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1.
J Surg Res ; 299: 329-335, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38788470

ABSTRACT

INTRODUCTION: Chat Generative Pretrained Transformer (ChatGPT) is a large language model capable of generating human-like text. This study sought to evaluate ChatGPT's performance on Surgical Council on Resident Education (SCORE) self-assessment questions. METHODS: General surgery multiple choice questions were randomly selected from the SCORE question bank. ChatGPT (GPT-3.5, April-May 2023) evaluated questions and responses were recorded. RESULTS: ChatGPT correctly answered 123 of 200 questions (62%). ChatGPT scored lowest on biliary (2/8 questions correct, 25%), surgical critical care (3/10, 30%), general abdomen (1/3, 33%), and pancreas (1/3, 33%) topics. ChatGPT scored higher on biostatistics (4/4 correct, 100%), fluid/electrolytes/acid-base (4/4, 100%), and small intestine (8/9, 89%) questions. ChatGPT answered questions with thorough and structured support for its answers. It scored 56% on ethics questions and provided coherent explanations regarding end-of-life discussions, communication with coworkers and patients, and informed consent. For many questions answered incorrectly, ChatGPT provided cogent, yet factually incorrect descriptions, including anatomy and steps of operations. In two instances, it gave a correct explanation but chose the wrong answer. It did not answer two questions, stating it needed additional information to determine the next best step in treatment. CONCLUSIONS: ChatGPT answered 62% of SCORE questions correctly. It performed better at questions requiring standard recall but struggled with higher-level questions that required complex clinical decision making, despite providing detailed responses behind its rationale. Due to its mediocre performance on this question set and sometimes confidently-worded, yet factually inaccurate responses, caution should be used when interpreting ChatGPT's answers to general surgery questions.


Subject(s)
General Surgery , Internship and Residency , Humans , General Surgery/education , Educational Measurement/methods , Educational Measurement/statistics & numerical data , United States , Clinical Competence/statistics & numerical data , Specialty Boards
2.
J Surg Res ; 298: 269-276, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38636183

ABSTRACT

INTRODUCTION: Despite improvements in preoperative image resolution, approximately 10% of curative-intent resection attempts for pancreatic ductal adenocarcinoma are aborted at the time of operation. To avoid nontherapeutic laparotomy, many surgeons perform intraoperative diagnostic laparoscopy (DL) to identify radiographically occult metastatic disease. There are no consensus guidelines regarding DL in pancreatic cancer. The goal of this study is to investigate the efficacy of same-procedure DL at avoiding nontherapeutic laparotomy. METHODS: A single-institution retrospective review was performed from 2016 to 2022, identifying 196 patients with pancreatic ductal adenocarcinoma who were taken to the operating room for open curative-intent resection. Patient demographic, tumor characteristic, treatment, and outcome data were abstracted. Univariate and multivariate Cox hazard ratio analysis was performed to investigate risk factors for overall survival and recurrence-free survival. Number needed to treat (NNT) was calculated to identify number of DLs necessary to avoid one nontherapeutic laparotomy. RESULTS: Curative-intent resection was achieved in 161 (82.1%) patients. One hundred twenty six (64.0%) patients received DL prior to resection and DL identified metastatic disease in three (2.4%) patients with an NNT of 42. NNT of DL in a subgroup analysis performed on clinically high-risk patients (defined by preoperative or preneoadjuvant therapy carbohydrate antigen 19-9 > 500 U/mL) is 11. Receipt of DL did not prolong operative times in patients receiving pancreaticoduodenectomy when accounting for completed versus aborted resection. CONCLUSIONS: Although intraoperative DL is a short procedure with minimal morbidity, these data demonstrate that same-procedure DL has potential efficacy in avoiding nontherapeutic laparotomy only in a subgroup of clinically high-risk patients. Focus should remain on optimizing preoperative patient selection and further investigating novel diagnostic markers predictive of occult metastatic disease.


Subject(s)
Carcinoma, Pancreatic Ductal , Laparoscopy , Pancreatic Neoplasms , Humans , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Female , Retrospective Studies , Male , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Aged , Middle Aged , Carcinoma, Pancreatic Ductal/surgery , Carcinoma, Pancreatic Ductal/diagnosis , Carcinoma, Pancreatic Ductal/mortality , Pancreatectomy , Aged, 80 and over , Adult
3.
Breast Cancer Res Treat ; 203(1): 125-134, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37740855

