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Mbonde AA, Gritsch D, Harahsheh EY, Kasule SN, Hasan S, Parsons AM, Zhang N, Butterfield R, Shiue H, Norville KA, Reynolds JL, Vikram HR, Chong B, Grill MF. Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults. JAMA Netw Open 2024; 7:e244294. [PMID: 38546642 PMCID: PMC10979308 DOI: 10.1001/jamanetworkopen.2024.4294] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/02/2024] [Indexed: 04/01/2024] Open
Abstract
Importance West Nile virus (WNV) is the leading cause of human arboviral disease in the US, peaking during summer. The incidence of WNV, including its neuroinvasive form (NWNV), is increasing, largely due to the expanding distribution of its vector, the Culex mosquito, and climatic changes causing heavy monsoon rains. However, the distinct characteristics and outcomes of NWNV in individuals who are immunosuppressed (IS) and individuals who are not IS remain underexplored. Objective To describe and compare clinical and radiographic features, treatment responses, and outcomes of NWNV infection in individuals who are IS and those who are not IS. Design, Setting, and Participants This retrospective cohort study used data from the Mayo Clinic Hospital system collected from July 2006 to December 2021. Participants were adult patients (age ≥18 years) with established diagnosis of NWNV infection. Data were analyzed from May 12, 2020, to July 20, 2023. Exposure Immunosuppresion. Main Outcomes and Measures Outcomes of interest were clinical and radiographic features and 90-day mortality among patients with and without IS. Results Of 115 participants with NWNV infection (mean [SD] age, 64 [16] years; 75 [66%] male) enrolled, 72 (63%) were not IS and 43 (37%) were IS. Neurologic manifestations were meningoencephalitis (98 patients [85%]), encephalitis (10 patients [9%]), and myeloradiculitis (7 patients [6%]). Patients without IS, compared with those with IS, more frequently reported headache (45 patients [63%] vs 18 patients [42%]) and myalgias (32 patients [44%] vs 9 patients [21%]). In contrast, patients with IS, compared with those without, had higher rates of altered mental status (33 patients [77%] vs 41 patients [57%]) and myoclonus (8 patients [19%] vs 8 patients [4%]). Magnetic resonance imaging revealed more frequent thalamic T2 fluid-attenuated inversion recovery hyperintensities in individuals with IS than those without (4 patients [11%] vs 0 patients). Individuals with IS had more severe disease requiring higher rates of intensive care unit admission (26 patients [61%] vs 24 patients [33%]) and mechanical ventilation (24 patients [56%] vs 22 patients [31%]). The 90-day all-cause mortality rate was higher in the patients with IS compared with patients without IS (12 patients [28%] vs 5 patients [7%]), and this difference in mortality persisted after adjusting for Glasgow Coma Scale score (adjusted hazard ratio, 2.22; 95% CI, 1.07-4.27; P = .03). Individuals with IS were more likely to receive intravenous immunoglobulin than individuals without IS (12 individuals [17%] vs 24 individuals [56%]), but its use was not associated with survival (hazard ratio, 1.24; 95% CI, 0.50-3.09; P = .64). Conclusions and Relevance In this cohort study of individuals with NWNV infection, individuals with IS had a higher risk of disease complications and poor outcomes than individuals without IS, highlighting the need for innovative and effective therapies to improve outcomes in this high-risk population.
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Affiliation(s)
- Amir A. Mbonde
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - David Gritsch
- Department of Neurology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ehab Y. Harahsheh
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Sabirah N. Kasule
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Shemonti Hasan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | | | - Nan Zhang
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Richard Butterfield
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Harn Shiue
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Kathryn A. Norville
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Jenna L. Reynolds
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Holenarasipur R. Vikram
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Brian Chong
- Department of Neuroradiology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Marie F. Grill
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
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Budhiraja P, Butterfield R, Gea-Banacloche J, Swaminathan S, Smith ML, Khamash HA, Me HM, Kodali L, Mour GK, Nair S, Misra S, Heilman RL. Outcomes of asymptomatic histologic pyelonephritis of kidney transplant. Clin Transplant 2023; 37:e15125. [PMID: 37705388 DOI: 10.1111/ctr.15125] [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: 04/26/2023] [Revised: 07/10/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Urinary Tract Infections are the most common post-transplant infection and can have varied presentations. This study aimed to describe the outcomes of kidney transplant recipients with asymptomatic histologic pyelonephritis on allograft biopsy. Histologic Pyelonephritis was defined as neutrophil cast or neutrophilic tubulitis, interstitial infiltrates with predominant neutrophils, and no evidence of rejection or glomerulonephritis on biopsy. METHODS The study included 123 kidney transplant recipients, of whom 95 underwent protocol biopsies, and 28 had biopsies for elevated creatinine within the first 2 years of a kidney transplant. RESULTS The mean age of the cohort was 55.3 years, with 52% females and 78% deceased donor transplants. The risk factors for asymptomatic histologic pyelonephritis were recipient female sex (OR 1.89, 1.3-2.7, diabetes mellitus (OR 2.479, 1.687-3.645), and deceased donation (OR 1.69, 1.098-2.63). The incidence of asymptomatic pyelonephritis on protocol biopsy was 1.7%, with 52% having positive urine cultures and Escherichia coli being the most common bacteria. Subjects with asymptomatic pyelonephritis had inferior graft survival compared to the matched cohort HR 1.88 (1.06-3.35), p = .0281. In addition, of these 123 subjects, 68 (55%) subsequently developed pyelonephritis, and 34 subjects had pyelonephritis within 6 months after this episode. Subjects with recurrent infections exhibited lower survival HR 2.86 (1.36-6.02) and a trend toward higher rejection risk. CONCLUSION Asymptomatic histologic pyelonephritis can occur in kidney transplant recipients and is associated with inferior graft survival.
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Affiliation(s)
- Pooja Budhiraja
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Juan Gea-Banacloche
- Department of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Maxwell L Smith
- Department of Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hassan A Khamash
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hay Me Me
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Lavanya Kodali
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Girish K Mour
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sumi Nair
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Suman Misra
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Besch JG, Kechter J, Hwang A, Shahin A, Bhullar P, Puri P, Butterfield R, Costello C, Rule W, Rosenthal A, DiCaudo DJ, Pittelkow M, Mangold A. Primary cutaneous diffuse large B-cell lymphoma, leg type, presenting as subcutaneous nodules: Case series and comparison of treatment outcomes. JAAD Case Rep 2023; 41:81-84. [PMID: 37916039 PMCID: PMC10615895 DOI: 10.1016/j.jdcr.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Jake G. Besch
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Jacob Kechter
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Angelina Hwang
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Ahmad Shahin
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Puneet Bhullar
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Pranav Puri
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Richard Butterfield
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - William Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Mark Pittelkow
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Aaron Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
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Kennedy MM, Abdel-Aty Y, Butterfield R, Zhang N, Lott DG. Is Continued Perioperative Antithrombotic Therapy Safe When Performing Open Tracheostomy? Ann Otol Rhinol Laryngol 2023; 132:1285-1292. [PMID: 36647237 DOI: 10.1177/00034894221147807] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To date, there are no specific guidelines on antithrombotic therapy (ATT) management, which includes both anticoagulation and antiplatelet medications, for open tracheostomy. The objective of this study was to evaluate whether the use of perioperative antithrombotic medication during open tracheostomy influences the incidence of perioperative or postoperative complications. METHODS A retrospective review was conducted of all patients who underwent open tracheostomies at a tertiary care medical center from January 2015 to December 2019. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, ATT use, operative details, and complications. RESULTS A total of 217 tracheostomies were evaluated for this study, of which 148 (68.2%) were not on ATT and 69 (31.8%) were on ATT during surgery. No significant difference was observed based on ATT status in perioperative bleeding (P = .983), postoperative bleeding (P = .24), or median days to decannulation (P = .5986). ATT patients were 2.67 times more likely to experience 30-day mortality than those non-ATT patients (P = .035). There was only one death due to hemorrhage in the ATT group. This was unrelated to the tracheostomy. This compares to 2 hemorrhage-related deaths in those not on ATT. CONCLUSION There was no significant difference in perioperative or postoperative bleeding based on ATT use. Patients on ATT were significantly more likely to experience 30-day mortality, however only one death was due to hemorrhage in the ATT group and was unrelated to tracheostomy. Therefore, continued perioperative ATT use appears to be safe when performing open tracheostomy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Maeve M Kennedy
- Head and Neck Regenerative Medicine Laboratory, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Yassmeen Abdel-Aty
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of South Florida Health
| | - Richard Butterfield
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, USA
| | - Nan Zhang
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, USA
| | - David G Lott
- Head and Neck Regenerative Medicine Laboratory, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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5
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Wang Y, Ayoub C, Yang AF, Sonbol MB, Butterfield R, Halfdanarson TR, Arsanjani R, Zhu W, Yang M. Gastroenteropancreatic Neuroendocrine Tumor Metastasis to the Heart: Evaluation of Imaging Manifestations. Curr Probl Diagn Radiol 2023; 52:340-345. [PMID: 36473799 PMCID: PMC10189797 DOI: 10.1067/j.cpradiol.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Neuroendocrine tumors (NET) may affect the heart by cardiac metastasis or carcinoid heart disease. NET metastasis to the heart is rare, with limited data characterizing it. We sought to evaluate 68Ga-DOTATATE PET scan imaging features and associated cardiac imaging characteristics where available in those with NET cardiac metastases. 68Ga-DOTATATE positron emission tomography (PET)/CT scans performed on patients with gastroenteropancreatic (GEP) NET at our institution were reviewed for cardiac involvement. Those identified with cardiac metastases had their electronic medical record, transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (MRI) reviewed for characterization. From a total of 1426 68Ga-DOTATATE PET/CT scans performed on patients with GEP-NET, 25 (1.75%) had cardiac uptake consistent with metastasis. Of these, 22 had myocardial metastases (29 distinct myocardial lesions: left ventricle - 16, right ventricle - 6, and ventricular septum -7) and 3 had periradial lymph node involvement only. NET patients with cardiac metastases as identified by DOTATATE scan did not appear to have any hemodynamically significant TTE features, aside from those (2/25) who had concomitant carcinoid heart disease. Of the 14 patients who had available TTE for review, only one with high metastatic cardiac tumor burden had detectable cardiac mass. Of the 6 cases who had available MRI, all had metastatic cardiac lesions seen with excellent correlation with tumor localization on 68Ga-DOTATATE PET scan. 68Ga-DOTATATE PET has excellent capability for the diagnosis of cardiac NET metastasis. Cardiac MRI may provide further anatomic and tissue characterization evaluation. Those with myocardial NET metastases without carcinoid heart disease did not have significant hemodynamic effect based on echocardiographic criteria.
