Comprehensive characterization of endometriosis patients and disease patterns in a large clinical cohort

Abstract Purpose In many diseases, it is possible to classify a heterogeneous group into subgroups relative to tumor biology, genetic variations, or clinical and pathological features. No such classification is available for endometriosis. In our retrospective case–case analysis we defined subgroups of endometriosis patients relative to the type and location of the endometriosis lesion and relative to basic patient characteristics. Methods From June 2013 to July 2017, a total of 1576 patients with endometriosis diagnosed at surgery were included in this study. The patients’ history and clinical data were documented using a web-based remote data entry system. To build subgroups, all possible combinations of endometriosis locations/types (peritoneal; ovarian endometriosis; deeply infiltrating endometriosis; adenomyosis) were used. Due to the variation in group sizes, they were combined into five substantial larger groups. Results Age, pregnancy rate, and live birth rate were identified as characteristics that significantly differed between the five patient groups that were defined. No significant differences were noted in relation to body mass index, length of menstrual cycle, age at menarche, reason for presentation, or educational level. Conclusion This study describes basic patient characteristics in relation to common clinical subgroups in a large clinical cohort of endometriosis patients. Epidemiological information about different clinical groups may be helpful in identifying groups with specific clinical courses, potentially suggesting novel approaches to early detection and to surgical and systemic treatment.

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Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211021251 ◽

2021 ◽

pp. 000348942110212

Author(s):

Nathan Kemper ◽

Scott B. Shapiro ◽

Allie Mains ◽

Noga Lipschitz ◽

Joseph Breen ◽

...

Keyword(s):

Skull Base ◽

Medical Center ◽

Academic Medical Center ◽

Significant Proportion ◽

Internal Auditory Canal ◽

Patient Characteristics ◽

Management Plan ◽

Case Review ◽

Retrospective Case ◽

Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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Abstract P363: Predictors of Utility of Advanced Cardiac Imaging in Revealing Cryptogenic Stroke Etiology

Stroke ◽

10.1161/str.52.suppl_1.p363 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Daniel M Schachter ◽

Micaela Schachter ◽

Blake Beehler ◽

Jeffrey Quinn ◽

Jeremy E Kulacz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cardiac Imaging ◽

Left Atrial ◽

Cryptogenic Stroke ◽

Case Series ◽

Patient Characteristics ◽

Current Data ◽

Common Finding ◽

Retrospective Case ◽

Patients With Diabetes

Introduction: Advanced cardiac imaging (ACI), including transesophageal echocardiogram (TEE), cardiac CT and cardiac MRI, is widely considered a crucial element in the work-up of cryptogenic and ESUS stroke. Current data on diagnostic yields are variable, though, and selection of patients to undergo such imaging is largely anecdotal. Methodology: We conducted a retrospective case series review of all cryptogenic ischemic strokes who received ACI, admitted to a large urban academic single-center over a 2.5-year period. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACI would uncover etiology. Results: Out of 277 total cryptogenic ischemic strokes reviewed, ACI determined etiology in 20 cases (7.2%). Median age was 61 (IQR = 52-73). Patient sex was 49.5% female. Race demographic was 1.8% Asian, 50.9% black, 14.1% latino(a), and 33.2% white. Etiology was found by TEE in 16 of 20 cases, and the most common finding was left atrial thrombus/smoke. Latino(a) race was significantly more likely (15.4%) for ACI to find etiology and white race was significantly less likely (1.1%), p = .03 and .005, respectively. The table included shows other notable findings. Analogous trends were observed in a subgroup analysis of patients greater or equal to 60 years old. Conclusion: Our data indicate that in cryptogenic stroke premorbid non-use of antithrombotic, elevated troponin and left atrial dilatation are each individually associated with increased likelihood that ACI will find an etiology. Meanwhile, patients with diabetes mellitus are significantly less likely to have etiology found by ACI; and, smokers with combined hypertension, hyperlipidemia, and diabetes mellitus trend towards ACI less frequently uncovering etiology. Finally, the data suggest potential racial disparities of finding etiology with ACI, the determinants of which remain to be studied.