ABSTRACT

PURPOSE: Compared to White women, there are higher mortality rates in Black/African American (BAA) women with hormone receptor-positive breast cancer (HR + BC) which may be partially due to differences in treatment resistance. We assessed factors associated with response to neoadjuvant endocrine therapy (NET). METHODS: The National Cancer Database (NCDB) was queried for women with clinical stage I-III HR + BC diagnosed 2006-2017 and treated with NET. Univariate and multivariate analyses described associations between the sample, duration of NET, and subsequent treatment response, defined by changes between clinical and pathological staging. RESULTS: The analytic sample included 9864 White and 1090 BAA women. Compared to White women, BAA women were younger, had more co-morbidities, were higher stage at presentation, and more likely to have > 24 weeks of NET. After excluding those with unknown pT/N/M, 3521 White and 365 BAA women were evaluated for NET response. On multivariate analyses, controlling for age, stage, histology, HR positivity, and duration of NET, BAA women were more likely to downstage to pT0/Tis (OR 3.0, CI 1.2-7.1) and upstage to Stage IV (OR 2.4, CI 1.002-5.6). None of the women downstaged to pT0/Tis presented with clinical stage III disease; only 2 of the women upstaged to Stage IV disease presented with clinical Stage I disease. CONCLUSION: Independent of NET duration and clinical stage at presentation, BAA women were more likely to experience both complete tumor response and progression to metastatic disease. These results suggest significant heterogeneity in tumor biology and warrant a more nuanced therapeutic approach to HR + BC.


Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Black or African American , Neoplasm Staging , Neoadjuvant Therapy/methods , White
4.
Ces med. vet. zootec ; 17(1): 47-57, ene.-abr. 2022. graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1404084

ABSTRACT

Resumo A pressão arterial é um parâmetro indispensável na monitorização anestésica. A mensuração da pressão artéria invasiva (iPA) mediante cateterização arterial periférica é confiável, mas requer experiência e pode desencadear complicações. A técnica oscilométrica não é invasiva (NiPA), só requer um manguito sobre uma artéria periférica e a mensuração é automatizada. Não obstante a acurácia da NiPA tem sido pouco explorada e, por tal motivo, este estudo objetivou comparar esta técnica com a iPA em ovelhas e cabras. Foram utilizadas 20 ovelhas e 20 cabras que seriam submetidas a laparoscopia sob anestesia geral. Uma vez em plano anestésico, foi cateterizada a artéria auricular caudal e conectada a um transdutor eletrônico de pressão acoplado a monitor multiparamétrico para mensuração da iPA, sistólica (S), diastólica (D) e média (M). Ao mesmo tempo um manguito de tamanho apropriado foi posicionado sobre a artéria radial e conectado ao mesmo monitor. A cada 5 minutos foram registradas as pressões arteriais por ambos os métodos, posteriormente, comparadas pelo teste Student, correlacionados pelo Pearson e avaliada a concordância pelo Bland-Altman. Nas ovelhas, a PAD foi semelhante e correlacionada entre NiPA e iPA (P=0,69; r=0,65; viés 0,7 ± 13,1 mmHg), já a PAS e PAM foram superestimadas pela NiPA. Em Cabras, a PAM resultou semelhante e correlacionada entre NiPA e iPA (P=0,566; r=0,57; viés 2,4 ± 20,2 mmHg), enquanto PAS foi superestimada e PAD subestimada. Conclui-se que, em ovelhas apenas a PAD e em cabras a PAM, mensuradas pelo método oscilométrico, são alternativas acuradas, factíveis e confiáveis para a monitoração anestésica da pressão arterial.


Abstract Blood pressure is an indispensable parameter in anesthetic monitoring. The measurement of invasive artery pressure (IBP) using peripheral arterial catheterization is reliable but requires experience and can lead to complications. The oscillometric technique is non-invasive (NIBP), it only requires a cuff over a peripheral artery and the measurement is automated. However, the accuracy of PANI has been little explored and, for this reason, this study aimed to compare this technique with PAI in sheep and goats. 20 sheep and 20 goats needed laparoscopy were used under general anesthesia. Once in anesthetic plane, the caudal auricular artery was catheterized and connected to an electronic pressure transducer, coupled to a multiparameter monitor to measure IBP, systolic (S), diastolic (D) and mean (M). At the same time, an appropriately sized cuff was placed over radial artery and connected to the same monitor. Every 5 minutes, blood pressures were recorded by both methods, subsequently compared by the Student test, correlated by Pearson and agreement assessed by the Bland-Altman. In sheep, DBP was similar and correlated between NIBP and IBP (P=0.69; r=0.65; bias 0.7 ± 13.1 mmHg), whereas SBP and MBP were overestimated by NIBP. In goats, MAP was similar and correlated between NIBP and IBP (P=0.566; r=0.57; bias 2.4 ± 20.2 mmHg), while SBP was overestimated and DBP underestimated. It is concluded that, in sheep only DBP and in goats, MBP, measured by the oscillometric method, are accurate, feasible and reliable alternatives for anesthetic monitoring of blood pressure.


