributed to a total of 240 active-duty military resident physicians at a large tertiary military medical center. RESULTS One hundred seventy-eight residents completed the survey with a 74% response rate. Residents from 15 specialty areas responded. Compared to male counterparts', female residents were more likely to miss routine scheduled health care appointments to include, behavioral health appointments (54.2% vs 28%, p < 0.01). Female residents were more likely to report that attitudes toward missing clinical duties for health care appointments impacted their decision to start or add to their family more than male coresidents (32.3% vs 18.3%, p = 0.03). Surgical residents are also more likely to miss routine screening appointments or scheduled follow ups than residents in nonsurgical training programs; (84.0-88% compared to 52.4%-62.8%) respectively. CONCLUSIONS Resident health and wellness have long been an issue, with resident physical and mental health being negatively impacted during residency. Our study notes that residents in the military system also face barriers accessing routine health care. Female surgical residents being the demographic most significantly impacted. Our survey highlights cultural attitudes in military graduate medical education regarding the prioritization of personal health, and the negative impact that can have on residents' utilization of care. Our survey also raises concerns particularly amongst female surgical residents, that these attitudes may impact career advancement, as well as influence their decision to start or add to their families.
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Affiliation(s)
- Meghan Munisteri
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas.
| | - Rebecca Wong
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Lina Loza
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Laura L F Scott
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas; Maternal-Fetal Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Erin A Keyser
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Veronica Gonzalez-Brown
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas; Maternal-Fetal Medicine, Brooke Army Medical Center, San Antonio, Texas
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12
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Ma LX, Espin-Garcia O, Bach Y, Aoyama H, Allen MJ, Wang X, Darling GE, Yeung J, Swallow CJ, Brar S, Veit-Haibach P, Kalimuthu S, Wong R, Chen EX, O’Kane GM, Jang RW, Elimova E. Comparison of Four Clinical Prognostic Scores in Patients with Advanced Gastric and Esophageal Cancer. Oncologist 2023; 28:214-219. [PMID: 36378560 PMCID: PMC10020804 DOI: 10.1093/oncolo/oyac235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prognostic scores that can identify patients at risk for early death are needed to aid treatment decision-making and patient selection for clinical trials. We compared the accuracy of four scores to predict early death (within 90 days) and overall survival (OS) in patients with metastatic gastric and esophageal (GE) cancer. METHODS Advanced GE cancer patients receiving first-line systemic therapy were included. Prognostic risks were calculated using: Royal Marsden Hospital (RMH), MD Anderson Cancer Centre (MDACC), Gustave Roussy Immune (GRIm-Score), and MD Anderson Immune Checkpoint Inhibitor (MDA-ICI) scores. Overall survival (OS) was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to analyze associations between prognostic scores and OS. The predictive discrimination was estimated using Harrell's c-index. Predictive ability for early death was measured using time-dependent AUCs. RESULTS In total, 451 patients with metastatic GE cancer were included. High risk patients had shorter OS for all scores (RMH high- vs. low-risk median OS 7.9 vs. 12.2 months, P < .001; MDACC 6.8 vs. 11.9 months P < .001; GRIm-Score 5.3 vs. 13 months, P < .001; MDA-ICI 8.2 vs. 12.2 months, P < .001). On multivariable analysis, each prognostic score was significantly associated with OS. The GRIm-Score had the highest predictive discrimination and predictive ability for early death. CONCLUSIONS The GRIm-Score had the highest accuracy in predicting early death and OS. Clinicians may use this score to identify patients at higher risk of early death to guide treatment decisions including clinical trial enrolment. This score could also be used as a stratification factor in future clinical trial designs.
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Affiliation(s)
- Lucy X Ma
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yvonne Bach
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Hiroko Aoyama
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Michael J Allen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Xin Wang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Canada
| | - Savtaj Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Sangeetha Kalimuthu
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Eric X Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Grainne M O’Kane
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Raymond W Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Elena Elimova
- Corresponding author: Elena Elimova, 700 University Ave, Toronto, ON M5G 1Z5, Canada. Tel: 416 946-2520; Fax: 416 946 6546; Email
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Affiliation(s)
- D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - R Wong
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - R Kearsley
- Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland
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14
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Lukovic J, Hosni A, Liu A, Chen J, Tadic T, Patel T, Li K, Han K, Lindsay P, Craig T, Brierley J, Barry A, Wong R, Ringash J, Dawson LA, Kim JJ. Evaluation of dosimetric predictors of toxicity after IMRT with concurrent chemotherapy for anal cancer. Radiother Oncol 2023; 178:109429. [PMID: 36455685 DOI: 10.1016/j.radonc.2022.11.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study investigates the impact of dosimetric parameters on acute and late toxicity for patients with anal squamous cell carcinoma (SCC) treated with image-guided intensity modulated radiation therapy (IG-IMRT) and concurrent chemotherapy. MATERIALS AND METHODS Patients were enrolled in an observational cohort study between 2008 and 2013 (median follow-up 3.4 years). They were treated with standardized target and organ-at-risk (OAR) contouring, planning, and IG-IMRT. Radiotherapy dose, based on clinicopathologic features, ranged from 45 Gy to 63 Gy to gross targets and 27 Gy to 36 Gy to elective targets. Chemotherapy was concurrent 5-fluorouracil and mitomycin C (weeks 1&5). Toxicity was prospectively graded using NCI CTCAE v.3 and RTOG scales. Logistic regression was used to assess the association between dose/volume parameters (e.g small bowel V5) and corresponding grade 2 + and 3+ (G2+/3 + ) toxicities (e.g. diarrhea). RESULTS In total, 87 and 79 patients were included in the acute and late toxicity analyses, respectively. The most common acute G2 + toxicities were skin (dermatitis in 87 % [inguino-genital skin], 91 % [perianal skin]) and hematologic in 58 %. G2 + late anal toxicity (sphincter dysfunction), gastrointestinal toxicity, and skin toxicity were respectively experienced by 49 %, 38 %, and 44 % of patients. Statistically significant associations were observed between: G2 + acute diarrhea and small bowel V35; G2 + acute genitourinary toxicity and bladder D0.5cc; G2 + inguino-genital skin toxicity and anterior skin V35; G2 + perianal skin toxicity and posterior skin V15; G2 + anemia and lower pelvis bone V45. D0.5 cc was significantly predictive of late toxicity (G2 + anal dysfunction, intestinal toxicity, and inguino-genital/perianal dermatitis). Maximum skin toxicity grade was significantly correlated with the requirement for a treatment break. CONCLUSION Statistically significant dose-volume parameters were identified and may be used to offer individualized risk prediction and to inform treatment planning. Additional validation of the results is required.
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Affiliation(s)
- Jelena Lukovic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Jasmine Chen
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Tony Tadic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Kecheng Li
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kathy Han
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Patricia Lindsay
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tim Craig
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - James Brierley
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Aisling Barry
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John J Kim
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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15
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Macefield V, Sesa-Ashton G, Wong R, McCarthy B, Datta S, Henderson L, Dawood T. Stimulation of the dorsolateral prefrontal cortex modulates sympathetic nerve activity to muscle and skin in humans. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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16
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Vasudevan Nampoothiri R, Yeung J, Pierre A, Wong R, Darling G, Kim J, Siu LL, Chen E, Bouttell E, Knox J, Kim D(DH, Lipton JH. Outcomes of patients with esophageal cancer after allogeneic hematopoietic stem cell transplantation. J Gastrointest Oncol 2022; 13:2705-2712. [PMID: 36636086 PMCID: PMC9830323 DOI: 10.21037/jgo-22-700] [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: 07/21/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The improving survival in patients after allogeneic hematopoietic stem cell transplantation (aHCT) has warranted an increased attention to the long-term complications after aHCT especially second malignancies. The risk of developing esophageal cancer is thought to be higher than other malignancies after aHCT. There are limited data on the clinical characteristics, staging, treatment options and outcomes in these patients. Methods We retrospectively reviewed all patients who underwent aHCT at our centre over 30 years and identified patients who developed secondary esophageal cancer. Patients were analyzed for transplant details, disease characteristics and therapy, relapse free survival (RFS), and overall survival (OS). Results Ten patients [females 40% (n=4); median age 62 years] were diagnosed with esophageal cancer after a median duration of 5.8 years since aHCT. The standardized incidence ratio (SIR) for esophageal ca after aHCT was 1.96. Five patients (55.5%) had advanced clinical stages (stage III-IV) at diagnosis. Esophagectomy (with or without neoadjuvant chemotherapy) was performed in 50% (n=5) patients. Remission was achieved in 70% (n=7) of patients while 1 patient had progressive disease after planned treatment. Progressive disease was the cause in 50% (n=3) of deaths. Estimated 2- and 5-year overall survival after diagnosis of esophageal cancer was 60% and 45% respectively (median survival: 44.1 months). Conclusions Despite the higher risk and increased incidence of esophageal cancer after aHCT, the outcomes these patients may be comparable to that in general population if diagnosed early. This implies the need for continued long term follow-up for patients after aHCT with a transplant physician.
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Affiliation(s)
- Ram Vasudevan Nampoothiri
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Yeung
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pierre
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gail Darling
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Bouttell
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dennis (Dong Huan) Kim
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H. Lipton
- Hans Messner Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Wong R, Gerstein H, Punthakee Z. Novel Combination of Continuous Glucose Monitoring Metrics to Predict HbA1c in Type 2 Diabetes. Can J Diabetes 2022. [DOI: 10.1016/j.jcjd.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Chew N, Zhang A, Kong G, Lee KL, Ng CH, Chong B, Ngiam N, Loh PH, Kuntjoro I, Wong R, Kong W, Yeo TC, Poh KK. Prognostically distinct phenotypes of metabolic health beyond obesity in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1608] [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: 11/13/2022] Open
Abstract
Abstract
Background
Whilst current evidence are in favour of metabolic health and non-obesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) based on the presence of metabolic health and obesity.
Methods
This retrospective cohort on consecutive patients presenting with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups based on obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to Program Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, sex, chronic kidney disease and AVR as a time-dependent covariate.
