المؤلفون: Baik, Isabel, Gonzalez, Humberto C, Jantz, Arin, Poparad-Stezar, Adina, Summers, Bryant, Venkat, Deepak, Samaniego-Picota, Milagros D, Fitzmaurice, Mary G

المصدر: Gastroenterology Meeting Abstracts

مصطلحات موضوعية: glucagon like peptide 1 receptor agonist, hemoglobin A1c, insulin, abdominal pain, acute graft rejection, adult, adverse drug reaction, body mass, body weight, cohort analysis, complication, conference abstract, controlled study, diabetes mellitus, drug safety, drug therapy, drug withdrawal, female, graft failure, human, incidence, kidney graft, liver graft, major clinical study, male, mortality, retrospective study, side effect, summer, surgery

الوصف: Purpose: To assess the safety and efficacy of GLP1 RA in a matched cohort of kidney transplant (KT) and liver transplant (LT) recipients who received these agents compared to patients who did not Methods: This single-center, retrospective analysis evaluated KT and LT recipients who were initiated on a GLP1 RA for at least 3 months (mo) matched to a nonintervention comparator group (non-GLP1 RA) based on organ type and diagnosis of diabetes mellitus present at time of transplant. The primary endpoint was change in hemoglobin A1C (HbA1c) at 6 mo. Secondary endpoints included weight (kg), BMI (kg/m2), insulin requirements, and number of oral diabetic agents (ODAs). Safety outcomes included incidence of adverse events (AEs), biopsy-proven acute rejection (BPAR), graft loss, and mortality. Results: Of the 74 patients included, 37 received GLP1 RA matched to 37 patients who did not. Baseline characteristics shown in Table 1. More patients in the GLP1 RA group were on ODAs and 10 patients (27%) initiated on an agent <1 year from transplant. Change in median HbA1c in GLP1 RA group from baseline to 6 mo was -0.5% [(7.0% (6.4-8.9); 6.5% (5.6-7.3)] compared to +0.6% in the non-GLP1 RA group [(5.8% (5.5-6.8); 6.6% (5.8-7.6)], p=0.53. Median change in total daily insulin units was -13 units vs +15 units in the GLP1 RA vs non-GLP1 RA group (p=0.16). GLP1 RA group median change in weight was -7.4 kg vs -0.3 kg in non-GLP1 RA group (p=0.02). BMI change was -3.1 kg/m2 in GLP1 RA vs +0.7 kg/m2 in non-GLP1 RA, p=0.02. In GLP1 RA group, 7 patients (38.9%) experienced an AEs related to drug with 4 (10.8%) leading to discontinuation. Common AE being abdominal pain. One patient (2.7%) discontinued drug due to cost, 3 patients (8.1%) found it ineffective, and 1 (2.7%) had a drug-unrelated discontinuation. Eight patients (21.6%) in each group experienced BPAR. In the GLP1 RA group, 1 patient had graft loss compared to 2 patients in the non-GLP1 RA. No patient deaths occurred with GLP1 RA while 2 patient deaths in the comparator ...

العلاقة: https://scholarlycommons.henryford.com/gastroenterology_mtgabstracts/200Test; http://sfxhosted.exlibrisgroup.com/hfhs?sid=EMBASE&issn=16006143&id=doi:10.1016%2Fj.ajt.2023.05.014&atitle=Evaluating+the+Use+of+Glucagon-Like+PeptideTest+1+Receptor+Agonists+%28GLP1+RA%29+in+a+Matched+Cohort+of+Kidney+and+Liver+Transplant+Recipients&stitle=Am.+J.+Transplant.&title=American+Journal+of+Transplantation&volume=23&issue=6&spage=S947&epage=&aulast=Baik&aufirst=I.&auinit=I.&aufull=Baik+I.&coden=&isbn=&pages=S947-&date=2023&auinit1=I&auinitm=

الإتاحة: https://scholarlycommons.henryford.com/gastroenterology_mtgabstracts/200Test

المؤلفون: Henderson, Timothy, Chen, Mingyi, Darrow, Morgan A, Li, Chin-Shang, Chiu, Chi-Lu, Monjazeb, Arta M, Murphy, William J, Canter, Robert J