Resumen La presión arterial es un parámetro indispensable en la monitorización anestésica. La medición de la presión arterial invasiva (PAI) mediante cateterismo arterial periférico es fiable, requiere experiencia y puede dar complicaciones. La técnica oscilométrica no es invasiva (PANI), requiere un manguito sobre una arteria periférica y medición automatizada. No obstante, la precisión de PANI ha sido poco explorada, por esta razón, este estudio tuvo por objetivo comparar esta técnica con la PAI en ovinos y caprinos. Se utilizaron 20 ovejas y 20 cabras que requerían laparoscopia bajo anestesia general. Una vez en plano anestésico, se cateterizó la arteria auricular caudal y se conectó a transductor de presión electrónico acoplado a monitor multiparamétrico para medir la PAI, sistólica (S), diastólica (D) y media (M). Al mismo tiempo, se colocó un manguito de tamaño adecuado sobre la arteria radial y se conectó al mismo monitor. Cada 5 minutos se registraron las presiones por ambos métodos, posteriormente se compraron por test de Student, correlacionaron por Pearson y se evaluó concordancia por Bland-Altman. En ovejas, la PAD fue similar y se correlacionó entre PANI y PAI (P=0,69; r=0,65; sesgo 0,7 ± 13,1 mmHg), mientras que PAS y MAP fueron sobreestimadas por PANI. En Cabras, la PAM fue similar y se correlacionó entre PANI y PAI (P=0,566; r=0,57; sesgo 2,4 ± 20,2 mmHg), mientras PAS se sobreestimó y PAD se subestimó. Se concluye que, en ovinos solo PAD y en caprinos PAM, medidas por el método oscilométrico son alternativas precisas, factibles y confiables para el monitoreo anestésico de la presión arterial.

6.
Ann Surg Oncol ; 29(2): 821-826, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34564772

ABSTRACT

BACKGROUND: We previously reported that professional forms of address in speaker introductions were inconsistently used at the Society of Surgical Oncology (SSO) 2018 and 2019 annual meetings, suggesting unconscious bias in speaker introductions. We sought to better understand how speakers would like to be introduced, and if guidelines could improve consistency in speaker introductions. METHODS: SSO 2021 abstract submitters received a survey regarding demographics and preferred form of address at the meeting. Respectful discourse guidelines were developed and distributed to meeting moderators. Speaker introductions were reviewed for the 2021 SSO annual meeting and were compared with the 2018 and 2019 meetings. RESULTS: The survey response rate was 183/347 (53%) abstract submitters, most of whom (143/183, 78%) indicated preference for a professional form of address (Doctor/Professor) during speaker introductions, which was significantly greater than those who were introduced with a professional form of address during the 2018 and 2019 meetings (351/499, 70%; Chi-square = 4.08, p = 0.043). There was no difference in speaker introduction preference based on gender or race/ethnic identification. Respectful discourse guidelines were developed and distributed to meeting moderators. During the 2021 SSO annual meeting, professional forms of address were used for 104 (84%) speakers, significantly greater than during the 2018 and 2019 meetings (Chi-square = 9.23, p = 0.002). CONCLUSIONS: More survey respondents preferred speaker introductions with a professional form of address than were used in prior meetings. This preference was similar across all demographic groups evaluated. Professional addresses during speaker introductions increased significantly after the distribution of guidelines encouraging consistency to decrease unconscious bias and promote an inclusive environment.


Subject(s)
Surgical Oncology , Bias, Implicit , Humans , Sexism , Societies, Medical
7.
Am J Surg ; 223(5): 939-944, 2022 05.
Article in English | MEDLINE | ID: mdl-34474917

ABSTRACT

BACKGROUND: A minority of patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) is diagnosed at younger age. This population-based study explores the broad clinical and pathologic features of the youngest 5% of adult patients with GEP-NETs. METHODS: A retrospective study of the National Cancer Database (NCDB) of patients with a primary GEP-NET was performed. Patients were stratified by age. Kaplan-Meier and multivariate Cox proportional hazards analyses were performed. RESULTS: We identified 31,983 patients with a diagnosis of a GEP-NET and only 5% of patients were under the age of 35. Young patients were found to have greater proportions of localized, well differentiated disease. On multivariate analysis, young age, well differentiated histology, early stage, and surgical intervention were associated with lower risk of mortality. CONCLUSIONS: Young patients with GEP-NETs tend to have earlier stage of presentation and well differentiated tumors, which may be most amenable to surgical intervention.