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Hyperglycemia After Cardiac Surgery

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000028 ◽

2014 ◽

Vol 25 (3) ◽

pp. 221-227

Author(s):

Lynda Stoodley ◽

Shu-Fen Wung

Keyword(s):

Cardiac Surgery ◽

Blood Glucose Control ◽

Surgical Care ◽

Patient Characteristics ◽

Performance Measure ◽

Adverse Outcomes ◽

Retrospective Case ◽

Improvement Project ◽

History Of ◽

Surgical Care Improvement Project

Background The Surgical Care Improvement Project #4 (SCIP#4) performance measure is used to evaluate achievement of target blood glucose control after cardiac surgery. Objectives The purpose of this study was to identify patient characteristics and outcomes in patients undergoing cardiac surgery who met the SCIP#4 performance measure versus those who did not. Methods A retrospective case-control design was used. Results Preoperative hemoglobin A1C (HbA1C) level and history of diabetes were 2 major risk factors for failing to meet the SCIP#4 measure. A trend toward a longer length of stay was observed, mortality was 3 times more prevalent, and renal failure was 4 times more frequent in patients who did not meet the SCIP#4 quality measure. Conclusions Not meeting the SCIP#4 measure is associated with adverse outcomes. History of diabetes and preoperative HbAIC level should be considered when evaluating strategies for managing postsurgical hyperglycemia.

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Non-Smoking-Associated Lung Cancer: A distinct Entity in Terms of Tumor Biology, Patient Characteristics and Impact of Hereditary Cancer Predisposition

Cancers ◽

10.3390/cancers11020204 ◽

2019 ◽

Vol 11 (2) ◽

pp. 204 ◽

Cited By ~ 10

Author(s):

Elisabeth Smolle ◽

Martin Pichler

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Tobacco Smoke ◽

Treatment Options ◽

Tumor Biology ◽

Patient Characteristics ◽

Driver Genes ◽

Unique Type ◽

Personalized Cancer Therapy ◽

Personalized Cancer

Non-small cell lung cancer (NSCLC) in non-, and especially in never-smoking patients is considered a biologically unique type of lung cancer, since risk factors and tumorigenic conditions, other than tobacco smoke, come into play. In this review article, we comprehensively searched and summarized the current literature with the aim to outline what exactly triggers lung cancer in non-smokers. Changes in the tumor microenvironment, distinct driver genes and genetic pathway alterations that are specific for non-smoking patients, as well as lifestyle-related risk factors apart from tobacco smoke are critically discussed. The data we have reviewed highlights once again the importance of personalized cancer therapy, i.e., careful molecular and genetic assessment of the tumor to provide tailored treatment options with optimum chances of good response—especially for the subgroups of never-smokers.

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Surgical Technique for Management of Severe Calcaneofibular Impingement: Case Series

Foot & Ankle Orthopaedics ◽

10.1177/2473011420953793 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142095379

Author(s):

Jay M. Levin ◽

James K. DeOrio

Keyword(s):

Surgical Technique ◽

Case Series ◽

Lateral Wall ◽

Patient Characteristics ◽

Calcaneal Fracture ◽

Lateral Approach ◽

Emergency Department Visits ◽

Retrospective Case ◽

Level Of Evidence ◽

Calcaneal Osteotomy

Background: Calcaneofibular impingement is characterized by lateral hindfoot pain and is commonly resulting from calcaneal fracture malunion or severe flatfoot deformity. Lateral calcaneal wall decompression has been used successfully to relieve pain in patients who have calcaneofibular impingement. However, in cases of severe impingement and hindfoot valgus, lateral wall excision may leave only a small remnant of calcaneal bone for weightbearing and can lead to chronic heel pain. We describe a surgical technique using a medial displacement calcaneal osteotomy (MDCO) combined with a lateral wall exostectomy and report on the outcomes from our series of patients. Methods: Retrospective study of a single surgeon’s patients was done from 2010 to 2020 who underwent medial slide calcaneal osteotomy and lateral wall exostectomy for calcaneofibular impingement. Descriptive statistics were used to summarize patient characteristics. Our study included 9 patients, 6 females and 3 males, with a mean age of 59 years (range: 19-77) and a mean follow-up of 62 weeks (range: 6-184). Results: Five had an Achilles split approach, 2 had an oblique lateral approach, and 1 had an extensile lateral approach. Patients achieved radiographic relief of impingement and improvement in pain. Minor skin and soft tissue complications occurred in 3 patients, all of which were associated with laterally based incisions, and all resolved after a 10-day course of oral antibiotics. No major complications, emergency department visits, or readmissions occurred. Conclusions: MDCO and lateral wall exostectomy was a safe and effective treatment for severe calcaneofibular impingement. Level of Evidence: Level IV, retrospective case series.