مصطلحات موضوعية: Humans, Sarcoma, Isoenzymes, Immunohistochemistry, Adult, Aged, 80 and over, Middle Aged, Female, Male, Retinal Dehydrogenase, Neoplastic Stem Cells, ErbB Receptors, Hyaluronan Receptors, Aldehyde Dehydrogenase 1 Family, ALDH, CD44, Cancer stem cells, EGFR, Oncologic outcomes, Soft-tissue sarcoma, Cancer, Genetics, Stem Cell Research, Stem Cell Research - Nonembryonic - Human, Human Genome, Clinical Research, Clinical Sciences, Surgery

الوصف: BackgroundCancer stem cells (CSCs) have been shown to resist chemotherapy and promote metastasis after cytotoxic therapies. We sought to determine if the expression of CSC markers (aldehyde dehydrogenase [ALDH], CD44, and epidermal growth factor receptor [EGFR]) predicted outcomes in soft-tissue sarcoma (STS) patients.MethodsWe queried an institutional database of 23 STS patients and evaluated immunohistochemical expression of CSC markers ALDH, CD44, and EGFR. The Cancer Genome Atlas (TCGA) was also queried for STS clinical and genomic data. Disease-specific (DSS) and overall survival (OS) were assessed by univariate and Kaplan-Meier analysis.ResultsOf the 23 institutional patients, the majority was female, had high-grade tumors and had extremity tumors. With a median follow-up of 27months, nine patients (39%) experienced distant recurrence, and four (17%) died of disease. Mean H-scores at diagnosis (±standard error of the mean) for CD44, ALDH1, and EGFR were 169±27, 77±15, and 144±23, respectively. On univariate analysis, there was a trend for increased CD44 score to predict both worse DSS and OS (hazard ratio=1.01, 95% confidence interval 1-1.02, P=0.056), whereas ALDH and EGFR scores did not. Analysis of 74 TCGA STS cases with complete clinical and genomic data revealed that CD44 copy number alterations predicted worse DSS (9.89months versus 72.5months, P=0.007) and a trend for worse OS (14.03months versus 38.6months, P=0.12), whereas ALDH1 and EGFR copy number alteration did not. Multivariate analysis of the combined data sets was consistent with worse DSS among patients with higher CD44 expression.ConclusionsInstitutional and national TCGA data show the association of elevated baseline CD44 expression with worse STS outcomes. Further study of CD44 as a possible novel STS biomarker appears indicated.

وصف الملف: application/pdf

العلاقة: qt0716629n; https://escholarship.org/uc/item/0716629nTest

الإتاحة: https://escholarship.org/uc/item/0716629nTest

المؤلفون: Kluijfhout, Wouter P, Beninato, Toni, Drake, Frederick Thurston, Vriens, Menno R, Gosnell, Jessica, Shen, Wen T, Suh, Insoo, Liu, Chienying, Duh, Quan-Yang

المصدر: World journal of surgery, vol 40, iss 12

مصطلحات موضوعية: Humans, Multiple Endocrine Neoplasia Type 1, Hypoparathyroidism, Recurrence, Technetium Tc 99m Sestamibi, Radiopharmaceuticals, Radionuclide Imaging, Ultrasonography, Parathyroidectomy, Reoperation, Thymectomy, Retrospective Studies, Patient Selection, Adult, Aged, Middle Aged, Female, Male, Hyperparathyroidism, Primary, Rare Diseases, Clinical Research, Patient Safety, Clinical Sciences, Surgery

الوقت: 2964 - 2969

الوصف: BackgroundPrimary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however,both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism.MethodsWe performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism.ResultsEight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52years). One patient in each group had persistent disease. One (13%) unilateral clearance and five (31%) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68months (p=0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p=0.54).ConclusionsSome MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations.

العلاقة: qt8dp2v422; https://escholarship.org/uc/item/8dp2v422Test

الإتاحة: https://doi.org/10.1007/s00268-016-3624-9Test
https://escholarship.org/uc/item/8dp2v422Test

المؤلفون: Dummer, R, Gyorki, D E, Hyngstrom, J, Berger, A C, Conry, R, Demidov, L, Sharma, A, Treichel, S A, Radcliffe, H, Gorski, K S, Anderson, A, Chan, E, Faries, M, Ross, M I

المصدر: Articles, Abstracts, and Reports

مصطلحات موضوعية: california, jwci, Adult, Aged, Biological Products, Combined Modality Therapy, Disease-Free Survival, Female, Herpesvirus 1, Human, Humans, Immunotherapy, Male, Melanoma, Middle Aged, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Neoplasm Staging, Oncolytic Virotherapy, Oncolytic Viruses, Oncology, Surgery