Results
Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%) and MHO (6.9%) groups (p=0.001). Compared to MHNO, MHO (HR 0.159, 95% CI 0.038–0.668, p=0.012) and MUO (HR 0.614, 95% CI 0.403–0.937, p=0.024) were independently associated with lower all-cause mortality rates, after adjusting for confounders. In obese patients, metabolic health had favourable survival compared to metabolically unhealthy (p=0.015), but this protective impact of metabolic health was not observed in overweight or normal weight individuals. Obesity had favourable survival compared to overweight and normal weight, in both metabolically health (p=0.002) and unhealthy (p=0.007) patients,
Conclusion
MHO patients with AS have the most favourable prognosis whilst the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift towards prioritising metabolic health rather than weight reduction in patients with significant AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Health System , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - K L Lee
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - B Chong
- National University of Singapore , Singapore , Singapore
| | - N Ngiam
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - R Wong
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
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Tie J, Cohen J, Lahouel K, Lo S, Wang Y, Wong R, Shapiro J, Harris S, Khattak A, Burge M, Horvath L, Karapetis C, Shannon J, Singh M, Yip D, Papadopoulos N, Tomasetti C, Kinzler K, Vogelstein B, Gibbs P. 318MO Circulating tumour DNA (ctDNA) dynamics, CEA and sites of recurrence for the randomised DYNAMIC study: Adjuvant chemotherapy (ACT) guided by ctDNA analysis in stage II colon cancer (CC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Murad S, Wong R, Brierley J, Ortega C, Kulanthaivelu R, Hinzpeter R, Hussey D, Duder J, Metser U. 107: Prevalence of Oligometastases at Initial Staging of Neuroendocrine Tumours? A 68GA DOTATATE PET (GA68PET) Population-Based Registry Estimate. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mariño R, Delany C, Manton DJ, Reid K, Satur J, Crombie F, Wong R, McNally C, Adams GG, Lopez D, Celentano A, Lim M, Morgan M. Preparedness for practice of newly qualified dental practitioners in the Australian context: an exploratory study. BMC Med Educ 2022; 22:625. [PMID: 35978326 PMCID: PMC9385413 DOI: 10.1186/s12909-022-03684-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/08/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND The current study explored the perspectives of preparedness for dental practice from a range of relevant stakeholders (i.e., educators, employers, final-year students, graduates, practitioners, and professional associations) using an anonymous online survey in which participants described either their preparedness for practice, or the preparedness of graduates they have encountered, across six domains. RESULTS A total of 120 participants completed the survey. Participants were from several Australian states and territories; regional, rural, and urban locations; and working in the public and private sector. Students and new graduates generally felt prepared for activities in all the identified domains. Stakeholders reported consistently that the knowledge of dental profession graduates was at the required level to enter practice in Australia in a safe way. Activities involving the knowledge of clinical entrepreneurship and financial solvency were the dimensions where students and graduates felt least prepared (e.g., explaining fees, negotiating finances). In the domains involving clinical and technical competencies, students and new graduates self-assessed as less prepared around managing dental trauma and medical emergencies. On the other hand, activities around social and community orientation, and to a lesser extent professional attitudes and ethical judgements, were the dimensions where students and graduates felt the most prepared. CONCLUSIONS Present findings indicate that there appear to be good standards of preparedness for practice for graduate dental professionals. This exploratory study provides insights into the nature of preparedness for Australian dental professionals and provides a basis for targeting education and professional development to address areas of need.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Clare Delany
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - David J. Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
- Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Katharine Reid
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Julie Satur
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Rebecca Wong
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Clare McNally
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Geoffrey G. Adams
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Diego Lopez
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Celentano
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Mathew Lim
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Mike Morgan
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Anconina R, Ortega C, Metser U, Liu ZA, Elimova E, Allen M, Darling GE, Wong R, Taylor K, Yeung J, Chen EX, Swallow CJ, Jang RW, Veit-Haibach P. Combined 18 F-FDG PET/CT Radiomics and Sarcopenia Score in Predicting Relapse-Free Survival and Overall Survival in Patients With Esophagogastric Cancer. Clin Nucl Med 2022; 47:684-691. [PMID: 35543637 DOI: 10.1097/rlu.0000000000004253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/14/2022]
Abstract
PURPOSE The aim of this study was to determine if radiomic features combined with sarcopenia measurements on pretreatment 18 F-FDG PET/CT can improve outcome prediction in surgically treated adenocarcinoma esophagogastric cancer patients. PATIENTS AND METHODS One hundred forty-five esophageal adenocarcinoma patients with curative therapeutic intent and available pretreatment 18 F-FDG PET/CT were included. Textural features from PET and CT images were evaluated using LIFEx software ( lifexsoft.org ). Sarcopenia measurements were done by measuring the Skeletal Muscle Index at L3 level on the CT component. Univariable and multivariable analyses were conducted to create a model including the radiomic parameters, clinical features, and Skeletal Muscle Index score to predict patients' outcome. RESULTS In multivariable analysis, we combined clinicopathological parameters including ECOG, surgical T, and N staging along with imaging derived sarcopenia measurements and radiomic features to build a predictor model for relapse-free survival and overall survival. Overall, adding sarcopenic status to the model with clinical features only (likelihood ratio test P = 0.03) and CT feature ( P = 0.0037) improved the model fit for overall survival. Similarly, adding sarcopenic status ( P = 0.051), CT feature ( P = 0.042), and PET feature ( P = 0.011) improved the model fit for relapse-free survival. CONCLUSIONS PET and CT radiomics derived from combined PET/CT integrated with clinicopathological parameters and sarcopenia measurement might improve outcome prediction in patients with nonmetastatic esophagogastric adenocarcinoma.
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Affiliation(s)
- Reut Anconina
- From the Department of Medical Imaging, Sunnybrook Health Sciences Centre
| | - Claudia Ortega
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
| | - Ur Metser
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
| | | | - Elena Elimova
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Michael Allen
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network
| | | | - Kirsty Taylor
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network
| | - Eric X Chen
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Carol J Swallow
- Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Raymond W Jang
- Medical Oncology, Princess Margaret Cancer Centre, University Health Network
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network
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Wang CA, Wong R, Kou TD, Zheng H, Wittstock K, Khaychuk V, Patel V. POS0343 TREATMENT PERSISTENCE AND ADHERENCE AMONG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS RECEIVING ABATACEPT OR TNF INHIBITORS USING US CLAIMS DATA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1289] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundJuvenile idiopathic arthritis (JIA) is the most common rheumatic condition among children and teens1 and contributes to a diminished quality of life.2 Previous data underscore the potential for abatacept to improve health-related outcomes in patients with JIA after demonstrating poor responses to other DMARDs.3 Patients with RA show greater persistence on abatacept vs TNF inhibitors (TNFi), and this should also be confirmed in patients with JIA.4ObjectivesTo evaluate treatment persistence and adherence at 12- and 18-month follow-up in patients with JIA newly initiating either abatacept or a TNFi.MethodsThis analysis used data from the IQVIA PharMetrics Plus claims database from Jan 2008–Apr 2021. We identified patients with ≥ 1 claim of JIA diagnosis after Jan 2008, who were < 18 years old at initial diagnosis, had ≥ 1 claim of abatacept or TNFi treatment (adalimumab, etanercept, golimumab) following diagnosis, had continuous enrollment in medical and pharmacy benefits for ≥ 12 months before index date (first prescription of abatacept or TNFi), and had 12 or 18 months’ continuous medical and pharmacy enrollment after index date. Patients receiving abatacept or TNFi treatment ≤ 12 months prior to index date and patients initiating combined abatacept + TNFi treatment on the index date were excluded. Specific outcomes included: discontinuation (absence of a new prescription for index treatment within the gap of 5× treatment half-life), persistence rate (proportion of patients continuing index medication without any gaps exceeding 5× treatment half-life), and treatment adherence (defined as medication possession ratio [MPR, proportion of follow-up period where medication supply is available] and proportion of days covered [PDC, proportion of follow-up period where a patient is covered by a given drug]). All outcomes were reported at 12 and 18 months. All statistical analyses are descriptive with the intent for hypothesis generation.ResultsThere were 2847 patients (abatacept, n = 111; TNFi, n = 2736) at 12-month follow-up; fewer completed the 18-month follow-up (2403 patients: abatacept, n = 94; TNFi, n = 2309). At index date, treatment groups were similar for sex, geographic location, and comorbidities (Table 1). Numerically higher persistence was observed in patients prescribed abatacept compared with TNFi overall at both time points. Abatacept persistence was higher than etanercept but similar to adalimumab (Figure 1). At 12 months, the percent of patients with PDC ≥ 0.8 was 57% for abatacept, 51% for adalimumab, and 38% for etanercept, while MPR ≥ 0.8 was 63% for abatacept, 55% for adalimumab, and 42% for etanercept. Patients prescribed abatacept had numerically greater proportions of PDC ≥ 0.8 (abatacept, 48%; adalimumab, 40%; etanercept, 29%) and MPR ≥ 0.8 (abatacept, 53%; adalimumab, 44%; etanercept, 33%) at 18 months.Table 1.Baseline characteristics of patients with 12-month follow-up dataCharacteristicAbatacept (n = 111)TNFi (n = 2736)Age, years, mean (SD)14.4 (3.8)12.6 (4.6)Female sex89 (80.2)1930 (70.5)Geographic region South43 (38.7)865 (31.6) Midwest40 (36.0)818 (29.9) West9 (8.1)408 (14.9) East19 (17.1)540 (19.7) Unknown0 (0)105 (3.8)Comorbidities Asthma9 (8.1)275 (10.1) COPD11 (9.9)323 (11.8) Cardiovascular disease14 (12.6)222 (8.1) Uveitis14 (12.6)321 (11.7) Iridocyclitisa12 (10.8)216 (7.9)CCI score, mean (SD)0.58 (0.73)0.46 (0.68)Data are shown as n (%) unless otherwise specified.aSubgroup disease under uveitis.CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease.ConclusionThe present findings suggest that patients with JIA initiating abatacept treatment display numerically higher persistence and adherence compared with patients treated with TNFis at both 12- and 18-months’ follow-up.References[1]Prakken B, et al. Lancet 2011;377:2138–49.