Search results

Title: The Accuracy Of Neutrophil To Lymphocyte Ratio And Platelet To Lymphocyte Ratio As A Marker For Gastrointestinal Malignancies.
Creator: Nora, Ian, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description: Background: Accurate predictors of locally advanced and recurrence disease in patients with gastrointestinal cancer are currently lacking. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have emerged as possible markers for predicting recurrence in these patients. In this study, we sought to evaluate the utility of NLR and PLR in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies....
Show moreBackground: Accurate predictors of locally advanced and recurrence disease in patients with gastrointestinal cancer are currently lacking. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have emerged as possible markers for predicting recurrence in these patients. In this study, we sought to evaluate the utility of NLR and PLR in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies. Methods: We queried a comprehensive gastrointestinal oncology database to identify patients who had undergone surgery for a GI malignancy. NLR and PLR values were determined via a complete blood count (CBC). In patients treated with neoadjuvant therapy (NT) the NLR and PLR were calculated from CBCs before and after NT and in patients proceeding to surgery within 2 weeks pre-operatively. The associations between NLR and PLR and the clinicopathologic parameters (sex, age, tumor size, differentiation, positive lymph nodes, and metastatic disease) were assessed via chi(2) or Fisher's exact tests where appropriate. All the tests were two-sided, and P<0.05 was considered statistically significant. Results: We identified 116 patients diagnosed with gastrointestinal malignancies. There were 76 (65.5%) males and 40 (34.5%) females with an average age of 69.4 +/- 10.7 years. The mean follow up was 14.1 +/- 15.5 months. We identified 49 (42.2%) esophageal, 34 (29.3%) pancreatic, 14 (12.1%) colorectal, 13 (11.2%) gastric, and 6 (5.2%) biliary cancers. There were 36 (31.0%) patients with node negative disease, 52 (44.8%) with node positive and 28 (24.2%) with metastatic disease at surgery. Of the metastatic patients 4 (3.4%) were found at staging laparoscopy and 24 (20.6%) were diagnosed pre-operatively. The median NLR for LN-patient's was 1.78 (0.23-8.2) and for LN+ and metastatic patients was 4.69 (2.27-36), P<0.001. The median PLR for LN-patient's was 123.03 (14-257.69) and for LN+ and metastatic patients was 212.42 (105.45-2,185.18), P<0.001. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a NLR >2.25 was 98.8%, 72.2%, 89%, and 96% respectively. The sensitivity, specificity, PPV, and NPV for PLR >140 was 95%, 78%, 90%, and 88% respectively. Utilizing both NLR and PLR the sensitivity, specificity, PPV and NPV was increased. Conclusions: Elevation of NLR and PLR can be used to help identify patients with advanced disease GI malignancies and recurrences after surgery. Additionally, failure of normalization of NLR and PLR 3-month post-surgical resection may indicate early recurrence or persistent disease. Individually, NLR has a higher sensitivity and negative predictive value while PLR has a higher specificity and positive predictive value for distinguishing metastatic disease and node positivity. The combination of NLR and PLR has the highest accuracy of predicting advanced disease among all gastrointestinal malignancies.
Show less
Date Issued: 2018-10-01
Identifier: FSU_libsubv1_wos_000445720200026, 10.21037/jgo.2018.08.05
Format: Citation

Title: Achalasia.
Creator: Oviedo, Rodolfo J., Sofiak, Chase W., Dixon, Bruce M.
Abstract/Description: INTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a...
Show moreINTRODUCTION: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. PRESENTATION OF CASE: Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy. There is sparse literature on combining laparoscopic Heller myotomy (LHM) and partial fundoplication versus POEM with either restrictive or malabsorptive minimally invasive bariatric procedures. DISCUSSION: LHM and partial fundoplication have long been considered the gold standard surgical treatment for achalasia by disrupting both the longitudinal and circular muscle layers of the LES. The newer, less invasive, POEM technique will be compared to the gold standard LHM and Dor fundoplication in this uncharacteristically young morbidly obese achalasia patient. The decision to pursue a laparoscopic sleeve gastrectomy over a laparoscopic Roux-en-Y gastric bypass was multifactorial due to the patient's concerns regarding malabsorption of vitamins and nutrients in the event of a future pregnancy. CONCLUSION: The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ) architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
Show less
Date Issued: 2016
Identifier: FSU_libsubv1_wos_000384278500002, 10.1016/j.ijscr.2016.06.046
Format: Citation

Title: Achalasia: A case report on its effect during surgical decision making for laparoscopic sleeve gastrectomy in the young morbidly obese patient..
Creator: Oviedo, Rodolfo J, Sofiak, Chase W, Dixon, Bruce M
Abstract/Description: Achalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. Achalasia is typically a disease that affects non-obese adults...
Show moreAchalasia is a condition that occurs when the lower esophageal sphincter (LES) fails to properly relax, combined with slowing/failure of esophageal peristalsis. This is seen clinically by not allowing solids and liquids to pass easily into the stomach. Achalasia is not historically associated with morbid obesity, yet dual treatment of morbid obesity and achalasia is becoming more prominent due to the worldwide obesity epidemic. Achalasia is typically a disease that affects non-obese adults over the age of 55, which makes the discussion of this case report unique in that our patient is a 23 year-old woman who successfully underwent per-oral endoscopic myotomy (POEM) in preparation for a future laparoscopic sleeve gastrectomy. There is sparse literature on combining laparoscopic Heller myotomy (LHM) and partial fundoplication versus POEM with either restrictive or malabsorptive minimally invasive bariatric procedures. LHM and partial fundoplication have long been considered the gold standard surgical treatment for achalasia by disrupting both the longitudinal and circular muscle layers of the LES. The newer, less invasive, POEM technique will be compared to the gold standard LHM and Dor fundoplication in this uncharacteristically young morbidly obese achalasia patient. The decision to pursue a laparoscopic sleeve gastrectomy over a laparoscopic Roux-en-Y gastric bypass was multifactorial due to the patient's concerns regarding malabsorption of vitamins and nutrients in the event of a future pregnancy. The patient has already undergone a POEM procedure, which was chosen to maintain the gastric fundus, cardia, and gastroesophageal junction (GEJ) architecture as opposed to a LHM with Dor fundoplication, which would have altered the anatomy, thus making a concomitant laparoscopic sleeve gastrectomy an unfeasible option.
Show less
Date Issued: 2016-01-01
Identifier: FSU_pmch_27423062, 10.1016/j.ijscr.2016.06.046, PMC4949807, 27423062, 27423062, S2210-2612(16)30230-9
Format: Citation