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Affiliation(s)
- Yuxiang Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Chadi Ayoub
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Aaron F Yang
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | | | | | | | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Wuqiang Zhu
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Ming Yang
- Department of Radiology, Mayo Clinic, Scottsdale, AZ.
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Hans A, Stonnington CM, Zhang N, Butterfield R, Friedman DI. The impact of resilience on headache disability as measured by the Migraine Disability Assessment (MIDAS). Headache 2023; 63:743-750. [PMID: 37218745 DOI: 10.1111/head.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Our objectives were to examine cross-sectional correlations of headache disability with measures of resilience, anxiety, and depression, and to determine if resilience modified the association between headache severity/frequency and disability. BACKGROUND Resilience is associated with quality of life and functioning among patients with chronic conditions. We investigated whether resilience strongly mitigates headache-related disability as measured by the Migraine Disability Assessment (MIDAS). METHODS We prospectively recruited 160 patients with primary headache disorders seen in a tertiary headache medicine program between February 20, 2018 and August 2, 2019. Each participant completed the MIDAS, Conner Davidson Resilience Scale (CDRS-25), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and WHO-5 Well-Being Index. RESULTS The CDRS-25 score was negatively correlated with the total MIDAS (r = -0.21, p = 0.009), GAD-7 (r = -0.56, p < 0.001), and PHQ-9 scores (r = -0.34, p < 0.001). Well-being inversely correlated with disability (r = -0.37, p < 0.001). Increases in anxiety and depression increased the odds of disability. A 1 point increase in the CDRS-25 score decreased the odds of being severely disabled by 4% (OR = 0.96, 95% CI: 0.94 to 0.99, p = 0.001). However, the CDRS-25 score did not significantly moderate the association between headache days and disability. CONCLUSION Traits associated with resilience decreased the odds of severe disability from headaches, whereas anxiety, depression, and headache frequency were strongly associated with higher disability from headache.
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Affiliation(s)
- Avneet Hans
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Richard Butterfield
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Deborah I Friedman
- Departments of Neurology and Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Shahin A, Janeczek M, Butterfield R, Bhullar P, Boudreaux B, Ho T, Mangold A. Characterization of cutaneous adverse events to enfortumab vedotin: A retrospective case-control study. JAAD Int 2023; 10:46-47. [DOI: 10.1016/j.jdin.2022.10.004] [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: 11/27/2022] Open
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8
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Janeczek M, Shimshak S, Hoss E, Butterfield R, Fathi R, Ochoa S. Characterization of Blood-borne Pathogen Exposures During Dermatologic Procedures: The Mayo Clinic Experience. Cutis 2023; 111:143-145. [PMID: 37224502 DOI: 10.12788/cutis.0728] [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: 05/26/2023]
Abstract
Dermatologists are at risk for blood-borne pathogen (BBP) exposures. We conducted a retrospective review of incidence reports to identify the incidence of BBP exposures in dermatologic procedures. Secondary aims included identification of the type of exposure, type of procedure associated with each exposure, anatomic locations of exposures, and instruments involved in each exposure. Data were obtained at 3 Mayo Clinic sites in Scottsdale, Arizona; Jacksonville Florida; and Rochester, Minnesota, from 2010 to 2021. Two hundred twenty-two exposures were identified over an 11-year period. Results indicated that quality improvement measures should focus on training all dermatologic staff to reduce BBP exposures.
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Affiliation(s)
- Monica Janeczek
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Serena Shimshak
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Elika Hoss
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Richard Butterfield
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Ramin Fathi
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
| | - Shari Ochoa
- Drs. Janeczek, Hoss, Fathi, and Ochoa are from the Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. Ms. Shimshak is from the Mayo Clinic Alix School of Medicine, Scottsdale. Mr. Butterfield is from the Department of Health Sciences Research, Mayo Clinic, Scottsdale
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Chao CJ, Butterfield R, Zhang N, Wen S, Naqvi TZ. QUALITATIVE CAROTID ULTRASOUND PLAQUE ASSESSMENT MAY NOT REFLECT THE TRUE ATHEROSCLEROSIS BURDEN IN LOW TO INTERMEDIATE RISK POPULATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01903-4] [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: 03/06/2023]
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10
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English SW, Chhabra N, Hanus A, Basharath R, Miller M, Butterfield R, Zhang N, Demaerschalk BM. Abstract WP37: Prehospital Stroke Scales Outperform National Institutes Of Health Stroke Scale In Predicting Large Vessel Occlusion In A Large Telestroke Network. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp37] [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: 02/05/2023]
Abstract
Introduction:
Prehospital telestroke is increasingly utilized in mobile stroke units and telemedicine-enabled ambulances for acute ischemic stroke (AIS). While the NIHSS remains the standard for telestroke assessment, simpler scales have been validated to help paramedics recognize large vessel occlusion (LVO) strokes but have not been evaluated in a traditional telestroke network. We aimed to determine the accuracy of common LVO scales in a large academic telestroke practice.
Methods:
This retrospective study included all telestroke consults performed in a large academic telestroke network from 2019 to 2020. Patients were excluded if no NIHSS or vessel imaging was performed. We recorded presenting NIHSS, site of vessel occlusion, and discharge diagnosis. LVO was defined as an acute occlusion of the internal carotid artery and/or M1 middle cerebral artery. The NIHSS was used to calculate 7 LVO scales (RACE, C-STAT, FAST-ED, 3I-SS, PASS, VAN, and G-FAST). Diagnostic performance was assessed by calculating sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy using the established thresholds of each scale. These results were compared to NIHSS at thresholds of 6, 8, and 10. Area under curve (AUC) was calculated using c-statistics by treating scales as continuous variables.
Results:
A total of 625 patients were included, 373/625 (59.7%) of which were diagnosed with AIS at discharge. LVO was identified in 78/625 (12.5%) patients. VAN was the most sensitive prehospital stroke scale (83.3%), whereas 3I-SS ≥ 4 was the most specific (95.2%). Both the RACE and FAST-ED scales demonstrated superior accuracy and AUC compared to the NIHSS (Table 1).