[2]Lovell DJ, et al. Arthritis Rheumatol 2015;67:2759–70.[3]Ruperto N, et al. Lancet 2008;372:383–91.[4]Han X, et al. J Health Econ Outcomes Res 2021;8:71–8.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Medical writing and editorial assistance were provided by Ryan Miller, of Caudex, and were funded by Bristol Myers Squibb. Project analysis was provided by Akshay Vinod (Mu Sigma).Disclosure of InterestsChing-An Wang Consultant of: Novartis (used to work there as an external contractor from Jan 2016 to Apr 2021), Employee of: Bristol Myers Squibb, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Tzuyung Douglas Kou Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Hanke Zheng Employee of: Bristol Myers Squibb, Keith Wittstock Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vadim Khaychuk Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vardhaman PATEL Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Emery P, Fleischmann R, Wong R, Lozenski K, Tanaka Y, Bykerk V, Bingham C, Huizinga T, Citera G, Elbez Y, Perera V, Murthy B, Maxwell K, Passarell J, Hedrich W, Williams D. POS0579 ABSENCE OF ASSOCIATION BETWEEN ABATACEPT EXPOSURE LEVELS AND INITIAL INFECTION IN PATIENTS WITH RA: A POST HOC ANALYSIS OF THE RANDOMIZED, PLACEBO-CONTROLLED AVERT-2 STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.44] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundInfections are the most commonly reported AE observed in patients with RA treated with immunosuppressive therapies and can be clinically significant. A recent review reported differences in the risk of infection for some biologics such as tocilizumab and TNF inhibitors.1 Abatacept selectively modulates T-cell co-stimulation and is approved for the treatment of RA. In patients with polyarticular-course juvenile idiopathic arthritis, no association was found between higher serum abatacept exposure and the incidence of infection.2 This has not been evaluated for adult patients with RA.ObjectivesTo determine if higher serum abatacept exposure during treatment with SC abatacept was associated with increased risk of infection in adult patients with RA.MethodsAVERT-2 (Assessing Very Early Rheumatoid arthritis Treatment-2) was a randomized, placebo-controlled study of SC abatacept + MTX vs abatacept placebo + MTX in MTX-naive, anti-citrullinated protein antibody–positive patients with early, active RA.3 A post hoc population pharmacokinetic (PK) analysis was performed using PK-evaluable patient data from the induction period (year 1) of AVERT-2. Association between steady-state abatacept exposure (min plasma concentration [Cmin], max plasma concentration [Cmax], and average plasma concentration [Cavg]) and first infection was evaluated using Kaplan–Meier plots of probability vs time on treatment by abatacept exposure quartiles and Cox proportional-hazards models.ResultsPK of SC abatacept was defined as a linear 2-compartment model with first-order absorption and first-order elimination. The findings of the updated PK analysis were consistent with those reported in prior population analyses of abatacept PK in adults with RA. The final model included effects of baseline body weight, estimated glomerular filtration rate, sex, age, albumin, MTX use, NSAID use, SJC, and race on abatacept clearance. The only covariate with a clinically relevant effect was higher body weight, which caused an increase in clearance and volume. Infections occurred in a total of 330/693 (47.6%; serious, 1.6%) patients treated with abatacept, and 134/301 (44.5%; serious, 1.3%) with placebo during the first year of AVERT-2. In patients taking abatacept, the mean (SD) study exposure to abatacept was 376 (60) days, while mean (SD) prednisone equivalent dose was 6.7 (3.8) mg/day and mean (SD) MTX dose was 9.6 (3.0) mg/week. No exposure–response relationship was observed between the probability of first infection and steady-state abatacept exposure quartiles (Cavg, Cmin, and Cmax), or compared with placebo (Figure 1A–C). Kaplan–Meier assessment also showed no increase in risk of infection with concomitant use of MTX and glucocorticoids.ConclusionNo association was found between initial infection and steady-state abatacept exposure (Cavg, Cmin, Cmax) or MTX and glucocorticoid use in patients with RA treated with SC abatacept.References[1]Jani M, et al. Curr Opin Rheumatol 2019;31:285–92.[2]Ruperto N, et al. J Rheumatol 2021;48:1073–81.[3]Emery P, et al. Arthritis Rheumatol 2019;71(suppl 10):L11.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Writing and editorial assistance were provided by Fiona Boswell, PhD, of Caudex, and was funded by Bristol Myers Squibb. Support was provided by Sandra Overfield as Protocol Manager, and Prema Sukumar and Renfang Hwang as Data Science Leads.Disclosure of InterestsPaul Emery Consultant of: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung, Grant/research support from: AbbVie, Bristol Myers Squibb, Eli Lilly, Novartis, Pfizer, Roche, Samsung, Roy Fleischmann Consultant of: Amgen, AbbVie, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Novartis, Pfizer, Grant/research support from: Amgen, AbbVie, Arthrosi, Biosplice, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Horizon, Novartis, Pfizer, Regeneron, TEVA, UCB, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Karissa Lozenski Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Yoshiya Tanaka Speakers bureau: AbbVie, Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead, Mitsubishi Tanabe, YL Biologics, Consultant of: AbbVie, Ayumi, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Taisho, Sanofi, Grant/research support from: AbbVie, Asahi Kasei, Boehringer Ingelheim, Chugai, Corrona, Daiichi Sankyo, Eisai, Kowa, Mitsubishi Tanabe, Takeda, Vivian Bykerk Consultant of: Amgen, Bristol Myers Squibb, Genzyme Corporation, Gilead, Regeneron, UCB, Grant/research support from: Amgen, Bristol Myers Squibb, Genzyme Corporation, Pfizer, Regeneron, Sanofi Aventis, UCB, Clifton Bingham Consultant of: AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Sanofi, Grant/research support from: Bristol Myers Squibb, Thomas Huizinga Speakers bureau: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Consultant of: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Grant/research support from: Abblynx, Abbott, Biotest AG, Bristol Myers Squibb, Crescendo Bioscience, Eli Lilly, Epirus, Galapagos, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi- Aventis, UCB, Gustavo Citera Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Yedid Elbez Consultant of: Bristol Myers Squibb, Employee of: Signifience, Vidya Perera Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Bindu Murthy Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Kelly Maxwell Consultant of: Bristol Myers Squibb, Employee of: Cognigen Corporation, Julie Passarell Consultant of: Bristol Myers Squibb, Employee of: Cognigen Corporation, William Hedrich: None declared, Daphne Williams Consultant of: Black Diamond Network, Joule, Syneos, Employee of: Bristol Myers Squibb.
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McKenzie J, Kosmider S, Wong R, To Y, Shapiro J, Dunn C, Burge M, Hong W, Caird S, Lim S, Wong H, Lee B, Gibbs P, Wong V. P-187 Epidermal growth factor receptor inhibitors (EGFRi) in patients with left-side, RAS wildtype metastatic colorectal cancer: Clinician use and outcomes for patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ruperto N, Brunner H, Berman A, Avila Zapata F, Horneff G, Wagner-Weiner L, Belot A, Burgos-Vargas R, Gámir Gámir ML, Goldenstein-Schainberg C, Terreri MT, Askelson M, Wong R, Martini A, Lovell DJ. POS0340 PREDICTORS OF CLINICAL RESPONSE TO ABATACEPT IN CHILDREN WITH POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.604] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFor children with polyarticular juvenile idiopathic arthritis (pJIA) and inadequate response or intolerance to initial treatment with MTX, treatment options include abatacept.1 Abatacept, a selective T-cell co-stimulation modulator, has a distinct mechanism of action from other current treatments for rheumatic diseases,2 and factors predicting clinical response can help determine optimal treatment strategy. Two phase 3 studies demonstrated the efficacy and safety of IV and SC abatacept in patients with pJIA and an inadequate response to other DMARDs.2,3ObjectivesTo determine baseline and post-baseline factors that may predict a clinical response in children and adolescents with pJIA treated with abatacept for 2 years.MethodsBaseline demographic and disease characteristics and post-baseline factors (50% and 70% improvement in ACR criteria [ACR50, ACR70] at days 57 and 85) were analyzed using data from 2 phase 3 studies of abatacept in patients with JIA aged 2–17 years (SC administration) and 6–17 years (IV administration). Efficacy endpoints were Juvenile Arthritis Disease Activity Score in 10 joints based on CRP (JADAS10-CRP) inactive disease (ID; score of ≤ 2.7),4 and remission, defined as 6 consecutive months of post-baseline JADAS10-CRP ID. Data were analyzed over the entire 2-year study period. The earliest time point at which patients achieved these outcomes was reported. The aforementioned study factors were subjected to a time-to-event analysis, including Cox proportional hazards univariate regression analysis and Cox proportional hazards multivariate regression analysis using stepwise regression; results of the multivariate analysis are reported. Kaplan–Meier analysis was used to estimate time to achieve clinical response. Receiver operating characteristic curves were used to determine threshold values for continuous variables.ResultsOverall, 347 patients were included in the analysis (SC, n = 219; IV, n = 128; 73.8% female; mean [SD] age, 11.3 [4.0] years). Following abatacept treatment, both time to JADAS10-CRP ID and time to JADAS10-CRP remission were predicted (nominal P ≤ 0.05) by age (≤ 11 years: hazard ratio [HR], 1.52 [95% CI, 1.14–2.02] and ≤ 10 years: HR, 1.73 [95% CI, 1.20–2.48], respectively), high-sensitivity CRP (hsCRP; ≤ 0.6 mg/dL: HR, 1.67 [95% CI, 1.22–2.28] and ≤ 0.21 mg/dL: HR, 1.67 [95% CI, 1.15–2.42], respectively), Parent/Patient Global Assessment of well-being (≤ 35.86: HR, 1.88 [95% CI, 1.41–2.51] and ≤ 43.16: HR, 2.05 [95% CI, 1.35–3.10], respectively), and Childhood HAQ-DI (CHAQ-DI; ≤ 1.63: HR, 2.23 [95% CI, 1.47–3.39] and ≤ 0.75: HR, 1.84 [95% CI, 1.24–2.73], respectively) (remission data shown in Figure 1). Disease duration ≤ 2 years from baseline (HR, 1.66 [95% CI, 1.25–2.21]) and SC route of administration (HR, 2.05 [95% CI, 1.45–2.91]) also predicted ID. Among the post-baseline factors, ACR50 at days 57 and 85 predicted both ID (HR, 1.57 [95% CI, 1.04–2.36] and HR, 1.88 [95% CI, 1.41–2.51], respectively) and remission (HR, 1.96 [95% CI, 1.11–3.45] and HR, 3.05 [95% CI, 1.47–6.34], respectively); ACR70 at day 57 also predicted ID (data not shown). Patients with predictive factors for age, hsCRP, Parent/Patient Global Assessment of well-being, and CHAQ-DI, and with lower disease activity achieved ID and/or remission earlier than patients with high disease activity.ConclusionWe identified baseline and post-baseline factors that predicted JADAS10-CRP ID and remission in patients with pJIA treated with abatacept for 2 years. Screening of abatacept-treated patients with pJIA for such factors may help predict earlier achievement of ID and/or remission.References[1]Ringold S, et al. Arthritis Rheumatol 2019;71:846–63.