Title: AKT expression is associated with degree of pathologic response in adenocarcinoma of the esophagus treated with neoadjuvant therapy.
Creator: Saeed, Nadia, Shridhar, Ravi, Hoffe, Sarah, Almhanna, Khaldoun, Meredith, Kenneth L
Abstract/Description: Neoadjuvant chemoradiation (NCRT) has become standard in the treatment of locally advanced esophageal adenocarcinoma (EAC) with survival correlated to degree of pathologic response. The phosphatidyl inositol 3 kinase (PI3K)/protein kinase B (AKT)/mTOR pathway plays an important role in tumorgenesis and resistance. We sought to elucidate the role of this pathway in patients with EAC who received NCRT. After IRB approval, a prospective trial was initiated in which patients with EAC underwent...
Show moreNeoadjuvant chemoradiation (NCRT) has become standard in the treatment of locally advanced esophageal adenocarcinoma (EAC) with survival correlated to degree of pathologic response. The phosphatidyl inositol 3 kinase (PI3K)/protein kinase B (AKT)/mTOR pathway plays an important role in tumorgenesis and resistance. We sought to elucidate the role of this pathway in patients with EAC who received NCRT. After IRB approval, a prospective trial was initiated in which patients with EAC underwent endoscopic biopsies of normal and tumor tissue prior to instituting NCRT. Patients then proceeded to esophagectomy. The pre-treatment tissues underwent gene expression profiling. SAM method was used to analyze expression of AKT within normal and tumor tissue. Expression was then correlated to degree of pathologic response. One-hundred patients were consented for the study, of which 67 met final eligibility. Nineteen patient's tumors ultimately underwent gene expression profiling via microarray. The differential expression of all AKT isoforms in tumor tissue was markedly overexpressed compared to normal tissue (P=6×10(-5)). There were 3 patients designated as pNR, 6 as pPR, and 10 as pCR. Partial and non-responders had higher expressions of AKT compared to pCR with the non-responders consistently illustrated the highest expression of AKT (P=0.02). There was a significant correlation between individual isoforms of AKT-1, AKT-2, and AKT-3 and degree of pathologic response (P=0.002, 0.04, and 0.04 respectively). AKT is overexpressed in patients with AC of the esophagus. Moreover, pathologic response to NCRT may be correlated with degree of AKT expression. Additional data is needed to clarify this relationship to potentially add targeted therapies to the neoadjuvant regimen.
Show less
Date Issued: 2016-04-01
Identifier: FSU_pmch_27034781, 10.3978/j.issn.2078-6891.2015.067, PMC4783740, 27034781, 27034781, jgo-07-02-158
Format: Citation

Title: Anal Squamous Intraepithelial Lesions and HPV Among Young Black Men Who Have Sex with Men.
Creator: Keglovitz, Kristin, Richardson, Andrew D, Lancki, Nicola, Walsh, Tim, Schneider, John A
Abstract/Description: Limited data are available on anal squamous intraepithelial lesions (ASILs) and anal human papillomavirus (HPV) infection in young, Black populations. The purpose of this study was to examine the prevalence of and relationships between ASILs and high-risk HPV infection in a young (
Show moreLimited data are available on anal squamous intraepithelial lesions (ASILs) and anal human papillomavirus (HPV) infection in young, Black populations. The purpose of this study was to examine the prevalence of and relationships between ASILs and high-risk HPV infection in a young (<30 years of age), predominantly Black, men who have sex with men (MSM) population. Results of anal cytology and HPV DNA were gathered for 83 individuals. Forty-two percent of individuals (35) had atypical squamous cells of undetermined significance and 33% (27) had low-grade squamous intraepithelial lesion by cytology. Only 9% tested positive for both high-risk HPV subtypes 16 and 18. Low rates of infection with both HPV types 16 and 18 may provide further evidence that we should continue to vaccinate young, Black MSM against HPV.
Show less
Date Issued: 2017-02-01
Identifier: FSU_pmch_27673362, 10.1089/lgbt.2016.0049, PMC5278831, 27673362, 27673362
Format: Citation

Title: Callosal Apraxia: A 34-year Follow-up Study.
Creator: Falchook, Adam D., Watson, Robert T., Heilman, Kenneth M.
Abstract/Description: Loss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and...
Show moreLoss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and movement) errors. Initially, she did not reveal loss of finger-hand deftness (limb-kinetic apraxia), and when tested again with the coin rotation task, her left hand performance was normal. Without vision, she could name objects placed in her left hand but not name numbers written in this hand. Since this woman had a callosal lesion, failure to recover cannot be accounted for by left hemisphere inhibition of her right hemisphere. Although failure for her LUL to improve may have been related to not using her LUL for skilled actions, her right hemisphere was able to observe transitive actions, and this failure of her LUL to produce skilled purposeful movements suggests her right hemisphere may have not had the capacity to learn these movement representations. Without vision, her ability to recognize objects with her left hand, but not numbers written on her left palm, suggests graphesthesia may require that her left hand did not have access to movement representations important for programming these numbers when writing.
Show less
Date Issued: 2016-06
Identifier: FSU_libsubv1_wos_000379936800011, 10.1080/13554794.2016.1148743
Format: Citation