Conclusions:
To our knowledge, this is the first study assessing LVO scale accuracy in a large telestroke network. As use of prehospital telestroke grows, this study highlights several scales that may allow for faster prehospital triage decisions without sacrificing accuracy.
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Mbonde A, David G, Harahsheh E, Kasule SN, Vikram HR, Hasan S, Butterfield R, Grill M. 1029. Clinical Characteristics and Outcomes of Neuroinvasive West Nile Virus Infection in Immunocompromised and Immunocompetent Individuals. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.870] [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: 12/23/2022] Open
Abstract
Abstract
Background
Despite the increasing incidence of neuroinvasive West Nile virus (NiWNV) infection in the US, the spectrum of disease characteristics and neuroimaging findings in immunosuppressed (IS) individuals are not adequately described. We aimed to compare the clinical characteristics and outcomes of NiWNV infection in IS and immunocompetent (IC) patients.
Methods
We extracted relevant data from all NiWNV patients hospitalized 7/2003-10/2021 at Mayo Clinic hospitals. Cohort was inclusive of patients from the recent historic WNV outbreak in Arizona in 2021. Chi-Square or Kruskal-Wallis and logistic regression were used to compare relevant variables and determine predictors of mortality respectively.
Results
We included 115 patients (72 IC and 43 IS), mean age 63.5 years; neurologic syndromes included meningoencephalitis (85.2%), encephalomyelitis (8.7%) and myeloradiculitis (6.1%). Presenting symptoms were malaise (72%), fever (66%), altered mentation (64%), gastrointestinal (47%) and myalgia (35.7%). MRI brain was abnormal in 62.8% (49/78), demonstrating T2/FLAIR hyperintensities in 47.4% (brainstem, thalamus, temporal lobes), leptomeningeal enhancement (16.7%) and diffusion restriction (20.5%). Altered mental status (76.7% vs 56.9%), myalgia (44.4% vs. 20.9%), myoclonus (18.6% vs. 4.2%) and thalamic MRI T2 FLAIR abnormalities (11.4% vs 0%) were more common in IS patients. Higher CSF WBC counts were observed in IC vs IS patients (P< 0.05). Immunosuppressed patients were more likely to be treated with intravenous immunoglobulin (44.2% vs 8.3% p=< 0.001) and/or interferon therapy (32.6% vs 6.9%, p=0.0003) and had increased odds of 90-day mortality on multivariable analysis (Adjusted Odds Ratio, AOR 2.22; 95% CI 1.065-4.627, p=0.0334). In the IS subgroup, ICU admission, mechanical ventilation, and Glasgow coma scale of < 8 were associated with reduced overall survival/increased 90-day mortality (p< 0.005).
Conclusion
Individuals presenting in summer/fall months with the aforementioned symptoms and/or MRI abnormalities should be evaluated for NiWNV infection. Compared to the immunocompetent, immunosuppressed patients with NiWNV are at a significantly greater mortality risk. Novel and effective antiviral therapies aimed at improving outcomes are warranted.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Sabirah N Kasule
- Bronx Healthcare Network , Bronx, NY, Long Island City, New York
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Hines A, Butterfield R, Boudreaux B, Bhullar P, Severson KJ, McBane RD, Davis MDP, Pittelkow MR, Mangold AR, Alavi A. Characteristics of ulcerated and non‐ulcerated necrobiosis lipoidica. Int J Dermatol 2022; 62:790-796. [PMID: 36479693 DOI: 10.1111/ijd.16529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. METHODS Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n = 83) and non-ulcerated NL (NUNL, n = 233) groups were compared. RESULTS Twenty-six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P = 0.01), was more likely to have a lesion-associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P = 0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non-ulcerated leg, but these differences were not statistically significant. CONCLUSIONS UNL was more likely to be painful, develop lesion-associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.
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Affiliation(s)
| | | | | | | | | | - Robert D. McBane
- Division of Vascular Medicine of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | | | | | | | - Afsaneh Alavi
- Department of Dermatology Mayo Clinic Rochester MN USA
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Demaerschalk BM, Pines A, Butterfield R, Haglin JM, Haddad TC, Yiannias J, Colby CE, TerKonda SP, Ommen SR, Bushman MS, Lokken TG, Blegen RN, Hoff MD, Coffey JD, Anthony GS, Zhang N. Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020. JAMA Netw Open 2022; 5:e2229958. [PMID: 36053531 PMCID: PMC9440401 DOI: 10.1001/jamanetworkopen.2022.29958] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE There was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic. OBJECTIVE To determine the concordance of provisional diagnoses established at a video telemedicine visit with diagnoses established at an in-person visit for patients presenting with a new clinical problem. DESIGN, SETTING, AND PARTICIPANTS This is a diagnostic study of patients who underwent a video telemedicine consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window. The provisional diagnosis made during the video telemedicine visit was compared with the reference standard diagnosis by 2 blinded, independent medical reviewers. A multivariate logistic regression model was used to determine factors significantly related to diagnostic concordance. The study was conducted at a large academic integrated multispecialty health care institution (Mayo Clinic locations in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; and Jacksonville, Florida; and Mayo Clinic Health System locations in Iowa, Wisconsin, and Minnesota) between March 24 and June 24, 2020. Participants included Mayo Clinic patients residing in the US without age restriction. Data analysis was performed from December 2020 to June 2021. EXPOSURES New clinical problem assessed via video telemedicine visit to home using Zoom Care Anyplace integrated into Epic. MAIN OUTCOMES AND MEASURES Concordance of provisional diagnoses established over video telemedicine visits compared against a reference standard diagnosis. RESULTS There were 2393 participants in the analysis. The median (IQR) age of patients was 53 (37-64) years; 1381 (57.7%) identified as female, and 1012 (42.3%) identified as male. Overall, the provisional diagnosis established over video telemedicine visit was concordant with the in-person reference standard diagnosis in 2080 of 2393 cases (86.9%; 95% CI, 85.6%-88.3%). Diagnostic concordance by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapter ranged from 64.7% (95% CI, 42.0%-87.4%) for diseases of the ear and mastoid process to 96.8% (95% CI, 94.7%-98.8%) for neoplasms. Diagnostic concordance by medical specialty ranged from 77.3% (95% CI, 64.9%-89.7%) for otorhinolaryngology to 96.0% (92.1%-99.8%) for psychiatry. Specialty care was found to be significantly more likely than primary care to result in video telemedicine diagnoses concordant with a subsequent in-person visit (odds ratio, 1.69; 95% CI, 1.24-2.30; P < .001). CONCLUSIONS AND RELEVANCE This diagnostic study of video telemedicine visits yielded a high degree of diagnostic concordance compared with in-person visits for most new clinical concerns. Some specific clinical circumstances over video telemedicine were associated with a lower diagnostic concordance, and these patients may benefit from timely in-person follow-up.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Andrew Pines
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
- Now with Department of Psychiatry, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Richard Butterfield
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Jack M. Haglin
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Tufia C. Haddad
- Department of Medical Oncology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - James Yiannias
- Department of Dermatology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Christopher E. Colby
- Department of Pediatric and Adolescent Medicine, Neonatology, Critical Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Sarvam P. TerKonda
- Department of Surgery and Plastic and Reconstructive Surgery, Center for Digital Health, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Steve R. Ommen
- Department of Cardiovascular Medicine and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Matthew S. Bushman
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Troy G. Lokken
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Rebecca N. Blegen
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Mekenzie D. Hoff
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Jordan D. Coffey
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Greg S. Anthony
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nan Zhang
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
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Bhullar P, Boudreaux B, Severson K, Zhang N, Butterfield R, Brumfiel C, Patel M, Li X, Hughes A, Zunich S, Branch E, Nelson S, Sekulic A, Pittelkow M, Mangold A. LB947 An open-label study of topical ruxolitinib in necrobiosis lipoidica. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.966] [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: 10/17/2022]
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15
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Shahin A, Janeczek M, Butterfield R, Bhullar P, Boudreaux B, Ho T, Mangold A. LB906 Characterization of cutaneous adverse events to enfortumab vedotin. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Carey EJ, Eaton J, Clayton M, Gossard A, Iqbal S, Ullah H, Zhang N, Butterfield R, Lindor KD. A pilot study of vidofludimus calcium for treatment of primary sclerosing cholangitis. Hepatol Commun 2022; 6:1589-1597. [PMID: 35238498 PMCID: PMC9234677 DOI: 10.1002/hep4.1926] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
The purpose of this pilot study was to explore the efficacy, safety, and tolerability of vidofludimus calcium (VC) in the treatment of primary sclerosing cholangitis (PSC). This was a single-arm open-label pilot study with a cohort of 18 patients with PSC. Study patients received VC for a period of 6 months. The study was undertaken at two sites, Mayo Clinic, Rochester, MN, and Mayo Clinic, Phoenix, AZ. The primary endpoint of the study was improvement of serum alkaline phosphatase (ALP) at the end of the study. Secondary endpoints included assessment of other liver biomarkers (bilirubin, alanine aminotransferase, and aspartate aminotransferase). Of 18 patients enrolled, 11 completed the 6 months of study treatment. Patients who completed treatment versus those who did not were similar other than a significantly higher direct bilirubin at baseline in the group that completed treatment (mean ± SD, 0.4 ± 0.3 versus 0.1 ± 0.1, p = 0.04). By intent to treat analysis, the primary outcome was met in 16.7% (3/18) of patients. By per-protocol analysis, including only patients who completed treatment, normalization of ALP occurred in 27.7% (3/11) at week 24 (95% confidence interval, 6.0% to 61.0%). VC was well tolerated with no drug-related serious adverse events. Conclusion: This proof of concept study provides support for further exploration of VC in patients with PSC.