[2]Brunner HI, et al. Arthritis Rheumatol 2018;70:1144–54.[3]Ruperto N, et al. Lancet 2008;372:383–91.[4]Trincianti C, et al. Arthritis Rheumatol 2021;73:1966–75.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Writing and editorial assistance were provided by Candice Judith Dcosta, MSc, of Caudex, funded by Bristol Myers Squibb. We would like to acknowledge Mara Becker, Duke Clinical Research Institute, Durham, NC, USA, for her contribution to the study analysis.Disclosure of InterestsNicolino Ruperto Speakers bureau: Honoraria for consultancies or speaker bureaus from the following pharmaceutical companies in the past 3 years: 2 Bridge, Amgen, AstraZeneca, Aurinia, Bayer, Brystol Myers Squibb, Cambridge Healthcare Research, Celgene, Domain Therapeutic, Eli Lilly, EMD Serono, GlaxoSmithKline, Idorsia, inMed, Janssen, Novartis, Pfizer, Sobi, UCB, Consultant of: Honoraria for consultancies or speaker bureaus from the following pharmaceutical companies in the past 3 years: 2 Bridge, Amgen, AstraZeneca, Aurinia, Bayer, Brystol Myers Squibb, Cambridge Healthcare Research, Celgene, Domain Therapeutic, Eli Lilly, EMD Serono, GlaxoSmithKline, Idorsia, inMed, Janssen, Novartis, Pfizer, Sobi, UCB, Hermine Brunner Speakers bureau: GlaxoSmithKline, Novartis, Pfizer, Consultant of: AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer, Bristol Myers Squibb, Celgene, Cerocor, Eli Lilly, EMD Serono, F. Hoffmann-La Roche, GlaxoSmithKline, Idorsia, Janssen, Merck, Novartis, R-Pharm, Sanofi, Grant/research support from: The Cincinnati Children’s Hospital, where HIB works as a full-time public employee, has received contributions from the following industries in the past 3 years: Bristol Myers Squibb, F. Hoffmann-La Roche, Janssen, Novartis, and Pfizer. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment to third parties, Alberto Berman Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Lilly, Novartis, Pfizer, Roche, Francisco Avila Zapata: None declared, Gerd Horneff Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, Grant/research support from: AbbVie, Chugai, MSD, Novartis, Pfizer, Roche, Linda Wagner-Weiner Grant/research support from: Abbott, Bristol Myers Squibb, Merck, Pfizer, UCB, Alexander Belot Speakers bureau: Chugai, GlaxoSmithKline, Novartis, Roche (punctual scientific intervention), Grant/research support from: Boehringer Ingelheim, Merck (joint research project), Ruben Burgos-Vargas: None declared, Maria Luz Gámir Gámir: None declared, Claudia Goldenstein-Schainberg Speakers bureau: AbbVie, Janssen, Novartis, Consultant of: AbbVie, Janssen, Novartis, Maria T. Terreri: None declared, Margarita Askelson Consultant of: Acerta Pharma, Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Alberto Martini Consultant of: AbbVie, Eli Lilly, EMD Serono, Idorsia, Janssen, Novartis, Pfizer, Daniel J Lovell Consultant of: AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffman LaRoche, Novartis, UBC (all contracts with employer, CCHMC), Grant/research support from: Bristol Myers Squibb, Janssen, Pfizer, Roche (all contracts with employer, CCHMC); NIH grants: NIAMS, NICHD
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Mariño R, Delany C, Manton D, Reid K, Satur J, Crombie F, Wong R, McNally C, Lopez D, Celentano A, Lim M, Morgan M. Preparedness for practice of newly qualified dental professionals in Australia - educator, employer, and consumer perspectives. BMC Med Educ 2022; 22:396. [PMID: 35606758 PMCID: PMC9125536 DOI: 10.1186/s12909-022-03476-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Limited data regarding the perspectives of other observers (i.e. those who educate, employ or receive care from) of new graduates' preparedness to practice is available. The present study aimed to explore perceptions of different observers regarding the preparedness to practice and work readiness of newly qualified dental professionals. This broader range of perspectives is crucial to inform the development of educational programs, including continuing professional development, for newly qualified dental professionals, by clarifying the skills, knowledge and behaviours expected by the dental profession and wider public. RESULTS Nineteen individual qualitative interviews were undertaken. Interview participants included clinical demonstrators (n = 9; 2 Oral Health Therapists; 5 Dentists; and 2 Prosthetists), dental course convenors (n = 4), representatives of large employers (n = 2), and consumers (n = 4). According to this diverse group of respondents, dental students receive adequate theoretical and evidence-based information in their formal learning and teaching activities, which prepares them for practice as dental professionals. There were no specific clinical areas or procedures where preparedness was highlighted as a major concern. Notwithstanding this, specific graduate skills which would benefit from further training and consolidation were identified, including areas where higher levels of experience would be beneficial. Nonetheless, respondents indicated that new graduates were aware of their limitations and had developed self-discipline and ethics that would allow them to identify conditions/situations where they would not have the experience or expertise to provide care safely. CONCLUSIONS From an observer perspective, dental students appeared to have gained adequate theoretical and evidence-based information in their formal learning and teaching activities to prepared them to commence practicing safely as dental professionals. Areas were identified in which new graduates were underprepared and when transitional support may be required.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Clare Delany
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - David Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
- Centre for Dentistry and Oral Hygiene, UMCG, Groningen, the Netherlands
| | - Kate Reid
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Julie Satur
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Rebecca Wong
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Clare McNally
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Diego Lopez
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Celentano
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Mathew Lim
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Michael Morgan
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
- Faculty of Dentistry, University of Otago, Te Whare Wānanga o Otāgo, Aotearoa, Dunedin, Ōtepoti, New Zealand
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Sesa-Ashton G, Wong R, McCarthy B, Datta S, Henderson LA, Dawood T, Macefield VG. Stimulation of the dorsolateral prefrontal cortex modulates muscle sympathetic nerve activity and blood pressure in humans. Cereb Cortex Commun 2022; 3:tgac017. [PMID: 35559424 PMCID: PMC9086585 DOI: 10.1093/texcom/tgac017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Muscle sympathetic nerve activity (MSNA) controls the diameter of arterioles in skeletalmuscle, contributing importantly to the beat-to-beat regulation of blood pressure (BP). Although brain imaging studies have shown that bursts of MSNA originate in the rostral ventrolateral medulla, other subcortical and cortical structures-including the dorsolateral prefrontal cortex (dlPFC)-contribute. Hypothesis We tested the hypothesis that MSNA and BP could be modulated by stimulating the dlPFC. Method dlPFC. In 22 individuals MSNA was recorded via microelectrodes inserted into the common peroneal nerve, together with continuous BP, electrocardiographic, and respiration.Stimulation of the right (n=22) or left dlPFC (n=10) was achieved using transcranial alternating current (tcACS; +2 to -2mA, 0.08 Hz,100 cycles), applied between the nasion and electrodes over the F3 or F4 EEG sites on the scalp. Results Sinusoidal stimulation of either dlPFC caused cyclicmodulation of MSNA, BP and heart rate, and a significant increase in BP. Conclusion We have shown, for the first time, that tcACS of the dlPFC in awake humans causes partial entrainment of MSNA, heart rate and BP, arguing for an important role of this higher-level cortical area in the control of cardiovascular function.
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Affiliation(s)
- Gianni Sesa-Ashton
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Rebecca Wong
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Brendan McCarthy
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Sudipta Datta
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Luke A Henderson
- School of Medical Sciences (Neuroscience), Brain and Mind Centre, The University of Sydney, NSW 2050, Australia
| | - Tye Dawood
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Human Autonomic Neurophysiology, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, VIC 3010, Australia
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Abdalla M, ElKhodiar S, Perez FS, Wong R, Austin H, Rau C, Patterson M, Garcia B, Leal T, Murphy C, Ceris T, Walton H. 1134 A comparison of the aerogen vibrating mesh nebuliser versus a standard jet nebuliser to deliver bronchodilators in moderate to severe asthma in the emergency department. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-rcem.11] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aims/Objectives/BackgroundNebulised bronchodilators provide effective therapy for patients with Asthma. We sought to investigate the effectiveness of vibrating mesh nebuliser(VMN) when compared to a standard jet nebuliser(JN) in patients with moderate-to-severe asthma presenting to the Emergency Department (ED). we compared time to discharge from ED, drug delivery, and rate admission when using VMN technology compared to the JN.Methods/DesignA prospective, single-centre, non-blinded study comparing the efficacy of the VMN (Aerogen Solo) against the current standard jet nebuliser (JN)(Cirrus2 Nebuliser) to deliver nebulised Salbutamol (2.5 mg) in moderate to severe adult asthma within the ED. Patients requiring bronchodilator therapy were allocated for each arm to receive medications via the VMN, or by standard JN. Patients were managed by emergency physicians according to the joint BTS guidance. The primary endpoint was time to discharge from ED (mins) after initial physician assessment, while among the secondary endpoints examined were Salbutamol dose (mg), and rate of discharge from ED (binary). Time to discharge & salbutamol dose were summarized via the Median (IQR), and a nonparametric Mann-Whitney U test was applied to derive a p-value for the comparison. The mean (SD) was also tabulated. The rate of admission for each arm was calculated, and compared using a chi-squared test.Results/Conclusions124 patients completed the study. Time to discharge and salbutamol dose, were significantly lower in those patients treated with VMN showing a statistical significance (p=0.003 and p=0.023 respectively).VMN time to discharge: Mean (SD) 136.44 mins (89.50). VMN salbutamol dose 7.58 mg; In comparison to those treated in the JN arm. JN time to discharge: Mean (SD) 175.31 mins (97.15) JN salbutamol: 9.69 mg. No Statistical Significance for the rate of admission.Treatment with a VMN led to a significant reduction in both the median length of stay and the requirement for bronchodilators in the ED.