Title: Caring for Older Adults with the Human Immunodeficiency Virus.
Creator: Sangarlangkarn, Aroonsiri, Appelbaum, Jonathan S
Abstract/Description: Increasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV...
Show moreIncreasing proportions of older adults are living with the human immunodeficiency virus (HIV). It is estimated that more than 50% of individuals with HIV in the United States are aged 50 and older. Part of this group consists of individuals who have aged with chronic HIV infection, but a large proportion also results from new HIV diagnosis, with approximately 17% of new HIV diagnoses in 2013 occurring in individuals aged 50 and older. Although many of the recommendations on management of HIV infection are not age-specific, individuals with HIV aged 50 and older differ from their younger counterparts in many aspects, including immune response to antiretroviral therapy, multimorbidity, antiretroviral toxicities, and diagnostic considerations. This article outline these differences, offers a strategy on how to care for this unique population, and provides special considerations for problem-based management of individuals with HIV aged 50 and older.
Show less
Date Issued: 2016-09-29
Identifier: FSU_libsubv1_scholarship_submission_1483969272, 10.1111/jgs.14584
Format: Citation

Title: Clinical Fate Of T0n1 Esophageal Cancer: Results From The National Cancer Database.
Creator: Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description: The long-term survival for patients with locally advanced esophageal cancer (EC) remains poor despite improvements in multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains pivotal in the management of patients with EC. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. Utilizing the National Cancer Database we identified...
Show moreThe long-term survival for patients with locally advanced esophageal cancer (EC) remains poor despite improvements in multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains pivotal in the management of patients with EC. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. Utilizing the National Cancer Database we identified patients with EC who underwent NCR followed by esophagectomy who had subsequent pathology of T0N1. Baseline univariate comparisons of patient characteristics were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson's Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method comparing survival curves with the log-rank test. All statistical tests were two-sided and alpha (type I) error <0.05 was considered statistically significant. We identified 7,116 patients diagnosed with EC; 6,235 (87.6%) adenocarcinoma (AC), 881 (12.4%) squamous cell carcinoma (SCC) with a median age of 62 [21-88] years. There were 6,031 (84.8%) males and 1,085 (15.2%) females. R0 resections were achieved in 6,668 (93.7%) patients and this correlated to improved median survival 39.5 (R0) and 20.1 (R1) months respectively, P<0.001. The median nodes harvested were 13 [0-83] with a mean positive LN's of 1.4 +/- 2.9. Pathologic complete response (pCR) was achieved in 1,334 (18.7%), partial response (pPR) 2,812 (39.5%) and non-response (pNR) 2,970 (41.7%). There were 230 (3.2%) patients deemed as pathologic T0N1. The median survival of patients with pCR was 61.7 months compared to 32.1 months in the T0N1 patients P<0.001. T0N1 patients did not demonstrate an improved survival over T1/2 patients who had a median survival of 30.5 months, P=0.79. However, T0N1 did reveal an improved survival over T3/4 patients who had a median survival of 24.6 months, P=0.02. Adjuvant chemotherapy in T0N1 did not provide a benefit in survival, median survival adjuvant versus no adjuvant 30.8 vs. 32.1 months respectively, P=0.08. Multivariate analysis in T0N1 patients demonstrated only number of LN's positive, and histology SCC vs. ACC as predictive of survival, HR, 1.22, 95% CI: 1.10-1.36, P<0.001; HR, 0.43, 95% CI: 0.24-0.75, P=0.003, respectively. Patients with EC who exhibit a pathologic T0N1 after NCR have oncologic fates similar to node positive patients. Patients with pCR of the primary tumor and regional lymph nodes continue to demonstrate significant survival benefits over all remaining pathologic cohorts.
Show less
Date Issued: 2018-10-01
Identifier: FSU_libsubv1_wos_000445720200016, 10.21037/jgo.2018.08.08
Format: Citation

Title: Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Creator: Sane, Mona, Shaikh, Naazli, Shaikh, Saad
Abstract/Description: We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for...
Show moreWe report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.
Show less
Date Issued: 2016
Identifier: FSU_libsubv1_wos_000378284400001, 10.1155/2016/9728035
Format: Citation

Title: Combined DSEK and Transconjunctival Pars Plana Vitrectomy.
Creator: Sane, Mona, Shaikh, Naazli, Shaikh, Saad
Abstract/Description: We report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for...
Show moreWe report here three patients who underwent combined Descemet's stripping with endothelial keratoplasty and transconjunctival pars plana vitrectomy for bullous keratopathy and posterior segment pathology. A surgical technique and case histories are described. Anatomic and visual outcomes of combined Descemet's stripping with endothelial keratoplasty and vitrectomy were excellent. Our experience provides technical guidelines and limitations. The combined minimally invasive techniques allow for rapid anatomical recovery and return of function and visual acuity in a single sitting.
Show less
Date Issued: 2016-01-01
Identifier: FSU_pmch_27413563, 10.1155/2016/9728035, PMC4927958, 27413563, 27413563
Format: Citation

Title: Correction: Retinopathy and Uveitis Associated with Sofosbuvir Therapy for Chronic Hepatitis C Infection..
Creator: Chin Loy, Katrina, Galaydh, Farah, Shaikh, Saad
Abstract/Description: [This corrects the article DOI: 10.7759/cureus.597.].
Date Issued: 2016-07-14
Identifier: FSU_pmch_27610281, 10.7759/cureus.c3, PMC4999155, 27610281, 27610281
Format: Citation