الوصف: Talimogene laherparepvec (T-VEC) is a herpes simplex virus type 1-based intralesional oncolytic immunotherapy approved for the treatment of unresectable melanoma. The present, ongoing study aimed to estimate the treatment effect of neoadjuvant T-VEC on recurrence-free survival (RFS) of patients with advanced resectable melanoma. An open-label, phase 2 trial (NCT02211131) was conducted in 150 patients with resectable stage IIIB-IVM1a melanoma who were randomized to receive T-VEC followed by surgery (arm 1, n = 76) or surgery alone (arm 2, n = 74). The primary endpoint was a 2-year RFS in the intention-to-treat population. Secondary and exploratory endpoints included overall survival (OS), pathological complete response (pCR), safety and biomarker analyses. The 2-year RFS was 29.5% in arm 1 and 16.5% in arm 2 (overall hazard ratio (HR) = 0.75, 80% confidence interval (CI) = 0.58-0.96). The 2-year OS was 88.9% for arm 1 and 77.4% for arm 2 (overall HR = 0.49, 80% CI = 0.30-0.79). The RFS and OS differences between arms persisted at 3 years. In arm 1, 17.1% achieved a pCR. Increased CD8+ density correlated with clinical outcomes in an exploratory analysis. Arm 1 adverse events were consistent with previous reports for T-VEC. The present study met its primary endpoint and estimated a 25% reduction in the risk of disease recurrence for neoadjuvant T-VEC plus surgery versus upfront surgery for patients with resectable stage IIIB-IVM1a melanoma.

العلاقة: https://digitalcommons.psjhealth.org/publications/5351Test; https://pubmed.ncbi.nlm.nih.gov/34608333Test

الإتاحة: https://digitalcommons.psjhealth.org/publications/5351Test
https://pubmed.ncbi.nlm.nih.gov/34608333Test

المؤلفون: Gibson, Angela L F, Holmes, James H, IV, Shupp, Jeffrey W, Smith, David, Joe, Victor, Carson, Joshua, Litt, Jeffrey, Kahn, Steven, Short, Tracee, Cancio, Leopoldo, Rizzo, Julie, Carter, Jeffrey E, Foster, Kevin, Allen-Hoffmann, B Lynn

المصدر: School of Medicine Faculty Publications

مصطلحات موضوعية: adult, autograft, burn, comparative effectiveness, conference abstract, controlled study, donor site, drug safety, esthetic surgery, excision, female, human, limb, major clinical study, male, pain intensity, phase 1 clinical trial, phase 3 clinical trial, randomized controlled trial, risk assessment, scar, thickness, trunk, wound closure, Dermatology, Surgery, Trauma

العلاقة: https://digitalscholar.lsuhsc.edu/som_facpubs/1115Test; https://doi.org/10.1093/jbcr/irab032.035Test

الإتاحة: https://doi.org/10.1093/jbcr/irab032.035Test
https://digitalscholar.lsuhsc.edu/som_facpubs/1115Test

المؤلفون: Walbert, Tobias, Damek, Denise, Nina, L. Martinez, Piccioni, David, Singer, Samuel, Cloughesy, Timothy

المصدر: Neurosurgery Meeting Abstracts

مصطلحات موضوعية: flucytosine, vocimagene amiretrorepvec, adult, cancer patient, cancer recurrence, cancer surgery, clinical article, clinical trial, compassionate use, conference abstract, controlled study, diarrhea, drug combination, drug therapy, female, glioblastoma, human, male, phase 1 clinical trial, phase 2 clinical trial, remission, side effect, treatment duration, Neurology, Neurosciences, Surgery

الوصف: Toca 511 (vocimagene amiretrorepvec) is an investigational nonlytic, retroviral replicating vector (RRV) constructed with a codon-optimized yeast cytosine deaminase (CD) gene. Toca 511 infects cancer cells, and stably delivers CD gene whose protein product converts courses of the prodrug TocaFC (5-fluorocytosine) into 5-fluorouracil (5-FU). Several phase 1 studies and a phase 2/ 3 clinical study tested Toca511 in combination with TocaFC in patients undergoing planned resection for recurrent glioblastoma (rGBM) or anaplastic astrocytoma (rAA). The last trial was completed in 2019, and although the Phase 2/3 study did not meet the primary objective, patients who appeared to benefit from the treatment elected to continue TocaFC through an expanded access or compassionate use pathway. Seven patients continued on treatment: 3 men and 4 women; 5 with rGBM, 2 with rAA. Duration of treatment with TocaFC ranges from 29 months to 7 years and 5 months (average 49.2 months). Six patients who are still on active treatment with TocaFC have either stable disease or complete response. TocaFC is well tolerated in these patients, typical side effects include diarrhea. Some patients with rGBM or rAA appear to benefit from extended TocaFC treatment after Toca511. Individual cases will be discussed.