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Allen MJ, Sertic A, Liu Z(A, Liu Z, Suzuki C, Panov ED, Ma LX, Bach Y, Jang RWJ, Chen EX, Darling GE, Yeung J, Swallow CJ, Brar SS, Kalimuthu S, Wong R, Veit-Haibach P, Elimova E. Survival prediction using radiomic signatures in metastatic gastric and esophageal adenocarcinoma (GEA). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
357 Background: Radiomic characterisation of tumour phenotypes can generate image-driven biomarkers that potentially aid in clinical decision-making. We sought to identify radiomic features in metastatic GEA that may be predictive for survival outcomes. Methods: A retrospective analysis between 2009-20 identified patients (pts) with metastatic GEA. All pts received chemotherapy (CTx), with a ‘baseline’ and 8-12 week ‘on-treatment’ contrast-enhanced CT chest/abdomen/pelvis performed. Radiomic analysis was performed with LIFEx (livexsoft.org). Population demographics and clinical outcomes were recorded. Univariable Cox proportional hazards model (UVA) assessed clinical variables (n=26) predictive of overall survival (OS) and progression-free survival (PFS) with p=0.05 indicating significance. Multivariable Cox model (MVA) was used to assess radiomic features (n=78) in the presence of clinical variables. Concordance index (C-index) was calculated to assess model performance (≥0.7 = high predictive accuracy). A ‘validation’ cohort analysis was performed to validate the model. Results: 166 pts were identified (primary cohort n=143; validation cohort n=23). 123 had de-novo metastatic disease, 43 recurrence following curative-intent therapy. In the primary cohort the median age was 58.1y, 101 (71%) were male, 120 (84%) were non-Asian and 131 (92%) were ECOG 0-1. Similar demographics were observed in the validation cohort. Both ‘baseline’ and ‘on-treatment’ scans UVA identified Her2 status, ethnicity, and the number of CTx cycles as predictive of PFS, while ECOG, brain metastases, neutrophil count (ANC), albumin and number of CTx cycles were predictive of OS. ‘Baseline’ model analysis for PFS and OS identified consistent radiomic features (HUskewness; HUpeakSphere), with an observed C-index 0.6 and 0.657 respectively. No radiomic features were identified on ‘on-treatment’ PFS analysis. ‘On-treatment’ OS analysis is shown in the table with 3 radiomic features (SHAPE Surface; SHAPE Compacity; PARAMS ZSpatial-Resampling) predictive for OS. The C-index is 0.76. Analysis of the validation cohort supported the model (C-index 0.815) for ‘on-treatment’ OS. Conclusions: Radiomic analysis identified a number of features associated with PFS and OS. The features specifically identified on ‘on-treatment’ scans were highly predictive for OS. Our analysis suggests radiomic features in addition to clinical variables can be predictive of outcome in patients with metastatic GEA receiving CTx.[Table: see text]
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Affiliation(s)
- Michael J Allen
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Andrew Sertic
- Joint Division of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada
| | - Zhihui (Amy) Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zijin Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Chihiro Suzuki
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elan David Panov
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lucy Xiaolu Ma
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Yvonne Bach
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gail Elizabeth Darling
- Division of Thoracic Oncology, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Jonathan Yeung
- Division of Thoracic Oncology, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | | | | | - Sangeetha Kalimuthu
- Laboratory Medicine Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rebecca Wong
- Division of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Division of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada
| | - Elena Elimova
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Davis AM, Wong R, Steinhart K, Cruz L, Cudmore D, Dwyer T, Li L, Marks P, McGlasson R, Urquhart N, Wilson JA, Nimmon L, Ogilvie-Harris D, Chahal J. Development of an intervention to manage knee osteoarthritis risk and symptoms following anterior cruciate ligament injury. Osteoarthritis Cartilage 2021; 29:1654-1665. [PMID: 34597801 DOI: 10.1016/j.joca.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is a risk factor for developing knee osteoarthritis (OA). We developed an intervention to support people manage risk factors for OA. METHODS We conducted one-on-one interviews with 20 individuals with OA symptoms 6-15 years post ACL injury and used a nominal group process during a workshop with 40 patients and healthcare professionals (HCPs) to elicit information on the intervention content and delivery characteristics (timing, HCPs, and methods). Interview data were analyzed using content analysis. Nominal group ideas with importance ratings ≥5 of 7 met criteria for inclusion. Results were integrated, considering similarities and differences. RESULTS Eight content categories were identified: 1. understanding knee injury and expectations about recovery; 2. understanding OA risk; 3. understanding OA signs and symptoms; 4. managing OA risk; 5. managing knee OA symptoms; 6. information for influencers; 7. credible sources; and, 8. updates on new evidence and treatments. Delivery timing reflected a lifespan approach from time of injury through symptomatic knee OA management. Although multiple media for delivery were identified, introductory face-to-face discussions and opportunity for re-accessing HCPs were critical. All HCPs who treat people with ACL should be familiar with and able to deliver the intervention. CONCLUSIONS This co-development approach identified that an intervention to support people with ACL injury to limit and manage knee OA requires content embedded within an easily accessible, multi-media delivery model with capacity for check-back with HCPs that is appealing to different age groups and personal preferences over the lifespan post injury.
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Affiliation(s)
- A M Davis
- Institute of Health Policy, Management and Evaluation and Department of Physical Therapy, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
| | - R Wong
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - K Steinhart
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
| | - L Cruz
- LiveActive Sport Medicine and Women's College Hospital, University of Toronto, Toronto, Canada.
| | - D Cudmore
- Family and Sport Medicine, St. Francis Xavier University, Antigonish, and Department of Family Medicine, Dalhousie University, Halifax, Canada.
| | - T Dwyer
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital College and Mount Sinai Hospital, University of Toronto, Toronto, Canada.
| | - L Li
- Arthritis Research Canada, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - P Marks
- University of Toronto Orthopaedic Sports Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | | | - N Urquhart
- Dartmouth General Hospital, Orthopaedic Surgery, Dalhousie University, Halifax, Canada.
| | - J A Wilson
- Department of Surgery, McMaster University, Hamilton, Canada.
| | - L Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - D Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, Toronto, Canada.
| | - J Chahal
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, University of Toronto, and Schroeder Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Canada.
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Spencer A, Rivero-Arias O, Wong R, Tsuchiya A, Bleichrodt H, Edward R, Norman R, Lloyd A, Clarke P. The QALY at 50: One story many voices. Soc Sci Med 2021; 296:114653. [DOI: 10.1016/j.socscimed.2021.114653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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Chew N, Tan EX, Tan CH, Lim WH, Xiao JL, Chin YH, Syn N, Low TT, Wong R, Yip J, Siddiqui MS, Muthiah M. A network meta-analysis on the vasomodulators for portopulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1956] [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: 11/13/2022] Open
Abstract
Abstract
Background
In patients with portopulmonary hypertension (PoPH) who are eligible and awaiting liver transplant, guidelines recommend lowering pulmonary pressures with vasomodulators as a bridge to transplant. However, efficacy of each vasomodulator class as a bridge to transplant remains unknown.
Purpose
This review compares the use of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5-I), prostacyclin (PC) and combination therapy in its pulmonary pressure-lowering effects and pre-transplant mortality in this strictly selected subset of patients.
Methods
A search conducted on Medline and Embase on articles relating to vasomodulator use in PoPH for pulmonary pressure-lowering effects and mortality. Network analysis was conducted to summarize the evidence. Surface under the cumulative ranking curve (SUCRA) was used to rank treatments.
Results
Ten studies with 180 patients were included. SUCRA analysis demonstrated largest mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) lowering effects in ERA and combination therapy, followed by PDE5-I and PC. mPAP-lowering effects were largest in ERA (MD −19.440, CI: −62.280 to 23.400) and combination therapy (MD −18.223, CI: −29.677 to −6.770) when compared to PDE5-I (table 1). Pre-transplant mortality were comparable between ERA, PDE5-I and combination therapy. Both ERA (RR:0.349. CI: 0.137–0.891) and PDE5-I (RR: 0.279, CI: 0.091–0.854) had significantly lower mortality than PC (table 2).
Conclusion
This meta-analysis provides preliminary evidence that ERA have shown larger pulmonary pressure-lowering effects than PDE5-I in PoPH patients who were eligible for LT. Both ERA and PDE5-I have comparable mortality outcomes, with unfavorable outcomes in PC users.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Health System, Singapore, Singapore
| | - E X Tan
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
| | - C H Tan
- National University of Singapore, Singapore, Singapore
| | - W H Lim
- National University of Singapore, Singapore, Singapore
| | - J L Xiao
- National University of Singapore, Singapore, Singapore
| | - Y H Chin
- National University of Singapore, Singapore, Singapore
| | - N Syn
- National University of Singapore, Singapore, Singapore
| | - T T Low
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - J Yip
- National University Heart Centre, Singapore, Singapore
| | - M S Siddiqui
- Virginia Commonwealth University, Division of Gastroenterology and Hepatology, Richmond, United States of America
| | - M Muthiah
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
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Lui G, Wong CK, Chan M, Chong KC, Wong R, Chu I, Zhang M, Li T, Hui D, Lee N, Chan P. Host inflammatory response is the major marker of severe respiratory syncytial virus infection in older adults. J Infect 2021; 83:686-692. [PMID: 34614399 DOI: 10.1016/j.jinf.2021.09.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We aim to study the viral kinetics and host inflammatory response of RSV infection in older adults, and their correlation with disease severity. METHODS We performed a prospective observational study in adults with RSV infection. We serially collected nasal-throat swabs for quantification of RSV-A and RSV-B viral load, and peripheral blood samples for measurement of cytokine/chemokine concentrations. The study endpoints were (i) requiring supplemental oxygen therapy, and (ii) non-invasive ventilation, intensive care, or died within 30 days of admission. We performed multivariable logistic regression models to identify independent variables for severe disease. RESULTS We enrolled 71 hospitalized patients and 10 outpatients treated for RSV infection (median age 75 years, 51% male, and 74% with comorbidities). Among hospitalized patients, 61% required supplemental oxygen therapy, and 18% had severe disease requiring non-invasive ventilation or intensive care, or died within 30 days. Inflammatory cytokine/chemokines IL-6, CXCL8/IL-8, CXCL9/MIG and CXCL10/IP-10 increased significantly during the acute phase of illness. IL-6 concentration was independently associated with severe disease after adjusting for confounding factors. RSV viral load was not associated with disease severity throughout the course of illness. CONCLUSION Host inflammatory response is a major marker of severe disease in older adults with RSV infection.
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Affiliation(s)
- G Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - C K Wong
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - M Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - K C Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Centre for Health System and Policy Research, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - R Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - I Chu
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - M Zhang
- Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - T Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - Dsc Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - N Lee
- Institute for Pandemics, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Pks Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region.
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Jalali A, Gard G, Banks S, Dunn C, Wong HL, Wong R, Lee M, Gately L, Loft M, Shapiro JD, Kosmider S, Tie J, Ananda S, Yeung JM, Jennens R, Lee B, McKendrick J, Lim L, Khattak A, Gibbs P. Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer. Curr Probl Cancer 2021; 46:100793. [PMID: 34565601 DOI: 10.1016/j.currproblcancer.2021.100793] [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: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.
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Affiliation(s)
- A Jalali
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Latrobe Regional Hospital, VIC, Australia.
| | - G Gard
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - S Banks
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - C Dunn
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - H L Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - R Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - M Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - L Gately
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - M Loft
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - J D Shapiro
- Department of Medical Oncology, Cabrini Hospital, VIC, Australia
| | - S Kosmider
- Department of Medical Oncology, Western Health, VIC, Australia
| | - J Tie
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - S Ananda
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - J M Yeung
- Department of Surgery, Western Health, University of Melbourne, VIC, Australia; Western Health Chronic Disease Alliance, Western Health, VIC, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, VIC, Australia
| | - B Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Northern Health, VIC, Australia
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - L Lim
- Department of Medical Oncology, Eastern Health, VIC, Australia
| | - A Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, WA, Australia
| | - P Gibbs
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia
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Elamir AM, Stanescu T, Shessel A, Tadic T, Yeung I, Letourneau D, Kim J, Lukovic J, Dawson LA, Wong R, Barry A, Brierley J, Gallinger S, Knox J, O'Kane G, Dhani N, Hosni A, Taylor E. Simulated dose painting of hypoxic sub-volumes in pancreatic cancer stereotactic body radiotherapy. Phys Med Biol 2021; 66. [PMID: 34438383 DOI: 10.1088/1361-6560/ac215c] [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: 04/28/2021] [Accepted: 08/26/2021] [Indexed: 12/26/2022]
Abstract
Dose painting of hypoxic tumour sub-volumes using positron-emission tomography (PET) has been shown to improve tumour controlin silicoin several sites, predominantly head and neck and lung cancers. Pancreatic cancer presents a more stringent challenge, given its proximity to critical gastro-intestinal organs-at-risk (OARs), anatomic motion, and impediments to reliable PET hypoxia quantification. A radiobiological model was developed to estimate clonogen survival fraction (SF), using18F-fluoroazomycin arabinoside PET (FAZA PET) images from ten patients with unresectable pancreatic ductal adenocarcinoma to quantify oxygen enhancement effects. For each patient, four simulated five-fraction stereotactic body radiotherapy (SBRT) plans were generated: (1) a standard SBRT plan aiming to cover the planning target volume with 40 Gy, (2) dose painting plans delivering escalated doses to a maximum of three FAZA-avid hypoxic sub-volumes, (3) dose painting plans with simulated spacer separating the duodenum and pancreatic head, and (4), plans with integrated boosts to geometric contractions of the gross tumour volume (GTV). All plans saturated at least one OAR dose limit. SF was calculated for each plan and sensitivity of SF to simulated hypoxia quantification errors was evaluated. Dose painting resulted in a 55% reduction in SF as compared to standard SBRT; 78% with spacer. Integrated boosts to hypoxia-blind geometric contractions resulted in a 41% reduction in SF. The reduction in SF for dose-painting plans persisted for all hypoxia quantification parameters studied, including registration and rigid motion errors that resulted in shifts and rotations of the GTV and hypoxic sub-volumes by as much as 1 cm and 10 degrees. Although proximity to OARs ultimately limited dose escalation, with estimated SFs (∼10-5) well above levels required to completely ablate a ∼10 cm3tumour, dose painting robustly reduced clonogen survival when accounting for expected treatment and imaging uncertainties and thus, may improve local response and associated morbidity.