Subject(s)
Intestinal Neoplasms , Neuroendocrine Tumors , Pancreatic Neoplasms , Stomach Neoplasms , Humans , Intestinal Neoplasms/pathology , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Retrospective Studies , Stomach Neoplasms/pathology , Young Adult
8.
Ann Surg Oncol ; 27(13): 5240-5247, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32909128

ABSTRACT

BACKGROUND: Melanoma of unknown primary (MUP) accounts for approximately 3% of melanoma diagnoses. This study sought to evaluate treatment and outcomes for a modern MUP cohort. METHODS: A retrospective review of MUP was performed at a tertiary referral cancer center. RESULTS: Of 815 melanoma patients, 67 (8.2%) had MUP. Men were more likely to have MUP than women (67% vs. 55%; p = 0.04). The most common sites of MUP were lymph nodes (28%), visceral solid organs (25%), brain (16%), and skin/subcutaneous tissues (10%). Of the patients who underwent tumor genomic profiling, 52% harbored pathogenic BRAF mutations. Of the 24 patients who underwent multi-gene panel testing, all had pathogenic mutations and 21 (88%) had mutations in addition to or exclusive of BRAF, including 11 patients (46%) with telomerase reverse transcriptase promoter mutations. Checkpoint inhibitors (39%) and BRAF-MEK inhibitors (7%) were the most common first-line treatments. Upfront surgical resection was used for 25% of the MUP patients, and 12 of these resections were for curative intent. During a median follow-up period of 22.1 months, the median overall survival (OS) was not met for the patients with MUP isolated to lymph nodes. At 56.8 months, 75% of these patients were alive. The median OS was 37.4 months for skin/soft tissue MUP, 33.3 months for single solid organ viscera MUP, and 29.8 months for metastatic brain MUP. CONCLUSION: Multigene panel testing identified pathogenic mutations in all tested MUP patients and frequently identified targets outside BRAF. Despite advanced stage, aggressive multimodal therapy for MUP can be associated with 5-year OS and should be pursued for appropriate candidates.


Subject(s)
Melanoma , Neoplasms, Unknown Primary , Skin Neoplasms , Female , Humans , Lymph Nodes , Male , Melanoma/genetics , Melanoma/therapy , Mutation , Neoplasms, Unknown Primary/genetics , Neoplasms, Unknown Primary/therapy , Proto-Oncogene Proteins B-raf/genetics , Retrospective Studies , Skin Neoplasms/genetics , Skin Neoplasms/therapy
9.
Ann Surg Oncol ; 27(10): 3754-3761, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32712891

ABSTRACT

BACKGROUND: Recent reviews of medical conferences have shown that women were less likely to receive a formal introduction compared with men. We examined speaker introductions at the Society of Surgical Oncology (SSO) annual meeting to determine whether similar biases exist within our organization. METHODS: An observational study of video-archived speaker introductions at the 2018 and 2019 SSO annual meetings was conducted. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regression was used to identify factors associated with form of address. RESULTS: There were 499 speaker introductions reviewed. Speakers included 290 (58%) men and 238 (49%) post-graduate trainees (residents and fellows). A non-professional form of address was used to introduce 148 (30%) speakers and was most often used for post-graduate trainees (33%). Full professors were more likely than junior faculty to introduce speakers with a non-professional form of address (37% of full professors vs 18% of assistant professors, p < 0.001). In multivariable regression analysis these findings persisted. Trainees were 2.8 times more likely to receive a non-professional form of address (p = 0.003). Use of a non-professional introduction did not significantly vary by the speaker's nor the introducer's gender. CONCLUSIONS: Residents and fellows were more likely to receive a non-professional form of address, and the likelihood of this increased with rising seniority of the introducer. The manner of speaker introduction did not vary by gender in our organization. More research is needed to explore the influence of these disparities on academic advancement for the next generation of surgical oncologists.


Subject(s)
Neoplasms , Sexism , Surgical Oncology , Female , Humans , Male , Neoplasms/surgery
10.
Rev Col Bras Cir ; 47: e20202640, 2020.
Article in English, Portuguese | MEDLINE | ID: mdl-32556033

ABSTRACT

Prioritizing surgical procedures aims at facilitating patient's access according to the clinical needs, maximizing access equity, and minimizing the damage from delayed access. Previous categorization of elective bariatric surgery have been adapted to define an objective prioritizing system that reflects those principles for bariatric and metabolic operations. Given the factors that contribute to the morbidity and mortality of obese and type 2 diabetes patients, surgical prioritization should be based on clinical risk stratification. For patients with type 2 diabetes, we suggest that the operation may be prioritized for those with a higher risk of morbidity and mortality in a relatively short term. Likewise, it is necessary to guide the surgical team regarding the necessary care both in the pre, per and postoperative periods of bariatric and metabolic surgery. These recommendations aim to reduce the risk of in-hospital contamination of the surgical team among health professionals and between health professionals and patients. In summary, these recommendations have been shaped after a thorough analysis of the available literature and are extremely important to mitigate the harm related to the clinical complications of obesity and its comorbidities while keeping healthcare providers' and patients' safety.