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Affiliation(s)
- Elizabeth J Carey
- Division of Gastroenterology and HepatologyMayo ClinicPhoenixArizonaUSA
| | - John Eaton
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Mitchell Clayton
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Andrea Gossard
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Sara Iqbal
- GastroenterologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Hamid Ullah
- GastroenterologyWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Nan Zhang
- Department of Quantitative Health ResearchMayo ClinicPhoenixArizonaUSA
| | | | - Keith D Lindor
- Division of Gastroenterology and HepatologyMayo ClinicPhoenixArizonaUSA
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17
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Langlais B, Mazza GL, Scherber RM, Geyer H, Gowin KL, Palmer J, Kosiorek HE, Mead-Harvey C, Butterfield R, Mesa RA, Dueck AC. Impact of imbalanced gender participation in online myeloproliferative neoplasm symptom surveys. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19078] [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
e19078 Background: Patients with myeloproliferative neoplasms (MPN), including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), experience chronic disease-related symptoms. Surveying these patients while incorporating the MPN-Symptom Assessment Form (SAF) gains valuable insight. Independent surveys evaluating symptoms among MPN patients have seen disproportionate participation among females compared to males (upwards of 4:1). Though the general MPN patient population is roughly gender balanced, epidemiological studies show the occurrence of MPN types differ between men and women (MPN [%male]: PV [65%], ET [33%], MF [50%]. Mehta, et al. Leuk & Lymph 2014). In-clinic evaluations and international MPN surveys of disease-related symptoms suggest women report higher symptom burden on average compared to men, despite MPN type [Emanuel, et al. JCO 2012. Geyer, et al. Haematol 2017]. Further, a recent study across cancer trials showed women had a 34% increased risk of reporting severe symptoms [Unger, et al. JCO 2022]. This study aimed to evaluate gender imbalance in survey participation among MPN patient surveys and investigate its potential to overestimate symptom burden if gender is ignored. Methods: Five anonymous web-based surveys were used to assess the impact of disproportionate gender participation. The MPN-10 assessing the 10 most clinically meaningful SAF items was present in these surveys and generated the Total Symptom Score (TSS). Survey responses with no self-reported gender or ≥5 missing MPN-10 symptoms were excluded. Raking weights based on expected MPN population were applied at the survey- and MPN type-level. Relative bias of mean TSS was calculated to evaluate over- and underestimation due to this participation imbalance. Relative bias <5% is commonly acceptable. Results: There were 4962 survey participants total and 74% were female (Table). Epidemiologically expected gender frequency by MPN type was not seen (MPN [%male]: PV [31%], ET [15%], MF [37%]). The gender participation imbalance accounted for a 3.1% overestimation of overall TSS. This also resulted in a 6.8% underestimation of the mean difference in TSS between genders, across MPNs. Conclusions: Overall bias due to gender participation imbalance was relatively low. However, analyses considering gender differences were more impacted. Anonymous surveys should seek to reduce participation bias during the survey design phase. More research is needed to evaluate gender and other participation biases in surveys across cancer domains.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amylou C. Dueck
- Alliance Statistics and Data Center and Mayo Clinic, Phoenix, AZ
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18
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Mbonde AA, Mbatidde L, Demaerschalk BM, Aden AA, Zhang N, Butterfield R, Muhindo R, Kayanja A, O'Carroll CB. HIV Infection Is an Independent Predictor of Mortality Among Adults with Reduced Level of Consciousness in Uganda. Am J Trop Med Hyg 2022; 106:909-914. [PMID: 35026731 PMCID: PMC8922480 DOI: 10.4269/ajtmh.21-0813] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
The clinical epidemiology of adults admitted with reduced level of consciousness (LOC) in sub-Saharan Africa (SSA) and the impact of HIV infection on the risk of mortality in this population is unknown. We secondarily analyzed data from a cohort study that enrolled 359 consecutive adults with reduced LOC presenting to Mbarara Regional Hospital in Uganda with the aim of comparing the prognostic utility of the Full Outline of Unresponsiveness (FOUR) score to the Glasgow Coma Scale (GCS) Score. For this analysis, we included 336 individuals with known HIV serostatus, obtaining clinical, laboratory, and follow-up data. We recorded investigations and treatments deemed critical by clinicians for patient care but were unavailable. We computed mortality rates and used logistic regression to determine predictors of 30-day mortality. The median GCS was 10. Persons living with HIV infection (PLWH) accounted for 97 of 336 (29%) of the cohort. The 30-day mortality rate in the total cohort was 148 of 329 (45%), and this was significantly higher in PLWH (57% versus 40%, adjusted odds ratio [aOR] 2.39: 95% confidence interval [CI]: 1.31–4.35, P = 0.0046). Other predictors of mortality were presence of any unmet clinical need (aOR 1.72; 95% CIL 1.04–2.84, P = 0.0346), anemia (aOR 1.68; 95% CI: 1.01–2.81, P = 0.047), and admission FOUR score < 12 [aOR 4.26; 95% CI: 2.36–7.7, P< 0.0001). Presentation with reduced LOC in Uganda is associated with high mortality rates, with worse outcomes in PLWH. Improvement of existing acute care services is likely to improve outcomes.
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Affiliation(s)
- Amir A Mbonde
- Department of Internal Medicine, Mbarara University of Science and Technology, Uganda.,Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Lydia Mbatidde
- College of Science and Engineering, St. Cloud State University, New Hope, Minnesota
| | - Bart M Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Abdirahim A Aden
- Department of Internal Medicine, Healthgate Hospital, Nairobi, Kenya
| | - Nan Zhang
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Richard Butterfield
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Rose Muhindo
- Department of Internal Medicine, Mbarara University of Science and Technology, Uganda
| | - Adrian Kayanja
- Department of Internal Medicine, Mbarara University of Science and Technology, Uganda
| | - Cumara B O'Carroll
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
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19
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Mbonde AA, O’Carroll CB, Grill MF, Zhang N, Butterfield R, Demaerschalk BM. Stroke Features, Risk Factors and Pathophysiology in SARS-CoV-2 infected Patients. Mayo Clin Proc Innov Qual Outcomes 2022; 6:156-165. [PMID: 35079695 PMCID: PMC8776423 DOI: 10.1016/j.mayocpiqo.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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20
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Sagaser S, Butterfield R, Kosiorek H, Kusne Y, Maldonado J, Fautsch MP, Patel D, Shen JF. Effects of Intense Pulsed Light on Tear Film TGF-β and Microbiome in Ocular Rosacea with Dry Eye. Clin Ophthalmol 2021; 15:323-330. [PMID: 33536740 PMCID: PMC7850425 DOI: 10.2147/opth.s280707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms. Methods Twenty patients were randomly assigned to IPL-MGX or MGX. Patients were examined, treated, and administered the ocular surface disease index (OSDI) survey every 4-6 weeks for four total treatments. Tear film and conjunctival samples were collected at first and last visits, and analyzed for TGF-β concentration and 16s rRNA amplicon sequencing of ocular microbiome. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline. Results OSDI revealed significantly greater improvement in symptoms after IPL-MGX (p=0.030) compared to MGX. There was no significant difference in mean TGF-β1, 2, or 3 concentration after IPL-MGX (p=0.385, 0.709, 0.948, respectively). Quantities of Clostridium, Klebsiella, Brevibacterium, Lactobacillus, Neisseria, Streptococcus, Corynebacterium, Butyricicoccus, and Actinomyces were significantly reduced from baseline in both groups but without a significant difference between the two treatment groups. Conclusion IPL-MGX improved dry eye symptoms more than MGX alone. IPL treatment offered no additional benefit to MGX in decreasing virulent bacteria present on the ocular surface and did not influence TGF-β levels in tears. Prospective studies on IPL-MGX with larger sample sizes are needed to further investigate cytokines and IPL in patients suffering from ocular rosacea with dry eye symptoms. ClinicalTrialsgov Identifier NCT03194698.