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Affiliation(s)
- Ahmed M Elamir
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Shessel
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ivan Yeung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - John Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Rebecca Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - James Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Steven Gallinger
- Ontario Institute for Cancer Research, PanCuRx Translational Research Initiative, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Jennifer Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Grainne O'Kane
- Ontario Institute for Cancer Research, PanCuRx Translational Research Initiative, Toronto, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Neesha Dhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Anconina R, Ortega C, Metser U, Liu ZA, Suzuki C, McInnis M, Darling GE, Wong R, Taylor K, Yeung J, Chen EX, Swallow CJ, Bajwa J, Jang RW, Elimova E, Veit-Haibach P. Influence of sarcopenia, clinical data, and 2-[ 18F] FDG PET/CT in outcome prediction of patients with early-stage adenocarcinoma esophageal cancer. Eur J Nucl Med Mol Imaging 2021; 49:1012-1020. [PMID: 34491404 DOI: 10.1007/s00259-021-05514-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the prognostic value of sarcopenia measurements done on staging 2-[18F] FDG PET/CT together with metabolic activity of the tumor in patients with adenocarcinoma esophagogastric cancer with surgical treatment. METHODS Patients with early-stage, surgically treated esophageal adenocarcinoma and available pre-treatment 2-[18F] FDG PET/CT were included. The standard uptake value (SUV) and SUV normalized by lean body mass (SUL) were recorded. Skeletal muscle index (SMI) was measured at the L3 level on the CT component of the PET/CT. Sarcopenia was defined as SMI < 34.4cm2/m2 in women and < 45.4cm2/m2 in men. RESULTS Of the included 145 patients. 30% were sarcopenic at baseline. On the univariable Cox proportional hazards analysis, ECOG, surgical T and N staging, lymphovascular invasion (LVI) positive lymph nodes, and sarcopenia were significant prognostic factors concerning RFS and OS. On multivariable Cox regression analysis, surgical N staging (p = 0.025) and sarcopenia (p = 0.022) remained significant poor prognostic factors for OS and RFS. Combining the clinical parameters with the imaging-derived nutritional evaluation of the patient but not metabolic parameters of the tumor showed improved predictive ability for OS and RFS. CONCLUSION Combining the patients' imaging-derived sarcopenic status with standard clinical data, but not metabolic parameters, offered an overall improved prognostic value concerning OS and RFS.
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Affiliation(s)
- Reut Anconina
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Claudia Ortega
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Chihiro Suzuki
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Kirsty Taylor
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Eric X Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and Sinai Health System, University of Toronto, Toronto, Canada
| | | | - Raymond W Jang
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Elena Elimova
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Tebbutt N, Burge M, Underhill C, Farrell M, Xie S, Nagrial A, Pavlakis N, Strickland A, Chong G, Tie J, Wong R, Price T. 435P The AGITG Modulate study: Randomised phase II study testing manipulation of the tumour micro environment (TME) to enable synergy with PD1 inhibitors in microsatellite stable (MSS) metastatic colorectal cancer (mCRC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Allen M, Espin-Garcia O, Suzuki C, Panov E, Ma L, Yvonne B, Jang R, Chen E, Darling G, Yeung J, Swallow C, Brar S, Kalimuthu S, Wong R, Veit-Haibach P, Elimova E. 1406P Survival outcomes in older adults with metastatic gastric and esophageal carcinoma receiving palliative chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yap SD, Hamblin PS, Bach L, Ekinci E, Wong R. Sodium glucose co-transporter-2 inhibitor-induced diabetic ketoacidosis following tooth extraction: improving awareness among dental practitioners. Aust Dent J 2021; 66:444-447. [PMID: 34432892 DOI: 10.1111/adj.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
Sodium glucose co-transporter-2 inhibitors (SGLT-2i) are a relatively new class of oral glucose lowering agents that improve glycaemic control and also provide significant cardiac and renal benefits. However, SGLT-2i use is associated with a small but significant increased risk of diabetic ketoacidosis (DKA) especially during periods of reduced oral intake such as following dental procedures, bowel preparation for colonoscopy, surgery and concurrent illness. In contrast with typical DKA, in many cases of SGLT2i-associated DKA, the blood glucose is normal or only slightly elevated, giving rise to the term euglycaemic DKA (euDKA). Patients with euDKA often present with non-specific symptoms. Moreover, their normal or only mildly elevated blood glucose levels might lead to delayed diagnosis and treatment and hence potentially life-threatening complications. Not only should patients taking an SGLT-2i be informed about the risk of euDKA, and be provided with SGLT-2i sick day management education, but clinicians should also be alert to this diagnosis.
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Affiliation(s)
- S D Yap
- Eastern Health, Melbourne, Victoria, Australia
| | - P S Hamblin
- Western Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - L Bach
- Alfred Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - E Ekinci
- University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - R Wong
- Eastern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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Senanayake TP, Fong HC, Millar BA, Barry A, Cummings B, Ringash J, Maganti M, Warde P, Wong R, Dawson LA. Variability in Steroid Prophylaxis for Radiation-Induced Pain Flare: Practice of Canadian Radiation Oncologists. J Palliat Med 2021; 24:965-966. [PMID: 34128714 DOI: 10.1089/jpm.2020.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tivanka P Senanayake
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Heng C Fong
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Barbara-Ann Millar
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Aisling Barry
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Bernard Cummings
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Jolie Ringash
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Padraig Warde
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Rebecca Wong
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Laura A Dawson
- Allan and Ruth Kerbel Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
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Butts CD, Bloom MS, McGough A, Lenhart N, Wong R, Mok-Lin E, Parsons PJ, Galusha AL, Browne RW, Yucel RM, Feingold BJ, Fujimoto VY. Toxic elements in follicular fluid adversely influence the likelihood of pregnancy and live birth in women undergoing IVF. Hum Reprod Open 2021; 2021:hoab023. [PMID: 34337160 PMCID: PMC8318822 DOI: 10.1093/hropen/hoab023] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/19/2021] [Indexed: 01/24/2023] Open
Abstract
STUDY QUESTION Are follicular fluid (FF), arsenic (As), mercury (Hg), cadmium (Cd) and lead (Pb) concentrations associated with IVF outcomes among women undergoing IVF? SUMMARY ANSWER There was a non-linear association between higher FF Hg concentration and a lower likelihood of biochemical pregnancy and live birth. Higher FF Pb concentration was also associated with a lower probability of live birth. WHAT IS KNOWN ALREADY Previous research suggests that toxic elements may affect fertility among couples conceiving with and without assistance. However, the results have been inconsistent, possibly related in part to exposure misclassification. Very few studies have used ovarian FF to measure toxic elements, as it requires an invasive collection procedure, yet it may offer a more accurate estimate of a biologically effective dose than blood or urine. STUDY DESIGN SIZE DURATION This is a prospective study of 56 women undergoing IVF, from October 2015 to June 2017. FF was collected for analysis on the day of oocyte retrieval. PARTICIPANTS/MATERIALS SETTING METHODS As, Cd, Hg and Pb were determined in 197 FF specimens, using inductively coupled plasma tandem mass spectrometry. FF glutathione peroxidase, glutathione reductase, total glutathione-S-transferase, superoxide dismutase, arylesterase and paraoxonase (PON1p) activities were measured using kinetic enzyme assays. MAIN RESULTS AND THE ROLE OF CHANCE Non-linear associations were detected, in which the probabilities of biochemical pregnancy (P = 0.05) and live birth (P = 0.05) were lower in association with FF Hg greater than ∼0.51 µg/l Hg, adjusted for age, race, cigarette smoking and recent seafood consumption. Higher FF Pb was also associated with a lower likelihood of live birth (relative risk (RR) = 0.68, 95% CI: 0.46, 1.00; P = 0.05). We also found a suggestive, although imprecise, antagonizing mediating effect of PON1p activity on the association between FF Pb and live birth (-28.3%; 95% CI: -358%, 270%). LIMITATIONS REASONS FOR CAUTION The results should be interpreted judiciously given the limited sample size and difficulty accounting for correlated data in generalized additive models and mediation analyses. Additionally, women undergoing IVF are highly selected with respect to age and socioeconomic status, and so the generalizability of the results may be limited. WIDER IMPLICATIONS OF THE FINDINGS Overall, the results suggest that FF Hg was associated with a lower likelihood of biochemical pregnancy and live birth, with a potential threshold effect, and that higher FF Pb was associated with a lower probability of live birth. These results may help to guide clinical recommendations for limiting the exposure of patients to Hg and Pb and ultimately improve IVF success rates. STUDY FUNDING/COMPETING INTERESTS This work was funded in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1R56ES023886-01, to the University at Albany (M.S.B.), and in part by the National Institute of Environmental Health Sciences (NIEHS), grant number 1U2CES026542-01, to the Wadsworth Center (P.J.P.). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Celeste D Butts
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Michael S Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Alexandra McGough
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Nikolaus Lenhart
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Rebecca Wong
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Evelyn Mok-Lin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Patrick J Parsons
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
- Laboratory of Inorganic & Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Aubrey L Galusha
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
- Laboratory of Inorganic & Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Richard W Browne
- Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Recai M Yucel
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA
| | - Beth J Feingold
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Victor Y Fujimoto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
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Harnett N, Tosoni S, Brandt C, Ito E, Milne E, Liu FF, Wong R. Accelerated Education Program in Radiation Medicine: International Learner Perceptions of Experiences, Outcomes, and Impact. Int J Radiat Oncol Biol Phys 2021; 109:656-660. [PMID: 33516435 DOI: 10.1016/j.ijrobp.2020.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The Accelerated Education Program (AEP) at the Princess Margaret Cancer Centre (PM) has been offering continuing medical education courses since 2006. The purpose of this study was to assess learner experiences, perspectives, and outcomes using Kirkpatrick's Four Level Training Evaluation Model (ie, reaction, learning, behavior, results) to ascertain whether it was meeting stated goals. METHODS AND MATERIALS Past course participants (2010-2018) were invited to participate in a semistructured interview. Interviews were transcribed verbatim; thematic analysis was conducted by a 4-person research team. RESULTS Seventeen participants including 2 medical physicists, 6 radiation oncologists, and 9 radiation therapists from 6 countries on 4 continents participated in the study. Interviews lasted an average of 25 minutes. Consistently positive outcomes were reported at each level of Kirkpatrick's model. At the reaction level, participants liked the small, interactive case-based design, exposure to renowned faculty and practices from PM and other major centers, and the interprofessional practice (IPP) approach. Suggestions for improvements include enhancing practical content. At the learning level, participants reported gaining new knowledge or skills and new awareness or attitudes. Behavior changes described included sharing learnings with colleagues, implementing changes in practice or techniques, departmental structure, and IPP. Participants described the effects on clinical practice (results) in quality of care, access to care, and academic contribution. Identified barriers to change related to the restricted internal capacity for change and the need for wider staff training. CONCLUSIONS AEP courses were found to have a positive effect on local practices ranging from confirmation of current practice through to increased access to and quality of advanced radiotherapeutic techniques and care. Our findings confirm that AEP is achieving its goal of "putting innovation to work" and suggest curricular improvements that can enhance these effects.