Title: Correlation Of Tumor Size And Survival In Pancreatic Cancer.
Creator: Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description: Background: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival. Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the...
Show moreBackground: Neoadjuvant therapy (NT) for resectable pancreatic adenocarcinoma (PAC) continues to be debated. We sought to establish the relationship between pancreatic tumor size, neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and definitive surgery (DS) on survival. Methods: Utilizing the National Cancer Database we identified patients with PAC who underwent NT and DS. Patient characteristics and survival were compared with Mann-Whitney U, Pearson's Chi-square, and the Kaplan-Meier method. Multivariable analysis (MVA) was developed to identify predictors of survival. All tests were two-sided and a <0.05 was significant. Results: We identified 11,707 patients: 9,722 patients with tumors >2 cm and 1,985 with tumors =2 cm. There were 523 patients treated with NCT, 559 treated with NCRT, and 10,625 DS. Patients with tumors >2 cm were more likely to have higher T-stage, P<0.001, positive lymph nodes, P<0.001, poor histologic grade, P<0.001, and R1 resections, P<0.001. The median survival for patients with tumors =2 cm was 30.6 months compared to 20.5 months for those whose tumors were >2 cm, P<0.001. In the >2 cm groups the median survival for NCT, NCRT, and DS was 22.9, 25.8 and 21.3 months, P=0.01. MVA revealed that age, Charlson/Deyo score, N-stage, grade, tumor size >2 cm, R0 resection, and NT were predictors of survival. Ninety-day mortality was worse in both the NCT and NCRT compared to DS, P<0.001. Conclusions: The size of pancreatic cancer correlates to pathologic stage and overall survival. Tumors >2 and <2 cm benefited from a NT. However, the 90-operative mortality was significantly worse in those patients receiving NT.
Show less
Date Issued: 2018-10-01
Identifier: FSU_libsubv1_wos_000445720200020, 10.21037/jgo.2018.08.06
Format: Citation

Title: CT-based assessment of visceral adiposity and outcomes for esophageal adenocarcinoma.
Creator: Saeed, Nadia, Shridhar, Ravi, Almhanna, Khaldoun, Hoffe, Sarah, Chuong, Michael, Meredith, Kenneth
Abstract/Description: Various methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI 182 cm...
Show moreVarious methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI <20 were excluded. Using the preoperative CT scan, the visceral (VFA), subcutaneous (SFA), and total abdominal fat (TFA) areas were calculated. Each was contoured on a Siemens Leonardo workstation at the level of the iliac crest (L4/5). The Hounsfield threshold was -30 to -130. Outcomes were analyzed using Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed using the Cox proportion hazard regression model. We identified 126 patients for the analysis. There were no statistically significant differences in overall survival or disease-free survival between groups above and below the medians for TFA, SFA, or VFA/SFA ratio. However, an increase in VFA was significantly associated with worsened OS and DFS when we further classified patients into quartiles. Patients with VFA ≥182 cm had larger tumor size (P=0.016), fewer involved lymph nodes (P=0.047), longer operating times (P=0.032), and were more likely to be males (P=0.042). Published data have demonstrated an association between treatment outcomes and degree of adiposity; our study found a correlation between VFA and OS and DFS in patients with EA. Median TFA, SFA, and VFA/SFA were not prognostic on MVA. While VFA >182 cm was associated with larger tumors, there were also fewer lymph nodes harvested in this group.
Show less
Date Issued: 2017-10-01
Identifier: FSU_pmch_29184687, 10.21037/jgo.2017.07.03, PMC5674266, 29184687, 29184687, jgo-08-05-833
Format: Citation

Title: Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE.
Creator: Nguyen, H. Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W., Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill...
Show moreNguyen, H. Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W., Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill, Jasreen Kaur, Gardner-Gray, Jayna, Pflaum, Jacqueline, Domecq, Juan Pablo, Hurst, Gina, Belsky, Justin B., Fowkes, Raymond, Elkin, Ronald B., Simpson, Steven Q., Falk, Jay L., Singer, Daniel J., Rivers, Emanuel P.
Show less
Abstract/Description: Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar...
Show morePrior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
Show less
Date Issued: 2016-07-01
Identifier: FSU_libsubv1_wos_000379790100001, 10.1186/s13054-016-1288-3
Format: Citation

Title: Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE..
Creator: Nguyen, H Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W, Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill,...
Show moreNguyen, H Bryant, Jaehne, Anja Kathrin, Jayaprakash, Namita, Semler, Matthew W, Hegab, Sara, Yataco, Angel Coz, Tatem, Geneva, Salem, Dhafer, Moore, Steven, Boka, Kamran, Gill, Jasreen Kaur, Gardner-Gray, Jayna, Pflaum, Jacqueline, Domecq, Juan Pablo, Hurst, Gina, Belsky, Justin B, Fowkes, Raymond, Elkin, Ronald B, Simpson, Steven Q, Falk, Jay L, Singer, Daniel J, Rivers, Emanuel P
Show less
Abstract/Description: Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar...
Show morePrior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
Show less
Date Issued: 2016-07-01
Identifier: FSU_pmch_27364620, 10.1186/s13054-016-1288-3, PMC4929762, 27364620, 27364620, 10.1186/s13054-016-1288-3
Format: Citation

Title: Eczema's Big Break In Hollywood.
Creator: Om, Amit
Date Issued: 2018-02
Identifier: FSU_libsubv1_wos_000425134900029
Format: Citation