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Affiliation(s)
| | | | - Heidi Kosiorek
- Research Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Yael Kusne
- Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Juan Maldonado
- Knowledge Enterprise, Genomics Core, Arizona State University, Tempe, AZ, USA.,Center for Fundamental and Applied Microbiomics, The Biodesign Institute, Arizona State University, Tempe, AZ, USA
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22
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Shah S, Butterfield R, Bendok B, Lyons M, Ariete J, Yancey E, Mrugala M. NCOG-10. ASSESSMENT OF SURVIVAL AND SAFETY FOLLOWING INTRATHECAL CHEMOTHERAPY VIA OMMAYA RESERVOIR FOR LEPTOMENINGEAL DISEASE. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.549] [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: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Leptomeningeal disease (LMD) is an aggressive, late-stage complication of systemic cancers that maintains a poor prognosis with an average survival of 3-6 months. Ommaya reservoirs (OR) are an accessible alternative to serial lumbar punctures for the delivery of intrathecal chemotherapy in the treatment of LMD. However, widespread use of OR has been limited by reports of complications, limited physicians trained in their use, and the stigma of brain surgery. Here, we assess survival and complication rates for patients who received intrathecal chemotherapy through OR for LMD treatment.
METHODS
After IRB approval, chart review of patients who received at least one administration of intrathecal chemotherapy through OR for LMD treatment between 2017- 2020 at Mayo Clinic in Phoenix, Arizona was conducted. Charts were reviewed for demographics, treatment type, complications, and outcomes.
RESULTS
A total of 10 patients were included. The median overall survival from date of first OR injection was 110.5 days (95% CI: 64 – not estimable). The median time to progression from the first injection was 55.5 days (95% CI: 45 – 753). A total of 82 OR injections were conducted for an average of approximately 8 injections per patient. Two patients (20%) experienced mild adverse events – grade 2 or lower by Common Terminology Criteria for Adverse Events with a single injection. The majority of injections involved no adverse events with the overall risk of any complication at 2.4%. None of the patients experienced infection, a commonly reported complication of OR use.
CONCLUSIONS
Our results support the inclusion of intrathecal chemotherapy via OR into the treatment paradigm in patients with leptomeningeal malignancies. This approach is feasible, safe, and median survival is comparable with data reported in published series. The overall complication rate in patients receiving intrathecal chemotherapy through OR is very low including the risk of infection.
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Affiliation(s)
- Shiv Shah
- Mayo Clinic Arizona, Scottsdale, AZ, USA
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23
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Chand D, Finkel R, Day J, Darris B, Kuntz N, Connolly A, Zaidman C, Crawford T, Butterfield R, Shieh P, Tennekoon G, Brandesma J, Iannaccone S, Meriggioli M, Tauscher-Wisniewski S, Shoffner J, Ogrinc F, Kavanagh S, Feltner D, Mendell J. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Mackintosh C, Butterfield R, Zhang N, Lorence J, Zlomanczuk P, Bendok BR, Zimmerman RS, Swanson K, Porter A, Mrugala MM. Does location matter? Characterisation of the anatomic locations, molecular profiles, and clinical features of gliomas. Neurol Neurochir Pol 2020; 54:456-465. [PMID: 32914406 DOI: 10.5603/pjnns.a2020.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuroanatomic locations of gliomas may influence clinical presentations, molecular profiles, and patients' prognoses. METHODS We investigated our institutional cancer registry to include patients with glioma over a 10-year period. Statistical tests were used to compare demographic, genetic, and clinical characteristics among patients with gliomas in different locations. Survival analysis methods were then used to assess associations between location and overall survival in the full cohort, as well as in relevant subgroups. RESULTS 182 gliomas were identified. Of the tumours confined to a single lobe, there were 51 frontal (28.0%), 50 temporal (27.5%), 22 parietal (12.1%), and seven occipital tumours (3.8%) identified. Tumours affecting the temporal lobe were associated with reduced overall survival when compared to all other tumours (11 months vs. 13 months, log-rank p = 0.0068). In subgroup analyses, this result was significant for males [HR (95%CI) 2.05 (1.30, 3.24), p = 0.002], but not for females [HR (95%CI) 1.12 (0.65, 1.93), p = 0.691]. Out of 82 cases tested for IDH-1, 10 were mutated (5.5%). IDH-1 mutation was present in six frontal, two temporal, one thalamic, and one multifocal tumour. Out of 21 cases tested for 1p19q deletions, 12 were co-deleted, nine of which were frontal lobe tumours. MGMT methylation was assessed in 45 cases; 7/14 frontal tumours and 6/13 temporal tumours were methylated. CONCLUSION Our results support the hypothesis that the anatomical locations of gliomas influence patients' clinical courses. Temporal lobe tumours were associated with poorer survival, though this association appeared to be driven by these patients' more aggressive tumour profiles and higher risk baseline demographics. Independently, female patients who had temporal lobe tumours fared better than males. Molecular analysis was limited by the low prevalence of genetic testing in the study sample, highlighting the importance of capturing this information for all gliomas. IMPORTANCE OF THIS STUDY The specific neuroanatomic location of tumours in the brain is thought to be predictive of treatment options and overall prognosis. Despite evidence for the clinical significance of this information, there is relatively little information available regarding the incidence and prevalence of tumours in the different anatomical regions of the brain. This study has more fully characterised tumour prevalence in different regions of the brain. Additionally, we have analysed how this information may affect tumours' molecular characteristics, treatment options offered to patients, and patients' overall survival. This information will be informative both in the clinical setting and in directing future research.
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Affiliation(s)
| | | | - Nan Zhang
- Mayo Clinic Arizona Department of Biostatistics
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25
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Everett C, Price A, Butterfield R, Morgan P, Smith V, Docherty S, Matheson E, Anderson J, Viera A, Jackson G. Provider Interdependence, Patient Complexity, and Continuity of Care. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13429] [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: 11/27/2022] Open
Affiliation(s)
- C. Everett
- Physician Assistant Program Duke University Medical School Durham NC United States
| | - A. Price
- Duke University School of Medicine Durham NC United States
| | - R. Butterfield
- Duke University School of Medicine Durham NC United States
| | - P. Morgan
- Duke University Durham NC United States
| | - V. Smith
- Durham Veterans Affairs Health Care System Durham NC United States
| | | | | | - J. Anderson
- Duke University School of Medicine Durham NC United States
| | - A. Viera
- Duke University Durham NC United States
| | - G. Jackson
- Division of General Internal Medicine Department of Medicine Duke University School of Medicine Durham NC United States
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Khera N, Sugalski J, Krause D, Butterfield R, Zhang N, Stewart FM, Carlson RW, Griffin JM, Zafar SY, Lee SJ. Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions. J Natl Compr Canc Netw 2020; 18:825-831. [DOI: 10.6004/jnccn.2020.7538] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022]
Abstract
Background: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distress. Patients and Methods: In November 2018, representatives from 17 (63%) of the 27 existing NCCN Member Institutions completed an online survey. The survey focused on screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes about such practices. Due to the lack of a validated questionnaire in this area, survey questions were generated after a comprehensive literature search and discussions among the study team, including NCCN Best Practices Committee representatives. Results: Responses showed that 76% of centers routinely screened for financial distress, mostly with social worker assessment (94%), and that 56% screened patients multiple times. All centers offered programs to help with drug costs, meal or gas vouchers, and payment plans. Charity care was provided by 100% of the large centers (≥10,000 unique annual patients) but none of the small centers that responded (<10,000 unique annual patients; P=.008). Metrics to evaluate the impact of financial advocacy services included number of patients assisted, bad debt/charity write-offs, or patient satisfaction surveys. The effectiveness of institutional practices for screening and management of financial distress was reported as poor/very poor by 6% of respondents. Inadequate staffing and resources, limited budget, and lack of reimbursement were potential barriers in the provision of these services. A total of 94% agreed with the need for better integration of financial advocacy into oncology practice. Conclusions: Three-fourths of NCCN Member Institutions reported screening and management programs for financial distress, although the actual practices and range of services vary. Information from this study can help centers benchmark their performance relative to similar programs and identify best practices in this area.