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Affiliation(s)
- Nicole Harnett
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Sarah Tosoni
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Colin Brandt
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Emma Ito
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Emily Milne
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Ruperto N, Schulert G, Sproles A, Thornton S, Vega Cornejo G, Anton J, Cuttica R, Henrickson M, Foeldvari I, Kingsbury D, Askelson M, Liu J, Mukherjee S, Wong R, Lovell DJ, Martini A, Grom A, Brunner H. POS0076 S100A8/A9 AND S100A12 AS POTENTIAL PREDICTIVE BIOMARKERS OF ABATACEPT RESPONSE IN POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1081] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The calcium-binding proteins S100A8/A9 (calprotectin) and S100A12 (extracellular newly identified receptor for advanced glycation end-products binding protein [EN-RAGE]) are involved in multiple signalling pathways to mediate inflammation, can be secreted by activated monocytes/macrophages and exhibit cytokine-like extracellular functions. Circulating levels of these proteins have been associated with disease and clinical responses in systemic juvenile idiopathic arthritis (sJIA), including treatment response.1 Studies suggest that serum S100A8/A9 and S100A12, which are released at inflammation sites, are more specific biomarkers of local inflammation (e.g. in the synovium) than systemic biomarkers such as CRP and ESR.2,3Objectives:To investigate if baseline S100A8/A9 and S100A12 predict clinical response to abatacept treatment in polyarticular JIA (pJIA), and to assess whether changes from baseline in S100A8/A9 or S100A12 can be better prognostic markers for response to abatacept treatment than CRP in pJIA.Methods:Data are from a phase III trial of SC abatacept for the treatment of pJIA (NCT01844518).4 This 24-month, single-arm, open-label, international, multicentre, two-part study included male and female patients with pJIA aged 2–17 years. This analysis examined the correlation between biomarkers (S100A8/A9, S100A12 and high-sensitivity CRP [hsCRP]) and disease activity (measured using Juvenile Arthritis Disease Activity Score [JADAS]) at baseline, baseline biomarker values as predictors of future treatment response (ACR and JADAS endpoints), and the correlation between change from baseline in biomarker values and treatment response at Day 113.Results:Of 219 total patients, 158 (72%) had S100A8/A9 values and 155 (71%) had S100A12 values at baseline. Median S100A8/A9 and S100A12 values were 3295 ng/mL (normal range, 716–3004 ng/mL) and 176 ng/mL (normal range, 32–385 ng/mL), respectively. S100A8/A9, S100A12 and hsCRP (median 0.20 mg/dL; normal ≤0.6 mg/dL) had a low-to-moderate but significant association with disease activity at baseline; coefficients for associations between JADAS71-CRP low disease activity (LDA) and the biomarkers S100A8/A9, S100A12 and hsCRP were 0.23 (p=0.0038), 0.16 (p=0.0448) and 0.26 (p=0.0001), respectively. Baseline S100A8/A9 level above the median was associated with lower odds of ACR100 at Day 113 (p=0.0052). Figure 1 shows the associations of baseline biomarker values with Day 113 ACR and JADAS scores in the overall population. Baseline S100A8/A9 or S100A12 did not significantly influence ACR50 or ACR70 responses at Day 113, but high baseline values were associated with reduced odds of ACR90 (p=0.01), ACR100 (p=0.005), ACR-inactive disease (ID) (p=0.0001), and JADAS71-CRP (LDA) (p=0.02). By Day 477, elevated baseline S100A12 was still significantly associated with lower odds of ACR100 overall (0.467; p=0.0248) but baseline S100A8/A9 was not; at Day 645, neither was significantly associated with ACR100 response. At Day 113, changes from baseline in S100A8/A9 and S100A12 were correlated with ACR100 (coefficients of 0.22 [p=0.0082] and 0.26 [p=0.0015], respectively) and with ACR-ID (0.22 [p=0.0067] and 0.26 [p=0.0014], respectively); change in hsCRP was not significantly correlated with disease response.Conclusion:S100A8/A9 and S100A12 may serve as prognostic biomarkers to predict response to abatacept treatment at Day 113. Changes from baseline S100A8/A9 and S100A12 levels were more highly correlated with efficacy outcomes including ACR100 and ACR-ID at Day 113 compared with hsCRP.References:[1]Aljaberi N, et al. Pediatr Rheumatol Online J 2020;18:7.[2]Hammer H, et al. Arthritis Res Ther 2011;13:R178.[3]Nordal HH, et al. BMC Musculoskelet Disord 2014;15:335.[4]Brunner H, et al. Arthritis Rheumatol 2018;70:1144–1154.Acknowledgements:Professional medical writing and editorial assistance was provided by Rob Coover, MPH, at Caudex and was funded by Bristol Myers Squibb.Disclosure of Interests:Nicolino Ruperto Speakers bureau: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers Squibb, Celgene, Eli Lilly, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB, Consultant of: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers Squibb, Celgene, Eli Lilly, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB, Grant/research support from: The IRCCS Istituto Giannina Gaslini (IGG), where NR works as full-time public employee has received contributions (>10.000 USD each) from the following industries in the last 3 years: Bristol Myers Squibb, Eli Lilly, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment with third parties., Grant Schulert Speakers bureau: Novartis, Consultant of: SOBI, Alyssa Sproles: None declared, Sherry Thornton: None declared, Gabriel Vega Cornejo Speakers bureau: AbbVie, Grant/research support from: Bristol Myers Squibb, Eli Lilly, Janssen, Parexel, Sanofi, Jordi Anton Speakers bureau: AbbVie, Gebro, GlaxoSmithKline, Novartis, Pfizer, Roche, Sobi, Consultant of: AbbVie, Gebro, GlaxoSmithKline, Novartis, Pfizer, Roche, Sobi, Grant/research support from: AbbVie, Amgen, Gebro, GlaxoSmithKline, Lilly, Novartis, Novimmune, Pfizer, Roche, Sanofi, Sobi, Ruben Cuttica Speakers bureau: AbbVie, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Novartis, Pfizer, Roche, UCB, Paid instructor for: AbbVie, Novartis, Pfizer, Roche, Consultant of: AbbVie, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Novartis, Pfizer, Roche, UCB, Michael Henrickson: None declared, Ivan Foeldvari Consultant of: Bristol Myers Squibb, Gilead, Hexal, MEDAC, Novartis, Pfizer, Sanofi, Daniel Kingsbury Consultant of: Pfizer, Margarita Askelson Consultant of: Currently working for Syneos Health providing services to Bristol Myers Squibb, Jinqi Liu Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sumanta Mukherjee Shareholder of: Bristol Myers Squibb, GlaxoSmithKline, Employee of: Bristol Myers Squibb, GlaxoSmithKline, Robert Wong Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Daniel J Lovell Speakers bureau: Genentech, Wyeth Pharm, Consultant of: Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Hoffman-La Roche, Novartis, Pfizer, Regeneron, Takeda, UBC, Wyeth Pharma, Xoma, Alberto Martini Speakers bureau: AbbVie, Novartis, Consultant of: AbbVie, Eli Lilly, EMD Serono, Idorsia, Janssen, Novartis, Pfizer, Alexei Grom Consultant of: AB2Bio, Novartis, Sobi (NovImmune), Grant/research support from: AB2Bio, Novartis, Sobi (NovImmune), Hermine Brunner Speakers bureau: GlaxoSmithKline, Novartis, Pfizer, Roche, Paid instructor for: Novartis, Pfizer (funds go to CCHMC/employer), Consultant of: Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, UCB (funds go to CCHMC/employer), Grant/research support from: Bristol Myers Squibb, Pfizer (funds go to CCHMC/employer).