Title: Educational Objectives And Skills For The Physician With Respect To Breastfeeding, Revised 2018.
Creator: Meek, Joan Younger, Young, Michal, Noble, Larry, Calhoun, Sarah, Dodd, Sarah, Elliott-Rudder, Megan, Lappin, Susan, Larson, Ilse, Lawrence, Ruth A., Marinelli, Kathleen A.,...
Show moreMeek, Joan Younger, Young, Michal, Noble, Larry, Calhoun, Sarah, Dodd, Sarah, Elliott-Rudder, Megan, Lappin, Susan, Larson, Ilse, Lawrence, Ruth A., Marinelli, Kathleen A., Marshall, Nicole, Mitchell, Katrina, Reece-Stremtan, Sarah, Rosen-Carole, Casey, Rothenberg, Susan, Seo, Tomoko, Wonodi, Adora
Show less
Abstract/Description: The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.
Date Issued: 2019-02-01
Identifier: FSU_libsubv1_wos_000463910000004, 10.1089/bfm.2018.29113.jym
Format: Citation

Title: Emergency incarcerated obturator hernia repair with biologic mesh in a male patient after ipsilateral hip disarticulation: A case report..
Creator: Oviedo, Rodolfo J, Molinari, Alexander H W
Abstract/Description: An obturator hernia is an uncommon form of abdominal hernia that is difficult to diagnose due to its non-distinct presentation. This case investigates an emergency treatment of an obturator hernia presenting in a patient with an ipsilateral hip disarticulation in a 266-bed community hospital. A 53-year old man with a history of a left hip disarticulation 3-weeks prior presented to the emergency department with fever, nausea, vomiting, and diarrhea for the past 5-days. An elevated WBC and...
Show moreAn obturator hernia is an uncommon form of abdominal hernia that is difficult to diagnose due to its non-distinct presentation. This case investigates an emergency treatment of an obturator hernia presenting in a patient with an ipsilateral hip disarticulation in a 266-bed community hospital. A 53-year old man with a history of a left hip disarticulation 3-weeks prior presented to the emergency department with fever, nausea, vomiting, and diarrhea for the past 5-days. An elevated WBC and presence of gas within the hip stump on CT led to an emergency operation to rule out necrotizing fasciitis within the stump. Opening of the stump incision revealed two herniated loops of small bowel corresponding to the left obturator foramen, revealing the diagnosis of an incarcerated obturator hernia. The bowel was reduced and secured within the hip stump and the defect was covered with Strattice biologic mesh. Obturator hernias are rare and can involve vague symptoms, but it is essential to make an accurate diagnosis and repair the defect on an emergency basis. Obturator hernias may appear in the setting of a hip disarticulation, being caused by iatrogenic anatomic alteration, and can be treated in a community acute care hospital. Being aware of the possibility of obturator foramen herniation and bowel incarceration as part of the differential diagnosis for patients with abdominal pain after a prior hip disarticulation can facilitate prompt diagnosis and reduce morbidity and mortality.
Show less
Date Issued: 2017-01-01
Identifier: FSU_pmch_28633126, 10.1016/j.ijscr.2017.06.003, PMC5479947, 28633126, 28633126, S2210-2612(17)30254-7
Format: Citation

Title: Emergency splenectomy for trauma in the setting of splenomegaly, axillary lymphadenopathy, and incidental B-cell chronic lymphocytic leukemia: A case report..
Creator: Oviedo, Rodolfo J, Glickman, Andrew A
Abstract/Description: The spleen is the most commonly injured intra-abdominal solid organ following blunt trauma. B-cell chronic lymphocytic leukemia (CLL) is the most common leukocytic dyscrasia affecting adults in Western countries. Splenomegaly with axillary and retroperitoneal lymphadenopathy are common physical findings. This case investigates an emergency splenectomy in a community hospital involving a 45-year-old man with blunt abdominal trauma following an assault with incidental splenomegaly and axillary...
Show moreThe spleen is the most commonly injured intra-abdominal solid organ following blunt trauma. B-cell chronic lymphocytic leukemia (CLL) is the most common leukocytic dyscrasia affecting adults in Western countries. Splenomegaly with axillary and retroperitoneal lymphadenopathy are common physical findings. This case investigates an emergency splenectomy in a community hospital involving a 45-year-old man with blunt abdominal trauma following an assault with incidental splenomegaly and axillary lymphadenopathy, with surgical pathology findings of B-cell CLL. A 45- year-old man without past medical or family history who was the victim of an assault presented to the emergency department 6h later with left upper quadrant pain and radiation to the left flank and a positive Kehr sign. An elevated absolute lymphocyte count above 7×10 and CT confirmation of a Grade V splenic laceration with splenomegaly, axillary lymphadenopathy, with hemodynamic compromise led to an exploratory laparotomy and emergency splenectomy regardless of the potential for malignancy. Hemoperitoneum with blunt splenic injury (BSI) caused by abdominal trauma with hemodynamic instability should be treated with exploratory laparotomy and splenectomy even in the face of potential malignancy with splenomegaly and axillary lymphadenopathy. An appropriate oncologic work up and treatment can be provided after the emergency intervention. An emergency splenectomy is an appropriate operative intervention for a grade V splenic laceration with hemoperitoneum, splenomegaly, and axillary lymphadenopathy regardless of the potential for a neoplastic process such as B-cell CLL. Post-splenectomy vaccinations and oncologic follow-up for systemic chemotherapy should be facilitated after recovery.
Show less
Date Issued: 2017-01-01
Identifier: FSU_pmch_28686924, 10.1016/j.ijscr.2017.06.032, PMC5499106, 28686924, 28686924, S2210-2612(17)30285-7
Format: Citation