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Affiliation(s)
- Nandita Khera
- 1Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - Jessica Sugalski
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Diana Krause
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | - Nan Zhang
- 1Mayo Clinic Alix School of Medicine, Phoenix, Arizona
| | - F. Marc Stewart
- 3Fred Hutchinson Cancer Research Center, University of Washington Children’s Hospital, Seattle, Washington
| | - Robert W. Carlson
- 2National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | | | - Stephanie J. Lee
- 3Fred Hutchinson Cancer Research Center, University of Washington Children’s Hospital, Seattle, Washington
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Connor N, Woodward S, Norwood M, Sturrock N, Woodard J, Skelly R, Butterfield R, Lewis S, Fogarty A. The potential to quantify polypharmacy in older adult hospital inpatients using electronic prescribing software: a feasibility study. Health Technol 2020. [DOI: 10.1007/s12553-020-00419-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractPolypharmacy in older adults is a growing problem, as some drugs may be either unnecessary or even harmful. Admission to hospital under a Medicine for the Elderly specialist physicians represents an opportunity to review patients’ medication. The recent introduction of electronic prescribing to some hospitals in the United Kingdom allows the development of tools to measure polypharmacy in in-patients, and subsequently to assess the efficacy of interventions that aim to optimize medication prescribing. We tested the feasibility of developing an Excel-based software code that measured the number of medications a group of patients were taking at admission and how many of these were still prescribed on discharge. Electronic prescribing data was obtained from the Royal Derby Hospital, over a period of 52 weeks from April 2017 to March 2018 for all patients over the age of 65 years who were admitted onto the medicine for the elderly wards and subsequently discharged. On admission, the median number of eligible medications was 11 (interquartile range IQR 8 to 15). At the time of discharge, the median number of eligible medications retained since admission was 9 (IQR 6 to 12). This represents a median number of medications that have been removed from the current medication regimen of 2 (IQR 1 to 3, p < 0.001). Electronic prescribing software in hospitals allows the development of tools to measure the burden of medications, and to examine the efficacy of future interventions that are developed to optimize drug prescribing in older adults.
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Talbott J, Butterfield R, Girardo M, Yi J, Wasson M. 28: Prevalence of pelvic organ prolapse after vaginal hysterectomy with prophylactic apical support. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu L, Yi J, Cornella J, Butterfield R, Buras M, Wasson M. Same-Day Discharge after Vaginal Hysterectomy with Pelvic Floor Reconstruction: Pilot Study. J Minim Invasive Gynecol 2020; 27:498-503.e1. [DOI: 10.1016/j.jmig.2019.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/20/2019] [Accepted: 04/04/2019] [Indexed: 11/16/2022]
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Edmonds V, Thomson H, Sharma A, Butterfield R, Zhang N, Sio T, Vora S, Daniels T, Schild S, Ashman J, Patel N, Zimmerman R, Mrugala M, DeLeon T, Bryce A, Porter A. CMET-05. EVALUATING RADIATION NECROSIS IN PATIENTS WITH INTRACRANIAL METASTASES FROM MELANOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.206] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Radiation is an integral component of the multidisciplinary treatment of patients with intracranial metastasis (ICM) from melanoma. The risk of radiation necrosis (RN) post-treatment can range from 5–25%. We retrospectively evaluated pre- and post-radiation clinical and radiographical characteristics in patients with ICM from melanoma to identify potential risk factors for RN.
METHODS
After IRB approval, patients with ICM from melanoma who received radiation at our institution between 2013 and 2018 were retrospectively reviewed. We recorded demographics, intracranial metastasis (burden and location), systemic therapy, resection, stereotactic radiosurgery versus whole brain radiation, and outcomes. Brain MRI was evaluated using the Response Assessment in Neuro-Oncology criteria (RANO).
RESULTS
A total of 27 patients were included in the study. RN was diagnosed in 14 patients (52%) at one month to three years following radiation. Cerebellar location (n=7) was significantly associated with RN (p=0.0058). Metastasis-associated hemorrhage was present in 7 patients, 6 of which developed RN (43% vs 8%, p=0.08). Surgical resection prior to radiation was performed in 9 patients, 7 of which developed RN (50% vs 15%, p=0.1). RN appeared to be less often diagnosed when ICM were treated with higher doses of radiation (24 Gy vs 20 Gy, p=0.07). Systemic treatment was administered prior to radiation in 25 patients and we found no relationship with systemic therapy type and RN. Presumed RN was treated in 12 of 14 patients (86%). Steroids or surgical resection were the primary treatment modalities, with laser ablation used in 1 case. Following treatment, improvement was noted in 3 patients radiographically and in 1 of these clinically.
CONCLUSIONS
This series of patients with radiotherapy-treated brain metastases from melanoma reveals cerebellar involvement, hemorrhage, and prior surgical resection as potential risk factors for radiation necrosis. Neoadjuvant systemic treatment did not appear to be a risk factor in our review.
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Affiliation(s)
| | | | | | | | - Nan Zhang
- Mayo Clinic Arizona, Phoenix, AZ, USA
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31
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Mackintosh C, Butterfield R, Zhang N, Bendok B, Zimmerman R, Swanson K, Porter A, Mrugala M. EPID-24. DOES THE LOCATION MATTER? CHARACTERIZATION OF THE ANATOMIC LOCATIONS, MOLECULAR PROFILES, AND CLINICAL FEATURES OF GLIOMAS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.324] [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: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Locations of gliomas may influence clinical presentations, molecular profiles, treatment options, and prognoses. Using the Mayo Clinic Arizona Cancer Center registry, we analyzed the frequency at which gliomas were identified in different regions of the brain. We evaluated molecular profiles, clinical courses and survival by anatomic location.
METHODS
Registry was queried to include patients with glioma over a 10-year period. Statistical analyses were used to compare demographic, genetic, and clinical characteristics among patients with gliomas in different locations.
RESULTS
182 gliomas were identified. Of the tumors confined to a single lobe, there were 51 frontal (28.0%), 50 temporal (27.5%), 22 parietal (12.1%), and 7 occipital tumors (3.8%) identified. Multifocal disease was noted in 38 patients (20.9%). Tumors affecting temporal lobe were associated with reduced overall survival when compared to all other tumors (11.0 months vs. 13.0 months, log-rank p=0.0068). However, this disparity became insignificant when adjusted for tumor grade, age, and surgical approach [HR(95% CI) 1.26(0.87, 1.82), p=0.212]. Out of 82 cases tested for IDH-1, 10 were mutated (5.5%). IDH-1 mutation was present in 6 frontal, 2 temporal, 1 thalamic, and 1 multifocal tumor. Out of 21 cases tested for 1p19q deletions, 12 were co-deleted, 9 of which were frontal lobe tumors. MGMT methylation was assessed in 45 cases; 7 of 14 frontal tumors and 6 of 13 temporal tumors were methylated. ATRX loss was detected in 2/42 assessed cases.
CONCLUSION
Our results support the hypothesis that the anatomical locations of gliomas influence patients’ clinical courses. Tumors involving the temporal lobe were associated with poorer survival, though this association appeared to be driven by these patients’ more aggressive tumor profiles and higher risk baseline demographics. Molecular analysis was limited by low prevalence of genetic testing in the study sample, highlighting the importance of capturing this information for all gliomas.