Subject(s)
Bariatric Surgery/standards , Betacoronavirus , Coronavirus Infections/prevention & control , Elective Surgical Procedures/standards , Obesity, Morbid/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Brazil , COVID-19 , Diabetes Mellitus, Type 2/complications , Guidelines as Topic , Health Priorities , Humans , Obesity, Morbid/complications , SARS-CoV-2
11.
Front Endocrinol (Lausanne) ; 11: 624251, 2020.
Article in English | MEDLINE | ID: mdl-33613455

ABSTRACT

Renal neuroendocrine neoplasms are rare, with descriptions of cases limited to individual reports and small series. The natural history of this group of neuroendocrine neoplasms is poorly understood. In this study, we queried the Surveillance, Epidemiology and End Results (SEER) database over a four-decade period where we identified 166 cases of primary renal neuroendocrine neoplasms. We observed a 5-year overall survival of 50%. On multivariate analysis, survival was influenced by stage, histology, and if surgery was performed. We observed that patients managed by operative management had a greater frequency of localized or regional stage disease as well as a greater frequency of neuroendocrine tumor, grade 1 histology; whereas those managed non-operatively tended to have distant disease and histologies of neuroendocrine carcinoma, NOS and small cell neuroendocrine carcinoma. This is the largest description of patients with renal neuroendocrine neoplasms. Increased survival was observed in patients with earlier stage and favorable histologies.


Subject(s)
Kidney Neoplasms/classification , Kidney Neoplasms/mortality , Neuroendocrine Tumors/classification , Neuroendocrine Tumors/mortality , SEER Program/trends , Adult , Aged , Female , Humans , Kidney Neoplasms/diagnosis , Male , Middle Aged , Multivariate Analysis , Neuroendocrine Tumors/diagnosis , Survival Rate/trends
12.
Rev. Col. Bras. Cir ; 47: e20202640, 2020.
Article in English | LILACS | ID: biblio-1136563

ABSTRACT

ABSTRACT Prioritizing surgical procedures aims at facilitating patient's access according to the clinical needs, maximizing access equity, and minimizing the damage from delayed access. Previous categorization of elective bariatric surgery have been adapted to define an objective prioritizing system that reflects those principles for bariatric and metabolic operations. Given the factors that contribute to the morbidity and mortality of obese and type 2 diabetes patients, surgical prioritization should be based on clinical risk stratification. For patients with type 2 diabetes, we suggest that the operation may be prioritized for those with a higher risk of morbidity and mortality in a relatively short term. Likewise, it is necessary to guide the surgical team regarding the necessary care both in the pre, per and postoperative periods of bariatric and metabolic surgery. These recommendations aim to reduce the risk of in-hospital contamination of the surgical team among health professionals and between health professionals and patients. In summary, these recommendations have been shaped after a thorough analysis of the available literature and are extremely important to mitigate the harm related to the clinical complications of obesity and its comorbidities while keeping healthcare providers' and patients' safety.


RESUMO A priorização de qualquer operação eletiva visa facilitar o acesso do paciente de acordo com as necessidades clínicas, maximizando a equidade de acesso e minimizando os danos causados pelo atraso. As categorias de operações eletivas foram adaptadas para definir sistema de priorização objetiva que reflete esses princípios para operações bariátricas e metabólicas. Em razão dos fatores que contribuem para a morbidade e mortalidade da obesidade e do diabetes tipo 2, a priorização cirúrgica deve ser baseada na estratificação de risco clínico. Para pacientes com diabetes tipo 2, sugerimos que a operação possa ser priorizada para aqueles com maior risco de morbidade e mortalidade, em prazo relativamente curto. Da mesma forma, é necessário orientar a equipe cirúrgica quanto aos cuidados necessários tanto no pré, per e pós-operatório da cirurgia bariátrica e metabólica. As recomendações visam reduzir o risco de contágio hospitalar da equipe cirúrgica tanto entre profissionais de saúde quanto entre profissionais de saúde e pacientes. Em resumo, estas recomendações foram moldadas após análise minuciosa da literatura disponível e são extremamente importantes para mitigar os danos das complicações clínicas, sensíveis a doença obesidade e comorbidades, mantendo a segurança dos profissionais de saúde e dos pacientes.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Obesity, Morbid/surgery , Elective Surgical Procedures/standards , Coronavirus Infections/prevention & control , Bariatric Surgery/standards , Pandemics/prevention & control , Betacoronavirus , Obesity, Morbid/complications , Brazil , Guidelines as Topic , Diabetes Mellitus, Type 2/complications , SARS-CoV-2 , COVID-19 , Health Priorities
13.
Am Surg ; 85(10): 1125-1128, 2019 Oct 01.
Article in English | MEDLINE | ID: mdl-31657307