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Overview of Current Targeted Anti-Cancer Drugs for Therapy in Onco-Hematology

Medicina ◽

10.3390/medicina55080414 ◽

2019 ◽

Vol 55 (8) ◽

pp. 414 ◽

Cited By ~ 4

Author(s):

Crisci ◽

Amitrano ◽

Saggese ◽

Muto ◽

Sarno ◽

...

Keyword(s):

Targeted Therapy ◽

Small Molecules ◽

Tumor Biology ◽

Patient Characteristics ◽

Cytochrome P450 Enzyme ◽

Targeted Agents ◽

Adherence To Treatment ◽

Anti Cancer ◽

P450 Enzyme ◽

Interfering Rna

The upgraded knowledge of tumor biology and microenviroment provides information on differences in neoplastic and normal cells. Thus, the need to target these differences led to the development of novel molecules (targeted therapy) active against the neoplastic cells’ inner workings. There are several types of targeted agents, including Small Molecules Inhibitors (SMIs), monoclonal antibodies (mAbs), interfering RNA (iRNA) molecules and microRNA. In the clinical practice, these new medicines generate a multilayered step in pharmacokinetics (PK), which encompasses a broad individual PK variability, and unpredictable outcomes according to the pharmacogenetics (PG) profile of the patient (e.g., cytochrome P450 enzyme), and to patient characteristics such as adherence to treatment and environmental factors. This review focuses on the use of targeted agents in-human phase I/II/III clinical trials in cancer-hematology. Thus, it outlines the up-to-date anticancer drugs suitable for targeted therapies and the most recent finding in pharmacogenomics related to drug response. Besides, a summary assessment of the genotyping costs has been discussed. Targeted therapy seems to be an effective and less toxic therapeutic approach in onco-hematology. The identification of individual PG profile should be a new resource for oncologists to make treatment decisions for the patients to minimize the toxicity and or inefficacy of therapy. This could allow the clinicians to evaluate benefits and restrictions, regarding costs and applicability, of the most suitable pharmacological approach for performing a tailor-made therapy.

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Extra-articular Medial Impression Fracture of the Talus: A Previously Undescribed Injury

Foot & Ankle Specialist ◽

10.1177/1938640018788431 ◽

2018 ◽

Vol 11 (6) ◽

pp. 553-558

Author(s):

Olivier Wijers ◽

Rosa C. Looijen ◽

Jens A. Halm ◽

Tim Schepers

Keyword(s):

Correct Diagnosis ◽

Case Series ◽

Patient Characteristics ◽

Trauma Mechanism ◽

Retrospective Case ◽

Articular Fractures ◽

First Case ◽

Impression Fracture ◽

Talar Fractures ◽

Almost All

Background: Peripheral fractures of the talus are uncommon. Almost all the literature regarding talar fractures consists of central intra-articular fractures, whereas studies about peripheral talar fractures are lacking. The aim of this study is to increase awareness in diagnosing an unusual peripheral extra-articular medial impression fracture of the talus. Methods: This study includes a retrospective case series of patients with an extra-articular medial impression fracture of the talus. Patient characteristics, trauma mechanism, diagnostics, fracture characteristics, and treatment were reported. Results: Eight consecutive patients with an extra-articular medial impression fracture of the talus were identified. In 80%, the trauma mechanism was a supination or inversion injury of the ankle and foot. An X-ray was obtained in all patients; in 7 (88%) patients, a computed tomography scan was done, and an additional magnetic resonance imaging was done in 3 (38%) patients. In 4 patients (50%), the correct diagnosis was missed at first presentation. The delay between injury and diagnosis was 0 to 180 days (of 36 days on average). Conclusion: This is the first case series to describe patients with a peripheral extra-articular medial impression fracture of the talus. Good clinical examination and judicious use of diagnostic imaging are a necessity to find the talar impression fractures in a timely manner, and treatment can be started immediately. Levels of Evidence: Level V

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Adjuvant Chemotherapy: Which Patient? What Regimen?