Title: Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital.
Creator: Oviedo, Rodolfo J., Dixon, Bruce M., Sofiak, Chase W.
Abstract/Description: INTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old...
Show moreINTRODUCTION: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. PRESENTATION OF CASE: A 41-year-old uninsured African American man with no past medical or family history presented to the emergency department with hematochezia lasting three days. A clinical diagnosis of FAP made on colonoscopy with biopsies revealed villous and tubulovillous adenomas without dysplasia. After blood products resuscitation, an emergency total proctocolectomy with end ileostomy was performed. A staged ileal J pouch to anal anastomosis and creation of protective loop ileostomy was performed months later after securing state funding. A final loop ileostomy reversal occurred six weeks later. His self reported quality of life is improved. DISCUSSION: Lower GI hemorrhage from FAP unresponsive to blood products may require emergency total proctocolectomy and end ileostomy with a staged ileal J pouch to anal anastomosis, which can be done in a community acute care hospital for an uninsured patient. CONCLUSION: A total proctocolectomy is feasible in the emergency setting in an uninsured patient with lower GI bleeding and FAP. A staged ileal J pouch-anal anastomosis is easier to justify to the hospital compared to a staged completion colectomy with proctectomy. It is essential to monitor the ileo-anal anastomosis with anoscopy. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
Show less
Date Issued: 2016
Identifier: FSU_libsubv1_wos_000384278500045, 10.1016/j.ijscr.2016.07.052
Format: Citation

Title: Emergency total proctocolectomy in an uninsured patient with Familial Adenomatous Polyposis Syndrome and acute lower gastrointestinal hemorrhage in a community hospital: A case report..
Creator: Oviedo, Rodolfo J, Dixon, Bruce M, Sofiak, Chase W
Abstract/Description: Rectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. A 41-year-old uninsured African American man with no past...
Show moreRectal bleeding is the most common symptom of Familial Adenomatous Polyposis (FAP). This case investigates the efficacy of emergency surgery for FAP with total proctocolectomy end ileostomy for recurrent lower gastrointestinal (GI) hemorrhage in an uninsured patient in a 266-bed community hospital. The optimal treatment for FAP with acute lower GI hemorrhage and hemodynamic compromise unresponsive to conservative management is unclear. A 41-year-old uninsured African American man with no past medical or family history presented to the emergency department with hematochezia lasting three days. A clinical diagnosis of FAP made on colonoscopy with biopsies revealed villous and tubulovillous adenomas without dysplasia. After blood products resuscitation, an emergency total proctocolectomy with end ileostomy was performed. A staged ileal J pouch to anal anastomosis and creation of protective loop ileostomy was performed months later after securing state funding. A final loop ileostomy reversal occurred six weeks later. His self reported quality of life is improved. Lower GI hemorrhage from FAP unresponsive to blood products may require emergency total proctocolectomy and end ileostomy with a staged ileal J pouch to anal anastomosis, which can be done in a community acute care hospital for an uninsured patient. A total proctocolectomy is feasible in the emergency setting in an uninsured patient with lower GI bleeding and FAP. A staged ileal J pouch-anal anastomosis is easier to justify to the hospital compared to a staged completion colectomy with proctectomy. It is essential to monitor the ileo-anal anastomosis with anoscopy.
Show less
Date Issued: 2016-01-01
Identifier: FSU_pmch_27497040, 10.1016/j.ijscr.2016.07.052, PMC4976607, 27497040, 27497040, S2210-2612(16)30290-5
Format: Citation

Title: Endonasal (Closed) Rhinoplasty Technique Securing Spreader Grafts With Barbed Suture.
Creator: Bradford, Benjamin D., Asher, Scott A., Ardeshirpour, Farhad
Date Issued: 2016-10
Identifier: FSU_libsubv1_wos_000384295300015, 10.1001/jamafacial.2016.0294
Format: Citation

Title: Esophagectomy From Then To Now.
Creator: Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description: We have come a long way from the onset of surgery for esophageal cancer. Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Moreover, advancements in post-operative care and surgical techniques have contributed to reductions in morbidity. More recently minimally invasive esophagectomy has been increasingly used in patients undergoing esophageal cancer resection. Potential advantages of MIE include: the decreased pulmonary...
Show moreWe have come a long way from the onset of surgery for esophageal cancer. Surgical resection is pivotal for the long-term survival in patients with locally advanced esophageal cancer. Moreover, advancements in post-operative care and surgical techniques have contributed to reductions in morbidity. More recently minimally invasive esophagectomy has been increasingly used in patients undergoing esophageal cancer resection. Potential advantages of MIE include: the decreased pulmonary complications, lower post-operative wound infection, decreased post-operative pain, and decreased length of hospitalization. The application of robotics to esophageal surgery is becoming more widespread. Robotic esophageal surgery has potential advantages over the known limitations of laparoscopic and thoracoscopic approaches to esophagectomy while adhering to the benefits of the minimally invasive approach. This paper is a review of the evolution from open esophagectomy to the most recent robotic approach.
Show less
Date Issued: 2018-10-01
Identifier: FSU_libsubv1_wos_000445720200019, 10.21037/jgo.2018.08.15
Format: Citation

Title: Extracranial Metastatic Burden In Extensive-stage Small Cell Lung Cancer: Implications For Prophylactic Cranial Irradiation.
Creator: Oliver, Daniel E., Donnelly, Olivia G., Grass, G. Daniel, Naghavi, Arash O., Yang, George Q., Dilling, Thomas J., Perez, Bradford A.
Abstract/Description: Background: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and...
Show moreBackground: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes. Results: Median follow-up was 10.7 months (range, 3-58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% vs. 61.3%; P=0.020) and multivariable (MVA) analysis (hazard ratio (HR) 2.33, 95% CI: 1.08-5.01; P=0.03). Conclusions: Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.
Show less
Date Issued: 2018-07-01
Identifier: FSU_libsubv1_wos_000440380200071, 10.21037/jtd.2018.06.92
Format: Citation