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Affiliation(s)
| | | | - Nan Zhang
- Mayo Clinic Arizona, Phoenix, AZ, USA
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Finkel R, Day J, Darras B, Kuntz N, Connolly A, Crawford T, Butterfield R, Shieh P, Tennekoon G, Iannaccone S, Ogrinc F, Kavanagh S, Kernbauer E, Whittle J, L'Italien J, Kaspar B, Sproule D, Spector S, Feltner D, Mendell J. O.40Intrathecal administration of onasemnogene abeparvovec gene-replacement therapy (GRT) for spinal muscular atrophy type 2 (SMA2): phase 1/2a study (STRONG). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.594] [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: 10/25/2022]
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Ryan M, De Vivo D, Bertini E, Hwu W, Crawford T, Swoboda K, Finkel R, Kirschner J, Kuntz N, Parsons J, Butterfield R, Topaloğlu H, Ben Omran T, Sansone V, Jong Y, Shu F, Foster R, Bhan I, Fradette S, Farwell W. P.356Nusinersen in infants who initiate treatment in a presymptomatic stage of spinal muscular atrophy: interim results from the phase 2 NURTURE study. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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LoRusso S, Johnson N, McDermott M, Eichinger K, Butterfield R, Higgs K, Lewis L, Mul K, Van Engelen B, Sacconi S, Sansone V, Carraro E, Shieh P, Wagner K, Wang L, Statland J, Tawil R, the ReSolve Investigators. P.46Clinical trial readiness to solve barriers to drug development in FSHD (ReSolve): protocol of a large, multi-center prospective study. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Abdallah A, Demaerschalk BM, Kimweri D, Aden AA, Zhang N, Butterfield R, Asiimwe SB, O'Carroll CB. A comparison of the Full Outline of Unresponsiveness (FOUR) and Glasgow Coma Scale (GCS) Scores in Predicting Mortality Among Patients with Reduced Level of Consciousness in Uganda. Neurocrit Care 2019; 32:734-741. [PMID: 31392656 DOI: 10.1007/s12028-019-00806-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reduced level of consciousness (LOC) is a common cause of presentation among acutely ill adults in sub-Saharan Africa and is associated with high rates of mortality. Although the Full Outline of Unresponsiveness (FOUR) score is often used in clinical practice, its utility in predicting mortality has not been assessed in the region. METHODS We prospectively enrolled adults presenting with reduced LOC to Mbarara Regional Referral Hospital in Uganda. We recorded clinical and laboratory data and performed the FOUR and Glasgow Coma Scale (GCS) scores at admission. We used survival analysis, fit Cox proportional hazards regression models to assess the predictive properties of the two scores, and compared their performance using area under the receiver operating characteristic curve (AUROC). RESULTS We enrolled 359 patients, mean (SD) age was 51 (22.2) years, and 58% (210/359) were male. The median (interquartile range) admission FOUR and GCS scores were 13.0 (3.0-16.0) and 10.0 (3.0-14.0), respectively. Subjects with the FOUR score of 0-11 had a 2.6-fold higher hazard of 30-day mortality (HR 2.6, 95% CI 1.9-3.6, p < 0.001) compared to those with the score of 12-16. Those with the GCS score of 3-8 had a 2.7-fold higher hazard of 30-day mortality (HR 2.7, 95% CI 2.0-3.8, p < 0.001) compared to those with the score of 9-15. The AUROC (95% CI) for the FOUR score and GCS score was 0.68 (0.62-0.73) and 0.67 (0.62-0.73), respectively (p = 0.825). CONCLUSIONS The FOUR score is comparable to the GCS score in predicting mortality in Uganda. Our findings support the introduction of the FOUR score in guiding the management of patients with reduced LOC in sub-Saharan Africa.
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Affiliation(s)
- Amir Abdallah
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. .,Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
| | | | - Davis Kimweri
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Abdirahim Abdi Aden
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nan Zhang
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Phoenix, AZ, USA
| | - Richard Butterfield
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Phoenix, AZ, USA
| | - Stephen B Asiimwe
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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36
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Palmer J, Kosiorek HE, Wolschke C, Fauble VDS, Butterfield R, Geyer H, Scherber RM, Dueck AC, Gathany A, Mesa RA, Kroger N. Assessment of Quality of Life following Allogeneic Stem Cell Transplant for Myelofibrosis. Biol Blood Marrow Transplant 2019; 25:2267-2273. [PMID: 31288096 DOI: 10.1016/j.bbmt.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/08/2019] [Accepted: 07/01/2019] [Indexed: 01/27/2023]
Abstract
Patient-reported outcomes (PROs) for patients with myelofibrosis (MF) have been well characterized, but little is known about quality of life (QoL) following allogeneic stem cell transplantation (allo-SCT). Medical data and PRO measures were collected before transplant and at day 30, day 100, and 1 year after allo-SCT. PRO measures include Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF), Brief Fatigue Inventory, Global Assessment of Change, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. Forty-four patients who had baseline QoL and at least 1 post-transplant assessment were included. The median age of the patients was 62.5 years (range, 35 to 74 years). At baseline, the mean MPN Total Symptom Score was 28.0, and at day 30, day 100, and 1 year, it was 25.4, 32.3, and 24.3, respectively. However, in myeloproliferative neoplasm-specific symptoms, such as itching, night sweats, bone pain, and fever, a statistically significant improvement was observed for at least 1 time point following transplant. At day 30, 10 (26.3%) patients reported a little/moderately/very much better overall QoL since their transplant, and 26 (68.45%) had a little/moderately/very much worse QoL. At day 100, 10 (30.3%) reported better QoL and 19 (57.6%) reported worsening since transplant. By 1 year, 16 (61.5%) reported feeling better. Our study shows that there is very little change in symptom burden at 1 year following transplant in general, but MF-specific symptoms showed improvement. By 1 year, 61% felt that their QoL was better than it was before transplant.
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Affiliation(s)
- Jeanne Palmer
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, Arizona.
| | | | - Christine Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Holly Geyer
- Department of Medicine, Mayo Clinic, Phoenix, Arizona
| | | | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Allison Gathany
- Division of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Ruben A Mesa
- UT Health San Antonio Cancer Center, San Antonio, Texas
| | - Nicolaus Kroger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chester RC, Mina SA, Lewis B, Zhang N, Butterfield R, Yang EH. Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry. Catheter Cardiovasc Interv 2019; 95:675-683. [DOI: 10.1002/ccd.28341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Bradley Lewis
- Department of Biomedical Statistics and InformaticsMayo Clinic Rochester Minnesota
| | - Nan Zhang
- Division of Health Sciences ResearchMayo Clinic Arizona Minnesota
| | | | - Eric H. Yang
- Department of CardiologyMayo Clinic Scottsdale Arizona
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Khera N, Sugalski J, Krause D, Butterfield R, Zhang N, Smedley W, Stewart FM, Griffin JM, Zafar Y, Lee S. Current practice for screening and management of financial distress at NCCN member institutions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
11615 Background: Deficiencies and barriers exist to delivering comprehensive and affordable cancer care. Understanding the variation in organizational commitment, existing programs, and expected outcomes for screening and management of financial distress is needed. Methods: Representatives from 17 of 27 NCCN Member Institutions (63%) completed an online survey in November 2018 conducted by the NCCN Best Practices Committee. Centers were classified based on number of unique patients seen per year, as large ( > 10,000) (76%), or small ( < 10,000) (34%). The survey focused on institutions’ screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes. Results: Routine screening for financial distress was reported by 77% of centers, and most used social worker assessments (94%). 56% screened patients throughout the cancer journey. Help with drug costs, meal or gas vouchers and payment plans were offered by 100% of centers. Formal pre-authorization programs and assistance with claims and denials was offered by 81%. Charity care for medical costs was provided by 100% of the large centers compared to only 33% of small centers (p = 0.03). Median number of social workers (24 vs. 3; p = 0.01) and pharmacy representatives (6 vs. 2; p = 0.02) was also different between large and small centers. 76% evaluated the impact of financial advocacy services through number of patients assisted (85%), bad debt and charity write-offs (85%) or patient satisfaction surveys (54%). 6% and 12% reported overall effectiveness of institutional practice for screening and management of financial distress as poor/ very poor respectively. Inadequate staffing and real time resources (69%), limited institutional budget (50%), lack of reimbursement (50%), and clinical time constraints (50%) were reported as potential barriers in provision of these services. 94% agreed about stronger integration of financial advocacy services into oncology practice and 84% felt that success of these services should be a quality metric. 31% of large centers vs. 100% of small centers plan to increase staffing in this area in the next 5 years. Conclusions: Majority of NCCN Member Institutions report screening and management programs for financial distress, though the actual practices and range of services vary widely. Information from this study can help centers benchmark their performance relative to similar cancer programs and identify best practices in this area.