ABSTRACT

Neuroendocrine tumors (NETs) are the most common malignancy arising in Meckel's diverticula (MDs). To date, there are no large series characterizing these tumors. The National Cancer Database was queried for patients with MD NETs (n = 162) from 2004 to 2014. Patient and tumor characteristics as well as outcomes were analyzed. MD NETs were more common in men (72.8%) at a median age of 62 years; 95.1 per cent of patients were white. All patients underwent surgery. Clinical M0 disease was present in 97.4 per cent of patients, and 88.2 per cent of tumors were well differentiated. Lymphovascular invasion was present in 13.2 per cent. Most (60.4%) tumors were less than 10 mm. Lymphadenectomy was performed in 32.9 per cent of patients, with 52.1 per cent of these found to have metastatic lymph node disease. Although most MD NETs are well differentiated, smaller than 10 mm, and do not have lymphovascular invasion, lymph node metastases are commonly found, suggesting that mesenteric lymphadenectomy with adequate resection of the small bowel may be necessary for adequate staging and disease clearance.


Subject(s)
Ileal Neoplasms/etiology , Meckel Diverticulum/complications , Neuroendocrine Tumors/etiology , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Humans , Ileal Neoplasms/epidemiology , Ileal Neoplasms/pathology , Ileal Neoplasms/surgery , Kaplan-Meier Estimate , Lymph Node Excision/statistics & numerical data , Lymphatic Metastasis , Male , Meckel Diverticulum/epidemiology , Middle Aged , Neuroendocrine Tumors/epidemiology , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgery , SEER Program/statistics & numerical data , Sex Distribution , Tumor Burden
14.
Nutrients ; 11(5)2019 Apr 26.
Article in English | MEDLINE | ID: mdl-31035477

ABSTRACT

Resveratrol is an anti-inflammatory compound found in several foods. Periodontal disease (PD) is associated to other systemic diseases, and inflammation may be responsible for the association. Consequently, controlling inflammation not only may benefit oral health but also may assist with the management of other chronic inflammatory conditions. We aimed to investigate the effects of resveratrol administration on PD control in preclinical studies. A systematic search was performed for scientific articles using both electronic databases and a manual search using combinations of the following keywords: "resveratrol" OR "3,5,4'-trihydroxystilbene" AND "periodontal disease" OR "periodontitis" OR "gingivitis". Only in vivo original studies investigating resveratrol treatment on experimental animal models of PD were selected. A quality assessment of the studies was performed using the Animal Research Reporting In Vivo Experiment (ARRIVE) guidelines, and the risk of bias was assessed using the Syrcle tool. The search returned 570 articles, and 11 matched the inclusion criteria. A meta-analysis showed that resveratrol treatment attenuated alveolar bone loss (τ2 = 0.0041; 95% CI: -0.14; -0.04). The ARRIVE criteria reported a good quality of studies in general (mean score 28.5 ± 2.5). However, five Syrcle domains indicated a high risk of bias or did not present information clearly. We concluded that, in preclinical studies, resveratrol treatment prevented PD progression.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Periodontal Diseases/drug therapy , Periodontal Diseases/etiology , Resveratrol/therapeutic use , Animals
15.
J Surg Oncol ; 119(5): 653-659, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30811033

ABSTRACT

Liver metastases and peritoneal carcinomatosis are a particular focus of surgeons in improving survival in stage IV colorectal cancer patients, with laparotomy long being the means to undertake these operations. The Louisville statement published in 2008 was the first international consensus on indications for minimally invasive liver resection. Herein we review the progress in innovative surgical techniques, including minimally invasive liver resection, robot-assisted hepatectomy, and we also describe initial reports in pressurized intraperitoneal aerosol chemotherapy.


Subject(s)
Colorectal Neoplasms/pathology , Hepatectomy/methods , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Aerosols , Antineoplastic Agents/administration & dosage , Colorectal Neoplasms/surgery , Humans , Laparoscopy , Robotic Surgical Procedures
16.
Ann Surg Oncol ; 25(10): 3004-3010, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30030731