Title: Extracranial metastatic burden in extensive-stage small cell lung cancer: implications for prophylactic cranial irradiation..
Creator: Oliver, Daniel E, Donnelly, Olivia G, Grass, G Daniel, Naghavi, Arash O, Yang, George Q, Dilling, Thomas J, Perez, Bradford A
Abstract/Description: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic...
Show morePatients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI. We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes. Median follow-up was 10.7 months (range, 3-58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% 61.3%; P=0.020) and multivariable (MVA) analysis [hazard ratio (HR) 2.33, 95% CI: 1.08-5.01; P=0.03). Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.
Show less
Date Issued: 2018-07-01
Identifier: FSU_pmch_30174879, 10.21037/jtd.2018.06.92, PMC6106034, 30174879, 30174879, jtd-10-07-4321
Format: Citation

Title: First 101 Robotic General Surgery Cases in a Community Hospital.
Creator: Oviedo, Rodolfo J, Robertson, Jarrod C, Alrajhi, Sharifah
Abstract/Description: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion...
Show moreThe general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.
Show less
Date Issued: 2016-07-01
Identifier: FSU_pmch_27667913, 10.4293/JSLS.2016.00056, PMC5027890, 27667913, 27667913, JSLS.2016.00056
Format: Citation

Title: Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction..
Creator: Abich, Estela, Glotzer, Daniel, Murphy, Edward
Abstract/Description: Gallstone ileus is a rare disease that accounts for 1-4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal...
Show moreGallstone ileus is a rare disease that accounts for 1-4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.
Show less
Date Issued: 2017-06-15
Identifier: FSU_pmch_29033757, 10.1159/000475749, PMC5637004, 29033757, 29033757, crg-0011-0389
Format: Citation

Title: Hypertension in Florida: Data From the OneFlorida Clinical Data Research Network..
Creator: Smith, Steven M, McAuliffe, Kathryn, Hall, Jaclyn M, McDonough, Caitrin W, Gurka, Matthew J, Robinson, Temple O, Sacco, Ralph L, Pepine, Carl, Shenkman, Elizabeth, Cooper-DeHoff...
Show moreSmith, Steven M, McAuliffe, Kathryn, Hall, Jaclyn M, McDonough, Caitrin W, Gurka, Matthew J, Robinson, Temple O, Sacco, Ralph L, Pepine, Carl, Shenkman, Elizabeth, Cooper-DeHoff, Rhonda M
Show less
Abstract/Description: Hypertension is highly prevalent in Florida, but surveillance through the Behavioral Risk Factor Surveillance System (BRFSS) is limited to self-reported hypertension and does not capture data on undiagnosed hypertension or measure blood pressure. We aimed to characterize the hypertensive population in the OneFlorida Clinical Research Consortium by using electronic health records and provide proof-of-concept for using routinely collected clinical data to augment surveillance efforts. We...
Show moreHypertension is highly prevalent in Florida, but surveillance through the Behavioral Risk Factor Surveillance System (BRFSS) is limited to self-reported hypertension and does not capture data on undiagnosed hypertension or measure blood pressure. We aimed to characterize the hypertensive population in the OneFlorida Clinical Research Consortium by using electronic health records and provide proof-of-concept for using routinely collected clinical data to augment surveillance efforts. We identified patients with hypertension, defined as having at least 1 outpatient visit from January 2012 through June 2016 with an ICD-9-CM or ICD-10-CM diagnosis code for hypertension, or in the absence of a diagnosis, an elevated blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) recorded in the electronic health record at the most recent visit. The hypertensive population was characterized and mapped by zip code of patient residence to county prevalence. Of 838,469 patients (27.9% prevalence) who met the criteria for hypertension, 68% had received a diagnosis and 61% had elevated blood pressure. The geographic distribution of hypertension differed between diagnosed hypertension (highest prevalence in northern Florida) and undiagnosed hypertension (highest prevalence along eastern coast, in southern Florida, and in some rural western Panhandle counties). Uncontrolled hypertension was concentrated in southern Florida and the western Panhandle. Our use of clinical data, representing usual care for Floridians, allows for identifying cases of uncontrolled hypertension and potentially undiagnosed cases, which are not captured by existing surveillance methods. Large-scale pragmatic research networks, like OneFlorida, may be increasingly important for tailoring future health care services, trials, and public health programs.
Show less
Date Issued: 2018-03-01
Identifier: FSU_pmch_29494332, 10.5888/pcd15.170332, PMC5833311, 29494332, 29494332, E27
Format: Citation

Title: Implementation of the Ten Steps to Successful Breastfeeding Saves Lives.
Creator: Meek, Joan Younger, Noble, Lawrence
Date Issued: 2016-10
Identifier: FSU_libsubv1_wos_000385643000005, 10.1001/jamapediatrics.2016.2015
Format: Citation

Title: Implementation Planning Of A Mhealth Vaccination Tool: A Workflow Study In Four Pediatric Clinics.
Creator: Staras, Stephanie, Rich, Natalie, Samarah, Esaa, Thompson, Lindsay, Muszynski, Michael, Shenkman, Elizabeth
Date Issued: 2018-03-28
Identifier: FSU_libsubv1_wos_000428652000056
Format: Citation

Title: Improving Adolescent Health Risk Assessment: A Multi-method Pilot Study..
Creator: Thompson, Lindsay A, Wegman, Martin, Muller, Keith, Eddleton, Katie Z, Muszynski, Michael, Rathore, Mobeen, De Leon, Jessica, Shenkman, Elizabeth A
Abstract/Description: Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement...
Show moreObjectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14-18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1-116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents' perceptions of high quality care.
Show less
Date Issued: 2016-12-01
Identifier: FSU_pmch_27406154, 10.1007/s10995-016-2070-5, PMC5124035, 27406154, 27406154, 10.1007/s10995-016-2070-5
Format: Citation