العلاقة: https://scholarlycommons.henryford.com/neurosurgery_mtgabstracts/100Test; http://sfxhosted.exlibrisgroup.com/hfhs?sid=EMBASE&issn=15235866&id=doi:10.1093%2Fneuonc%2Fnoab196.228&atitle=Extended+benefits+in+patients+with+recurrent+high+grade+glioma+that+continuously+receive+TOCA+fc+after+toca+511+treatmen&stitle=Neuro-Oncology&title=Neuro-Oncology&volume=23&issue=SUPPL+6&spage=vi58&epage=vi59&aulast=Walbert&aufirst=Tobias&auinit=T.&aufull=Walbert+T.&coden=&isbn=&pages=vi58-vi59&date=2021&auinit1=T&auinitmTest=

الإتاحة: https://scholarlycommons.henryford.com/neurosurgery_mtgabstracts/100Test

المؤلفون: Mamidi, Ishwarya S, Li, Lilun, Jones, Joel W, Lee, Ryan, Rana, Md Sohel, Reilly, Brian K

المصدر: Surgery Faculty Publications

مصطلحات موضوعية: Adolescent, Adult, Diabetes Mellitus, Type 1, Type 2, Female, Humans, Male, Postoperative Complications, Quality Improvement, Tonsillectomy, Young Adult, Surgery

العلاقة: https://hsrc.himmelfarb.gwu.edu/smhs_surgery_facpubs/3382Test; http://dx.doi.org/10.1177/0003489420967041Test

الإتاحة: https://doi.org/10.1177/0003489420967041Test
https://hsrc.himmelfarb.gwu.edu/smhs_surgery_facpubs/3382Test

المؤلفون: Benedict, KA, Moassesfar, S, Adi, S, Gitelman, SE, Brennan, JL, McEnhill, M, Stock, PG, Portale, AA, Posselt, AM

المصدر: American Journal of Transplantation, vol 13, iss 8

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Transplantation, Pediatric, Diabetes, Autoimmune Disease, Organ Transplantation, Kidney Disease, Clinical Research, Metabolic and endocrine, Renal and urogenital, Adult, Blood Glucose, Child, Diabetes Mellitus, Type 1, Female, Humans, Kidney Failure, Chronic, Kidney Transplantation, Male, Pancreas Transplantation, Prognosis, Islet transplantation, renal disease, type I diabetes, Medical and Health Sciences, Surgery, Immunology

الوقت: 2207 - 2210

الوصف: Islet transplantation after successful kidney transplantation is a recognized treatment for adults with diabetes and end-stage renal disease (ESRD), but has not been considered an option in the pediatric population. To our knowledge, we report the first combined islet and kidney transplant in a child. The patient was born with bilateral renal hypoplasia and was diagnosed with type 1 diabetes mellitus at age 13 months. He had erratic glycemic control and hypoglycemia unawareness. At 6 years of age, the child safely underwent simultaneous islet and live donor kidney transplantation. Although function of the islet graft was transient, the combined transplant provided significant benefits in terms of glucose control and overall growth and development. Such an approach represents a viable treatment option for pediatric patients with ESRD and unstable diabetes.

وصف الملف: application/pdf

العلاقة: qt8gb9j9cf; https://escholarship.org/uc/item/8gb9j9cfTest

الإتاحة: https://escholarship.org/uc/item/8gb9j9cfTest

المؤلفون: Carter, Damien W, Sood, Ravi F, Seaton, Max E, Muffley, Lara A, Honari, Shari, Hocking, Ann M, Arbabi, Saman A, Gibran, Nicole S

المصدر: Maine Medical Center

مصطلحات موضوعية: Adolescent, Adult, Aged, Burns, Female, Genetic Markers, Genotyping Techniques, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, Polymorphism, Single Nucleotide, Receptor, Melanocortin, Type 1, Retrospective Studies, Systemic Inflammatory Response Syndrome, Wound Infection, Young Adult, Surgery, Women's Health