ABSTRACT

BACKGROUND: Access to health care poses particular challenges for patients living in rural communities. Intraoperative radiotherapy (IORT) offers a treatment alternative to traditional whole-breast radiation therapy (WBRT) for select patients. This study aimed to analyze the use of IORT for patients undergoing breast-conserving surgery at an academic institution located in a rural state. METHODS: A retrospective review analyzed all patients at a single institution with a diagnosis of ductal carcinoma in situ (DCIS) or invasive breast cancer from April 2012 to January 2017 who were undergoing breast-conserving surgery with either IORT or WBRT. Student's t test or Fisher's exact test was used to make statistical comparisons. RESULTS: Patients undergoing IORT (n = 117) were significantly older than patients treated with WBRT (n = 191) (65.6 vs 58.6 years; p < 0.001) and had smaller tumors on both preoperative imaging (1.04 vs 1.66 cm; p < 0.05) and final pathology (0.99 vs 1.48 cm; p < 0.05). Patients receiving IORT lived farther from the treating facility than patients treated with WBRT (67.2 vs 30.8 miles; p < 0.05). To account for biases created in the IORT selection criteria, subgroup analysis was performed for women receiving WBRT who fulfilled IORT selection criteria, and distance traveled remained significant (67.2 vs 31.4 miles; p < 0.05). Neither recurrence nor survival differed between the IORT and WBRT groups. Medicare reimbursement for IORT was approximately 50% more than for WBRT. CONCLUSIONS: For women from rural communities, IORT appears to be an attractive option because these women tend to be older and to live farther from the treatment facility.


Subject(s)
Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/therapy , Carcinoma, Lobular/therapy , Intraoperative Care , Mastectomy, Segmental/methods , Neoplasm Recurrence, Local/diagnosis , Radiotherapy , Aged , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Lobular/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Iowa/epidemiology , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Prognosis , Retrospective Studies , Rural Population
17.
Stem Cells ; 35(1): 170-180, 2017 01.
Article in English | MEDLINE | ID: mdl-27350343

ABSTRACT

Stem cells possess the ability to home in and travel to damaged tissue when injected intravenously. For the cells to exert their therapeutic effect, they must cross the blood vessel wall and enter the surrounding tissues. The mechanism of extravasation injected stem cells employ for exit has yet to be characterized. Using intravital microscopy and a transgenic zebrafish line Tg(fli1a:egpf) with GFP-expressing vasculature, we documented the detailed extravasation processes in vivo for injected stem cells in comparison to white blood cells (WBCs). While WBCs left the blood vessels by the standard diapedesis process, injected cardiac and mesenchymal stem cells underwent a distinct method of extravasation that was markedly different from diapedesis. Here, the vascular wall undergoes an extensive remodeling to allow the cell to exit the lumen, while the injected cell remains distinctively passive in activity. We termed this process Angio-pello-sis, which represents an alternative mechanism of cell extravasation to the prevailing theory of diapedesis. Stem Cells 2017;35:170-180 Video Highlight: https://youtu.be/i5EI-ZvhBps.


Subject(s)
Blood Vessels/physiology , Extravasation of Diagnostic and Therapeutic Materials/pathology , Animals , CD11 Antigens/metabolism , Cell Aggregation , Cell Membrane/metabolism , Cell Shape , Dogs , Female , Humans , Injections , Intravital Microscopy , Male , Mesenchymal Stem Cells , Microspheres , Myocytes, Cardiac/cytology , Polymers/chemistry , Rats , Time Factors , Transendothelial and Transepithelial Migration , Zebrafish/metabolism
18.
Oncotarget ; 8(70): 114801-114815, 2017 Dec 29.
Article in English | MEDLINE | ID: mdl-29383121

ABSTRACT

Cancer stem cells (CSCs) are expanded in anaplastic thyroid cancer (ATC) and standard treatment approaches have failed to improve survival, suggesting a need to specifically target the CSC population. Recent studies in breast and colorectal cancer demonstrated that inhibition of the SUMO pathway repressed CD44 and cleared the CSC population, mediated through SUMO-unconjugated TFAP2A. We sought to evaluate effects of inhibiting the SUMO pathway in ATC. ATC cell lines and primary ATC tumor samples were evaluated. The SUMO pathway was inhibited by knockdown of PIAS1 and use of SUMO inhibitors anacardic acid and PYR-41. The expression of TFAP2A in primary ATC was examined by immunohistochemistry. All ATC cell lines expressed TFAP2A but only 8505C expressed SUMO-conjugated TFAP2A. In 8505C only, inhibition of the SUMO pathway by knockdown of PIAS1 or treatment with SUMO inhibitors repressed expression of CD44 with a concomitant loss of SUMO-conjugated TFAP2A. The effect of SUMO inhibition on CD44 expression was dependent upon TFAP2A. Treatment with SUMO inhibitors resulted in a statistically improved tumor-free survival in mice harboring 8505C xenografts. An examination of primary ATC tissue determined that TFAP2A was expressed in 4 of 11 tumors surveyed. We conclude that inhibition of the SUMO pathway repressed the CSC population, delaying the outgrowth of tumor xenografts in ATC. The effect of SUMO inhibition was dependent upon expression of SUMO-conjugated TFAP2A, which may serve as a molecular marker for therapeutic effects of SUMO inhibitors. The findings provide pre-clinical evidence for development of SUMO inhibitors for the treatment of ATC.