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MacKenzie M, Ma LX, Epsin-Garcia O, Suzuki C, Bach Y, Allen MJ, Darling GE, Swallow CJ, Brar SS, Yeung J, Kalimuthu S, Wong R, Panov ED, Veit-Haibach P, Chen EX, Elimova E, Jang RWJ. Predictors of survival after metastasectomy of oligometastatic recurrence following gastroesophageal cancer treatment. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16060 Background: Recurrent gastroesophageal (GE) carcinomas carry a poor prognosis and are usually treated with palliative chemotherapy (CTX). However, recent studies suggest that certain patients with oligometastatic recurrence can have long term survival after metastasectomy. Appropriate patient selection for metastasectomy remains a challenge, as few predictors of overall survival (OS) after metastasectomy have been identified. Our primary aim was to identify predictors of OS following metastasectomy in GE cancers. Methods: We conducted a retrospective study of GE cancer patients treated from 2007 to 2015 using the Princess Margaret Hospital Cancer Registry. We included patients who underwent curative-intent surgery or definitive chemoradiation (CRT) for localized GE cancer who then had single organ recurrence treated with metastasectomy. The probability of OS from date of recurrence was estimated with the Kaplan Meier method. Predictors of OS after metastasectomy for isolated recurrence were determined using Cox proportional hazards analysis. Covariates included time to recurrence (interval from curative-intent surgery or completion of definitive CRT), site of recurrence (lung/non-lung), sex, age and race (Asian/Non-Asian). Within the multivariable model, predictors with a p-value less than 0.05 were deemed significant. Results: Of 44 patients, median age was 58 years (28-78), and 59% were male. Primary sites were: esophagus 25%, GE junction 41% and gastric 34%. Treatment of the primary was: surgery alone 13%, surgery and (neo)adjuvant CTX 76%, and CRT 11%. Recurrent sites were brain 22%, ovary 20%, lung 18%, bone 7%, adrenals 7%, liver 7%, distant lymph node 6%, and other 13%. The median follow up time was 38.9 months. The 1, 3 and 5-year (yr) OS following metastasectomy were 79% (95% CI 68-92%), 40% (27-58%) and 28% (16-49%). Univariable analysis revealed that time to recurrence greater than 1 yr (HR=0.45 95% CI 0.21-0.93, p=0.032) and lung site recurrence (HR=0.16 95% CI 0.04-0.67, p=0.012) were associated with longer OS. On multivariable analysis, only lung site recurrence was significant (HR=0.12 95% CI 0.03-0.54, p=0.0056). The 1, 3 and 5-yr OS for patients after resection of isolated lung recurrence were 100% (95% CI 100-100%), 86% (63-100%) and 69% (40-100%). Conclusions: In our study, patients with isolated pulmonary recurrences demonstrated prolonged overall survival following metastasectomy. These patients could be considered for resection following recurrence of GE cancer. [Table: see text]
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Affiliation(s)
| | - Lucy Xiaolu Ma
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Chihiro Suzuki
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yvonne Bach
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael J Allen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Carol Jane Swallow
- Princess Margaret Cancer Centre, University Health Network & Mount Sinai Hospital, Toronto, ON, Canada
| | - Savtaj Singh Brar
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jonathan Yeung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Rebecca Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Elan David Panov
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Division of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada
| | - Eric Xueyu Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Elena Elimova
- University of Texas MD Anderson Cancer Center, Houston, TX
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Chuah S, Yong C, Chew J, Cheow Y, Teo K, Zhang S, Lai R, Wong R, Lim A, Lim S, Tohu W. Mesenchymal stromal cell-derived small extracellular vesicles promote angio-osteogenesis and modulate macrophage polarization to enhance bone regeneration. Cytotherapy 2021. [DOI: 10.1016/s1465324921004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elamir AM, Hutchinson S, Albaba H, Keshavarzi S, Xu W, Moulton CA, McGilvary I, Cleary S, Wei A, Dodd A, Knox J, O'Kane G, Prince RM, Kalimuthu S, Kim J, Ringash J, Dawson LA, Wong R, Barry A, Brierley J, Gallinger S, Hosni A. A Risk Score Model for Locoregional Recurrence Following Upfront Surgery for Pancreatic Adenocarcinoma: Implications for Adjuvant Therapy. Clin Oncol (R Coll Radiol) 2021; 33:527-535. [PMID: 33875360 DOI: 10.1016/j.clon.2021.03.007] [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: 09/28/2020] [Revised: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
AIMS The aims of the study were to identify predictors of locoregional failure (LRF) following surgery for pancreatic adenocarcinoma, develop a prediction risk score model of LRF and evaluate the impact of postoperative radiation therapy (PORT) on LRF. MATERIALS AND METHODS A retrospective review was conducted on patients with stages I-III pancreatic adenocarcinoma who underwent surgery at our institution (2005-2016). Univariable and then multivariable analyses were used to evaluate clinicopathological factors associated with LRF for patients who did not receive PORT. The risk score of LRF was calculated based on the sum of coefficients of the predictors of LRF. The model was applied to the entire cohort to evaluate the impact of PORT on the high- and low-risk groups for LRF. RESULTS In total, 467 patients were identified (median follow-up 22 months). Among patients who did not receive PORT (n = 440), predictors of LRF were pN+, involved or close ≤1 mm margin(s), moderately and poorly differentiated tumour grade and lymphovascular invasion. After adding patients who received PORT, the 2-year LRF in the high-risk group was 57% for patients who did not receive PORT (n = 242) and 32% among patients who received PORT (n = 22), with an absolute benefit to LRF of 25% (95% confidence interval 5-52%, P = 0.07). The 2-year overall survival for the high-versus the low-risk group was 36% versus 67% (P < 0.001). CONCLUSION This risk group classification could be used to identify pancreatic adenocarcinoma patients with higher risk of LRF who may benefit from PORT. However, validation and prospective evaluation are warranted.
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Affiliation(s)
- A M Elamir
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - S Hutchinson
- McCain Centre for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto, Canada
| | - H Albaba
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - S Keshavarzi
- Princess Margaret Cancer Center, Department of Biostatistics, Toronto, Canada
| | - W Xu
- Princess Margaret Cancer Center, Department of Biostatistics, Toronto, Canada
| | - C-A Moulton
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - I McGilvary
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - S Cleary
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Wei
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Dodd
- McCain Centre for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto, Canada
| | - J Knox
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - G O'Kane
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - R M Prince
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - S Kalimuthu
- Princess Margaret Cancer Center, Department of Pathology, Toronto, Canada
| | - J Kim
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - J Ringash
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - L A Dawson
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - R Wong
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - A Barry
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - J Brierley
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - S Gallinger
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Hosni
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada.
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Morgan G, Tagliamento M, Lambertini M, Devnani B, Westphalen B, Dienstmann R, Bozovic-Spasojevic I, Calles A, Criscitiello C, Curioni A, Garcia AM, Lamarca A, Pilotto S, Scheffler M, Strijbos M, Wong R, de Azambuja E, Peters S. Impact of COVID-19 on social media as perceived by the oncology community: results from a survey in collaboration with the European Society for Medical Oncology (ESMO) and the OncoAlert Network. ESMO Open 2021; 6:100104. [PMID: 33838532 PMCID: PMC8038939 DOI: 10.1016/j.esmoop.2021.100104] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background The COVID-19 pandemic has impacted all aspects of modern-day oncology, including how stakeholders communicate through social media. We surveyed oncology stakeholders in order to assess their attitudes pertaining to social media and how it has been affected during the pandemic. Materials and methods A 40-item survey was distributed to stakeholders from 8 July to 22 July 2020 and was promoted through the European Society for Medical Oncology (ESMO) and the OncoAlert Network. Results One thousand and seventy-six physicians and stakeholders took part in the survey. In total, 57.3% of respondents were medical oncologists, 50.6% aged <40 years, 50.8% of female gender and mostly practicing in Europe (51.5%). More than 90% of respondents considered social media a useful tool for distributing scientific information and for education. Most used social media to stay up to date on cancer care in general (62.5%) and cancer care during COVID-19 (61%) given the constant flow of information. Respondents also used social media to interact with other oncologists (78.8%) and with patients (34.4%). Overall, 61.1% of respondents were satisfied with the role that social media was playing during the COVID-19 pandemic. On the other hand, 41.1% of respondents reported trouble in discriminating between credible and less credible information and 30% stated social networks were a source of stress. For this reason, one-third of respondents reduced its use during the COVID-19 pandemic. Regarding meeting attendance, a total of 59.1% of responding physicians preferred in-person meetings to virtual ones, and 51.8% agreed that virtual meetings and social distancing could hamper effective collaboration. Conclusion Social media has a useful role in supporting cancer care and professional engagement in oncology. Although one-third of respondents reported reduced use of social media due to stress during the COVID-19 pandemic, the majority found social media useful to keep up to date and were satisfied with the role social media was playing during the pandemic. More than 90% of the 1076 respondents believed in the role of social media promoting scientific information and education. 41% of respondents had trouble discriminating between credible and less credible information on social media. 61% of respondents used social media to stay up to date with scientific information regarding cancer care and COVID-19. The flow of information on COVID-19 via social media was deemed useful for 49% of respondents but caused stress in 30%. 52% of respondents agreed that virtual meetings and social distancing could hamper effective collaboration.
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Affiliation(s)
- G Morgan
- Department of Medical and Radiation Oncology, Skane University Hospital, Lund, Sweden.
| | - M Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - B Devnani
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - B Westphalen
- Department of Medicine 3 and Comprehensive Cancer Center, Ludwig-Maximilians University Munich, Munich, Germany
| | - R Dienstmann
- Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - A Calles
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - C Criscitiello
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Hematology and Oncology (DIPO), University of Milan, Milan, Italy
| | - A Curioni
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - A M Garcia
- Section of Medical Oncology, Dagupan Doctors Villaflor Memorial Hospital, Dagupan, Philippines
| | - A Lamarca
- Department of Medical Oncology, The Christie NHS Foundation, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - S Pilotto
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - M Scheffler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - M Strijbos
- Department of Medical Oncology, GZA Hospitals, Sint-Augustinus, Antwerp, Belgium; Monash University, Eastern Health Clinical School, Box Hill, Australia
| | - R Wong
- Department of Medical Oncology, Eastern Health, Box Hill, Australia
| | - E de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.LB.), Brussels, Belgium
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
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Wanyana D, Wong R, Hakizimana D. Rapid assessment on the utilization of maternal and child health services during COVID-19 in Rwanda. Public Health Action 2021; 11:12-21. [PMID: 33777716 DOI: 10.5588/pha.20.0057] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
SETTING All public health facilities in Rwanda, East Africa. OBJECTIVE To assess the change in the utilization of maternal and child health (MCH) services during the COVID-19 outbreak. DESIGN This was a cross-sectional quantitative study. RESULTS During the COVID-19 outbreak in Rwanda, the utilization of 15 MCH services in all four categories-antenatal care (ANC), deliveries, postnatal care (PNC) and vaccinations-significantly declined. The Northern and Western Provinces were affected the most, with significant decrease in respectively nine and 12 services. The Eastern Province showed no statistically significant utilization changes. Kigali was the only province with significant increase in the fourth PNC visits for babies and mothers, while the Southern Province showed significant increase in utilization of measles + rubella (MR) 1 vaccination. CONCLUSION Access and utilization of basic MCH services were considerably affected during the COVID-19 outbreak in Rwanda. This study highlighted the need for pre-emptive measures to avoid disruptions in MCH service delivery and routine health services during outbreaks. In order for the reductions in MCH service utilization to be reversed, targeted resources and active promotion of ANC, institutional deliveries and vaccinations need to be prioritized. Further studies on long-term impact and geographical variations are needed.
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Affiliation(s)
- D Wanyana
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
| | - R Wong
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda.,School of Public Health, Yale University, New Haven, CT, USA
| | - D Hakizimana
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
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Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R. Factors associated with pain at the end-of-life among older adults in Mexico. Public Health 2021; 191:68-77. [PMID: 33540186 DOI: 10.1016/j.puhe.2020.11.025] [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: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.
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Affiliation(s)
- R Samper-Ternent
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
| | | | - J D Zazueta
- Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands
| | - R Wong
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
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