الوصف: BACKGROUND: Systemic inflammatory response syndrome (SIRS) is associated with organ failure and infectious complications after major burn injury. Recent evidence has linked melanocortin signaling to anti-inflammatory and wound-repair functions, with mutations in the melanocortin 1 receptor (MC1R) gene leading to increased inflammatory responses. Our group has previously demonstrated that MC1R gene polymorphisms are associated with postburn hypertrophic scarring. Thus, we hypothesized that MC1R single nucleotide polymorphisms (SNPs) would be associated with increased burn-induced SIRS and increased infectious complications. METHODS: We performed a retrospective cohort study of adults (>18 y of age) admitted to our burn center with >20% total body surface area (TBSA) partial/full thickness burns between 2006 and 2013. We screened for five MC1R SNPs (V60L, V92M, R151C, R163Q, T314T) by polymerase chain reaction from genomic DNA isolated from blood samples. We performed a detailed review of each patient chart to identify age, sex, race, ethnicity, %TBSA burned, burn wound infections (BWIs), and 72-hr intravenous fluid volume, the latter a surrogate for a dysfunctional inflammatory response to injury. Association testing was based on multivariable regression. RESULTS: Of 106 subjects enrolled, 82 had complete data for analysis. Of these, 64 (78%) were male, with a median age of 39 and median burn size of 30% TBSA. A total of 36 (44%) subjects developed BWIs. The median total administered IV crystalloid in first 72h was 24.6 L. In multivariate analysis, the R151C variant allele was a significant independent risk factor for BWI (adjusted prevalence ratio 2.03; 95% CI: 1.21-3.39; P = 0.007), and the V60L variant allele was independently associated with increased resuscitation fluid volume (P = 0.021). CONCLUSIONS: This is the first study to demonstrate a significant association between genetic polymorphisms and a nonfatal burn-induced SIRS complication. Our findings suggest that MC1R polymorphisms contribute to ...

العلاقة: https://knowledgeconnection.mainehealth.org/mmc/1471Test; https://pubmed.ncbi.nlm.nih.gov/30278967Test

الإتاحة: https://knowledgeconnection.mainehealth.org/mmc/1471Test
https://pubmed.ncbi.nlm.nih.gov/30278967Test

المؤلفون: Relles, Daniel, MD, Baek, Jennie, Witkiewicz, Agnieszka, Yeo, Charles J, MD, FACS

المصدر: Department of Surgery

مصطلحات موضوعية: Adult, Ampulla of Vater, Common Bile Duct Neoplasms, Duodenal Neoplasms, Female, Humans, Male, Middle Aged, Neurofibromatosis 1, Department of Pediatrics, Department of Pediatrics Faculty, Department of Surgery, Department of Surgery Faculty, Surgery

الوصف: BACKGROUND: Patients with neurofibromatosis type 1 (NF1) are at increased risk to develop tumors throughout the gastrointestinal tract, including neuromas, gastrointestinal stromal tumors (GIST), and periampullary somatostatin-rich carcinoids. Here, we briefly describe two male patients with NF1 and review the recent literature on this topic. METHODS: Databases for PubMed and MEDLINE were searched for English-language articles since 1989 using a list of keywords, as well as references from review articles. RESULTS: The results generated by the search yielded 50 articles and 74 cases. Patients most commonly presented with jaundice, weight loss, GI bleeding, or anemia. The mean age at presentation was 47.9 years, with 59% of patients being female. Mean tumor size was 3.8 cm (range 0.9-27 cm). Tumor location was the duodenum (60%), ampulla (31%), pancreas (5%), or bile duct/gallbladder (4%). Tumor type was reported as somatostatinoma (40%), GIST (34%), adenocarcinoma (8%), carcinoid (6%), neurofibroma (5%), schwannoma (4%), or gangliocytic paraganglioma (3%). Treatment included classic Whipple procedure (42%), local excision (25%), pylorus-preserving pancreaticoduodenectomy (17%), and other resection (6%). Mean follow-up was 31 months postresection (range 0-99 months): 75% of patients were alive with no evidence of disease. CONCLUSIONS: These results underscore the importance of a thorough evaluation for tumors in NF1 patients with gastrointestinal symptoms, as well as subsequent surgical management when findings suggest a tumor in the periampullary region, as resection remains the mainstay of treatment.

وصف الملف: application/pdf

العلاقة: https://scholarlyworks.lvhn.orgTest/surgery/1454; https://www.ncbi.nlm.nih.gov/pubmed/20300877Test

الإتاحة: https://scholarlyworks.lvhn.orgTest/surgery/1454
https://www.ncbi.nlm.nih.gov/pubmed/20300877Test