19.
Stem Cell Reports ; 7(6): 1140-1151, 2016 12 13.
Article in English | MEDLINE | ID: mdl-27916539

ABSTRACT

Many solid cancers have an expanded CD44+/hi/CD24-/low cancer stem cell (CSC) population, which are relatively chemoresistant and drive recurrence and metastasis. Achieving a more durable response requires the development of therapies that specifically target CSCs. Recent evidence indicated that inhibiting the SUMO pathway repressed tumor growth and invasiveness, although the mechanism has yet to be clarified. Here, we demonstrate that inhibition of the SUMO pathway repressed MMP14 and CD44 with a concomitant reduction in cell invasiveness and functional loss of CSCs in basal breast cancer. Similar effects were demonstrated with a panel of E1 and E3 SUMO inhibitors. Identical results were obtained in a colorectal cancer cell line and primary colon cancer cells. In both breast and colon cancer, SUMO-unconjugated TFAP2A mediated the effects of SUMO inhibition. These data support the development of SUMO inhibitors as an approach to specifically target the CSC population in breast and colorectal cancer.


Subject(s)
Breast Neoplasms/pathology , Colorectal Neoplasms/pathology , Neoplastic Stem Cells/metabolism , Neoplastic Stem Cells/pathology , Signal Transduction , Small Ubiquitin-Related Modifier Proteins/metabolism , Anacardic Acids/chemistry , Anacardic Acids/pharmacology , Breast Neoplasms/metabolism , Carcinogenesis/drug effects , Carcinogenesis/metabolism , Carcinogenesis/pathology , Cell Line, Tumor , Colorectal Neoplasms/metabolism , Female , Gene Knockdown Techniques , Humans , Hyaluronan Receptors/metabolism , Matrix Metalloproteinase 14/metabolism , Neoplasm Invasiveness , Neoplastic Stem Cells/drug effects , Phenotype , Signal Transduction/drug effects , Xenograft Model Antitumor Assays
20.
Mol Cancer Ther ; 15(3): 503-11, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26832794

ABSTRACT

Expression of TFAP2C in luminal breast cancer is associated with reduced survival and hormone resistance, partially explained through regulation of RET. TFAP2C also regulates EGFR in HER2 breast cancer. We sought to elucidate the regulation and functional role of EGFR in luminal breast cancer. We used gene knockdown (KD) and treatment with a tyrosine kinase inhibitor (TKI) in cell lines and primary cancer isolates to determine the role of RET and EGFR in regulation of p-ERK and tumorigenesis. KD of TFAP2C decreased expression of EGFR in a panel of luminal breast cancers, and chromatin immunoprecipitation sequencing (ChIP-seq) confirmed that TFAP2C targets the EGFR gene. Stable KD of TFAP2C significantly decreased cell proliferation and tumor growth, mediated in part through EGFR. While KD of RET or EGFR reduced proliferation (31% and 34%, P < 0.01), combined KD reduced proliferation greater than either alone (52% reduction, P < 0.01). The effect of the TKI vandetanib on proliferation and tumor growth response of MCF-7 cells was dependent upon expression of TFAP2C, and dual KD of RET and EGFR eliminated the effects of vandetanib. The response of primary luminal breast cancers to TKIs assessed by ERK activation established a correlation with expression of RET and EGFR. We conclude that TFAP2C regulates EGFR in luminal breast cancer. Response to vandetanib was mediated through the TFAP2C target genes EGFR and RET. Vandetanib may provide a therapeutic effect in luminal breast cancer, and RET and EGFR can serve as molecular markers for response.


Subject(s)
Antineoplastic Agents/pharmacology , Breast Neoplasms/genetics , Breast Neoplasms/metabolism , ErbB Receptors/genetics , Gene Expression Regulation, Neoplastic/drug effects , Piperidines/pharmacology , Quinazolines/pharmacology , Transcription Factor AP-2/metabolism , Animals , Biomarkers, Tumor , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Carcinogenesis/genetics , Carcinogenesis/metabolism , Cell Line, Tumor , Cell Proliferation/drug effects , Disease Models, Animal , Female , Humans , MCF-7 Cells , Proto-Oncogene Proteins c-ret/genetics , Proto-Oncogene Proteins c-ret/metabolism , Transcription Factor AP-2/genetics , Tumor Burden/drug effects , Tumor Burden/genetics , Xenograft Model Antitumor Assays
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