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Affiliation(s)
| | | | | | | | | | - Warren Smedley
- Patient Care Connect - Powered By UAB Health System, Birmingham, AL
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Abstract
5063 Background: The systemic therapies available to patients with metastatic prostate cancer (mPC) have improved dramatically over the past decade. Prior to 2010, the only agents with a proven survival benefit for patients with metastatic disease were androgen deprivation therapy and docetaxel. Since then, five new agents have been FDA approved and have proven survival benefit in phase III trials. Anecdotal experience suggests that the increased available lines of therapy have changed the profile of mPC to include a higher prevalence of visceral metastases. Methods: A retrospective review of 474 patients with prostate cancer who died in 2009 and in 2016 was performed. Patients with metastatic disease who had imaging within 6 months of death were included. A total of 164 patients were eligible for analysis. Results: Mean age at death overall was 77.4 years (SD 9.5) and did not differ signifiantly by cohort. Overall rates of visceral and distant metastases to include lung, liver, adrenal, brain, renal, spleen, and thyroid, were higher in patients who died in 2016 as compared to those who died in 2009 (40.0% and 26.1%, respectively, p = 0.07). Lung metastases were more prevalent in patients who died in 2016 versus in 2009 at 26.3% and 13.0%, respectively (p = 0.05). Patients who died in 2009 received a median of 3 (range 1-10) systemic treatments versus 4 (range 0-13) in those who died in 2016 (p = 0.005). Forty-four percent of patients who died in 2016 used five or more lines of systemic treatments compared to 26.1% of patients in 2009. Conclusions: The emergence of new systemic therapies for mPC is changing the natural history of the disease. Forty percent of patients now develop visceral metastases compared to 26% in the past. These changes will drive the need for new treatment approaches targeting visceral metastases. [Table: see text]
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40
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Sharma A, Mountjoy L, Butterfield R, Zhang N, Ross H, Schild S, Ashman J, Daniels T, Paripati H, Mrugala M, Vora S, Patel N, Zimmerman R, Sio T, Porter A. EP-1211 Radiation necrosis after SRS for intracranial metastases from lung cancer: A retrospective review. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31631-7] [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: 10/26/2022]
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41
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Salazar MM, DeCook L, Butterfield R, Zhang N, Sen A, Fitch T, Vanness DJ, Khera N. Intensity of Care at End-of-Life in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.656] [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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42
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Jain T, Guerrero C, Kosiorek H, Butterfield R, Mountjoy L, Reeder C, Bergsagel PL, Larsen JT, Stewart K, Fonseca R. Do Cytogenetics Predict Likelihood to Attain Minimal Residual Disease (MRD) Post Autologous Stem Cell Transplantation (SCT) in Multiple Myeloma (MM)? Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.806] [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: 12/01/2022]
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43
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Cumsky HJL, Costello CM, Zhang N, Butterfield R, Buras MR, Schmidt JE, Drenner K, Nelson SA, Ochoa SA, Baum CL, Pittelkow MR, DiCaudo DJ, Sekulic A, Mangold AR. The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma. J Am Acad Dermatol 2019; 80:626-632.e1. [PMID: 30359624 PMCID: PMC10577667 DOI: 10.1016/j.jaad.2018.10.018] [Citation(s) in RCA: 10] [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: 06/23/2018] [Revised: 09/13/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inositol polyphosphate 5-phosphatase (INPP5A) has been shown to play a role in development and progression of cutaneous squamous cell carcinoma (cSCC). The goal of the current study was to explore the prognostic value of INPP5A expression in cSCC. METHODS A total of 189 cases of actinic keratosis and SCC in 174 patients were identified; clinical and outcome data were abstracted, histopathology was rereviewed, and immunohistochemical staining and interpretation was performed for INPP5A. RESULTS The majority of tumors (89.4%) had an INPP5A score of 2 or 3. No patients had complete loss of INPP5A. Tumors with an INPP5A score of 1 were more likely to be intermediate- to high-risk tumors (Brigham and Women's Hospital stage ≥T2a 85.0% vs 23.7% [P < .0001]) characterized by a larger diameter (2.4 cm vs 1.3 cm [P = .0004]), moderate-to-poor differentiation (86.7% vs 17.6% [P < .0001]), and perineural invasion (37.5% vs 5.3%, [P < .0001]). An INPP5A score of 1 was associated with a worse 3-year survival (a rate of 42.3% [hazard ratio, 2.81, P = .0006]) and a local metastasis rate of 48.0% (hazard ratio, 4.71; P < .0001). CONCLUSIONS Low INPP5A scores are predictive of aggressive tumors and may be a useful adjunct to guide clinical management of cSCC.
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Affiliation(s)
- Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Nan Zhang
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Matthew R Buras
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Kevin Drenner
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | - Shari A Ochoa
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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Scheckel CJ, Kosiorek HE, Butterfield R, Ho TH, Hilal T. Germ Cell Tumors with Malignant Somatic Transformation: A Mayo Clinic Experience. Oncol Res Treat 2019; 42:95-100. [DOI: 10.1159/000495802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/25/2018] [Indexed: 01/04/2023]
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Valencia-Sanchez C, Schild S, Vora S, Ashman J, Daniels T, Halyard M, Rule W, Zhang N, Butterfield R, Sharma A, Mrugala M, Porter A. CMET-47. CLINICAL EVALUATION OF FITNESS TO DRIVE IN PATIENTS WITH BRAIN METASTASES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.256] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Nan Zhang
- Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | - Maciej Mrugala
- Mayo Clinic, Department of Neurology and Neurosurgery, Mathematical Neuro-Oncology Lab, Precision Neurotherapeutics Innovation Program, Phoenix, AZ, USA
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46
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Scheckel C, Kosiorek HE, Butterfield R, Ho TH, Hilal T. Testicular germ cell tumors with malignant somatic component: A single-center experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16544] [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: 11/20/2022] Open
Affiliation(s)
- Caleb Scheckel
- Mayo Clinic Department of Internal Medicine, Scottsdale, AZ
| | | | | | | | - Talal Hilal
- Mayo Clinic Department of Internal Medicine Division of Hematology and Oncology, Phoenix, AZ
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47
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Reghan Foley A, Donkervoort S, Bolduc V, Hu Y, Cummings B, Lek M, Sarkozy A, Jimenez-Mallebrera C, Butterfield R, Lamande S, Kirschner J, Allamand V, Stojkovic T, Quijano-Roy S, Gualandi F, Ferlini A, Bertini E, MacArthur D, Muntoni F, Bönnemann C. A common COL6A1 deep-intronic pseudo-exon inserting mutation causes a distinct phenotype of Ullrich congenital muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.055] [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: 11/30/2022]
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48
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Butterfield R, Dunn D, Hu Y, Bonnemann C, Weiss R. Transcriptome profiling identifies key pathways important in collagen VI related muscular dystrophies including differences between patients with dominant negative vs. null mutations. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.371] [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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49
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Wanaski S, Shieh P, Kuntz N, Ciafaloni E, Butterfield R, Brantley S, Grasfeder L, Dubow J, Beers B, Kernbauer E, Wells C, Cunniff T, Griggs R. Pharmacokinetics of 21-desacetyldeflazacort and the safety of deflazacort after oral administration to children and adolescents with Duchenne muscular dystrophy. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.343] [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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50
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Butterfield R, Stedman W, Herod R, Aneman A. Does adding ICU data to the POSSUM score improve the prediction of outcomes following surgery for upper gastrointestinal malignancies? Anaesth Intensive Care 2015; 43:490-6. [PMID: 26099762 DOI: 10.1177/0310057x1504300412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre- and intraoperative POSSUM variables did not significantly enhance the precision.
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Affiliation(s)
- R Butterfield
- Senior Registrar, Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales
| | - W Stedman
- Consultant VMO, Intensive Care Unit, Princess Alexandria Hospital, Brisbane, Queensland
| | - R Herod
- Senior Registrar, Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, New South Wales
| | - A Aneman
- Senior Staff Specialist, Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District and Associate Professor, University of New South Wales, Western Sydney Clinical School, Sydney, New South Wales
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