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2013.33.3 ◽

2013 ◽

pp. 3-8 ◽

Cited By ~ 1

Author(s):

Natalie Turner ◽

Laura Biganzoli ◽

Luca Malorni ◽

Ilenia Migliaccio ◽

Erica Moretti ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Breast Cancer Subtype ◽

Tumor Biology ◽

Patient Characteristics ◽

Tumor Stage ◽

Luminal A ◽

Genomic Analyses ◽

Cancer Subtype ◽

Clinicopathologic Factors

In the past, treatment decisions regarding adjuvant chemotherapy in early breast cancer (EBC) were made solely based on clinicopathologic factors. However, with increased awareness of the importance of underlying tumor biology, we are now able to use genomic analyses to determine molecular breast cancer subtype and thus identify patients with tumors that are chemotherapy resistant and unlikely to benefit from the addition of chemotherapy. Although genomics has allowed some patients to avoid chemotherapy—specifically those with luminal A–like breast cancer—these assays do not indicate which regimen is most appropriate. For this, consideration must be given to the combination of underlying tumor biology, tumor stage, and patient characteristics, such as age and tolerability of side effects.

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Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective

Neurology International ◽

10.3390/neurolint13010003 ◽

2021 ◽

Vol 13 (1) ◽

pp. 25-31

Author(s):

Francesco Corea ◽

Silvia Ciotti ◽

Antonella Cometa ◽

Claudia De Carlo ◽

Giancarlo Martini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Care Delivery ◽

Oral Treatment ◽

Case Series ◽

Patient Characteristics ◽

Stroke Care ◽

Retrospective Case ◽

Short Disease Duration ◽

Relapsing Remitting ◽

Relapsing Remitting Multiple Sclerosis

Background: During the COVID-19 pandemic, the need for a broader implementation of telemedicine for many diseases has become apparent. Televisits are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. The use of televisits is more established in Stroke care but was also recently formally evaluated for Multiple Sclerosis (MS). This retrospective case series describes patient characteristics and reasons for televisits in persons with MS during the COVID-19 pandemic outbreak in Italy, which was declared in February 2020. Methods: Recruitment occurred in a general hospital based MS clinic during Italy’s lockdown months period (9 March–18 May). Each subject completed at least one televisit. The baseline data included were demographics and MS history; reasons for the remote house calls were analyzed focusing on COVID-19 related needs. Results: Forty-six participants completed at least one study visit. The patients enrolled were more often females suffering from Relapsing Remitting Multiple Sclerosis (RRMS). Half of the patients had an intermediate level of education and lived within a 60 min drive from the clinic. These patients predominately had a short disease duration and were mostly involved in oral treatment. The main reasons for the call were drug use and counseling on social distancing. In 5 cases, COVID-19 infection was reported. Conclusions: Televisits during the COVID-19 outbreak demonstrated their utility as a care delivery method for MS. Hence, it is vital to facilitate the implementation of this technology in common practice to both face infectious threats and increase accessibility of the health care system.

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Does Ovarian Endometriosis Increase Oocyte Sensitivity to ICSI-Induced Mechanical Damage?

Journal of Clinical Medicine ◽

10.3390/jcm10081757 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1757

Author(s):

Carlotta Scarafia ◽

Martina Masciovecchio ◽

Stefano Canosa ◽

Andrea Roberto Carosso ◽

Gianluca Gennarelli ◽

...

Keyword(s):

Pregnancy Rate ◽

Birth Rate ◽

Detrimental Effect ◽

Mechanical Damage ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Cumulative Live Birth Rate ◽

Ovarian Endometriosis ◽

Cumulative Live Birth

Some studies have shown that ICSI obtains poorer results than conventional IVF in women with ovarian endometriosis, suggesting that oocytes could be sensitive to ICSI-induced mechanical damage. The aims of this study were to clarify (a) whether ovarian endometriosis could induce peculiar fragility in the oocyte, so that ICSI would finally result harmful, and (b) whether endometrioma removal before IVF could be advisable in order to avoid any hypothetical detrimental effect. We retrospectively studied 368 women, 203 with in situ endometrioma (128 of which underwent ICSI, 75 conventional IVF) and 164 who received laparoscopic stripping of endometrioma before ICSI. For women with in situ endometrioma, cIVF and ICSI outcome was comparable for all parameters studied, including the clinical pregnancy rate per embryo transfer (PR/ET: 31.8% vs. 39.5% in the cIVF and ICSI groups) and cumulative live birth rate per ovum pick-up (CLBR/OPU: 24.4% vs. 27.7%). ICSI outcome was similar comparing women with in situ endometrioma and women previously submitted to laparoscopic stripping of cysts (CLPR/OPU 27.7% vs. 25.3%). Our findings suggest that (a) in women with in situ endometrioma ICSI may be performed, when needed, without harming oocytes and compromising the outcome and (b) that there is no advantage in removing endometrioma before ICSI.

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