Title: Interprofessional Education in the Internal Medicine Clerkship Post-LCME Standard Issuance: Results of a National Survey..
Creator: Alexandraki, Irene, Hernandez, Caridad A, Torre, Dario M, Chretien, Katherine C
Abstract/Description: Several decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard. To examine the status of IPE within internal medicine (IM) clerkships including perspectives, curricular content, barriers, and assessment a year after the LCME standard issuance. Anonymous online survey...
Show moreSeveral decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard. To examine the status of IPE within internal medicine (IM) clerkships including perspectives, curricular content, barriers, and assessment a year after the LCME standard issuance. Anonymous online survey. IM clerkship directors from each of the Clerkship Directors in Internal Medicine's 121 U.S. and Canadian member medical schools in 2014. In 2014, a section on IPE (18 items) was included in the Clerkship Directors in Internal Medicine annual survey of its 121 U.S. and Canadian member medical schools. Items (18) assessed clerkship director (CD) perspectives, status of IPE curricula in IM clerkships, and barriers to IPE implementation. Data were analyzed using descriptive statistics and qualitative analysis of free-text responses to one of the survey questions. The overall survey response rate was 78% (94/121). The majority (88%) agreed that IPE is important to the practice of IM, and 71% believed IPE should be part of the IM clerkship. Most (76%) CDs agreed there is need for faculty development programs in IPE; 27% had such a program at their institution. Lack of curricular time, scheduling conflicts, and lack of faculty trained in IPE were the most frequently cited barriers. Twenty-nine percent had formal IPE activities within their IM clerkships, and 38% were planning to make changes. Of those with formal IPE activities, over a third (37%) did not involve student assessment. Since LCME standard issuance, only a minority of IM clerkships have included formal IPE activities, with lectures as the predominant method. Opportunities exist for enhancing educational methods as well as IPE faculty development.
Show less
Date Issued: 2017-08-01
Identifier: FSU_pmch_28284014, 10.1007/s11606-017-4004-3, PMC5515782, 28284014, 28284014, 10.1007/s11606-017-4004-3
Format: Citation

Title: Intravitreal Injection-Induced Migraine Headaches.
Creator: Lerebours, Valerie C, Nguyen, Thanh-Giao, Sarup, Vimal, Rossi, Fabian, Shaikh, Saad
Abstract/Description: A case of migraine headache triggered by intravitreal injection, and aborted by retrobulbar injection, is reported. To date, migraine and related cephalgia have not been reported after intravitreal injection. Ophthalmologists and neurologists should be aware of this potential sequela of a very common procedure.
Date Issued: 2016-04-06
Identifier: FSU_pmch_27190726, 10.7759/cureus.561, PMC4859816, 27190726, 27190726
Format: Citation

Title: Linear IgA dermatosis after infliximab infusion for ulcerative colitis.
Creator: Bryant, Kelli D, DeNunzio, Matthew J, Ford, Michael J
Date Issued: 2016-12-05
Identifier: FSU_pmch_27981215, 10.1016/j.jdcr.2016.09.002, PMC5148767, 27981215, 27981215, S2352-5126(16)30102-3
Format: Citation

Title: Malignant Peritoneal Mesothelioma Presenting As Mucinous Ascites.
Creator: Field, Zachary, Zori, Andreas, Khullar, Vikas, Mota, Manoela, Feely, Michael, Firpi, Roberto J.
Abstract/Description: We present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the...
Show moreWe present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the literature.
Show less
Date Issued: 2018-03-14
Identifier: FSU_libsubv1_wos_000427466000004, 10.14309/crj.2018.23
Format: Citation

Title: Malignant Peritoneal Mesothelioma Presenting as Mucinous Ascites.
Creator: Field, Zachary, Zori, Andreas, Khullar, Vikas, Mota, Manoela, Feely, Michael, Firpi, Roberto J
Abstract/Description: We present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the...
Show moreWe present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the literature.
Show less
Date Issued: 2018-03-14
Identifier: FSU_pmch_29577057, 10.14309/crj.2018.23, PMC5852305, 29577057, 29577057, crj.2018.23
Format: Citation

Title: Medical Concerns in HIV-Positive Aging.
Creator: Simone, Mark, Appelbaum, Jonathan
Abstract/Description: The management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will...
Show moreThe management and prognosis of HIV disease has changed dramatically since the introduction of combination HIV antiretroviral therapy in 1996. Thus, the number of older adults with HIV is increasing partly because people with HIV are living longer. At the same time, the rates of new HIV cases in older adults (usually defined as people over the age of 50) are also increasing. Currently, about 25 percent of all patients living with HIV are older than 50, and by 2015 adults older than 50 will account for 50 percent of the population living with HIV.1 These trends make understanding the medical challenges of HIV in older adults more important than ever. This article reviews the special issues associated with HIV and AIDS in an older population.
Show less
Date Issued: 2009
Identifier: FSU_migr_clinicalsciences_faculty_publications-0001
Format: Citation

Title: MicroRNA-211 Regulates Oxidative Phosphorylation and Energy Metabolism in Human Vitiligo.
Creator: Sahoo, Anupama, Lee, Bongyong, Boniface, Katia, Seneschal, Julien, Sahoo, Sanjaya K, Seki, Tatsuya, Wang, Chunyan, Das, Soumen, Han, Xianlin, Steppie, Michael, Seal, Sudipta,...
Show moreSahoo, Anupama, Lee, Bongyong, Boniface, Katia, Seneschal, Julien, Sahoo, Sanjaya K, Seki, Tatsuya, Wang, Chunyan, Das, Soumen, Han, Xianlin, Steppie, Michael, Seal, Sudipta, Taieb, Alain, Perera, Ranjan J
Show less
Abstract/Description: Vitiligo is a common chronic skin disorder characterized by loss of epidermal melanocytes and progressive depigmentation. Vitiligo has complex immune, genetic, environmental, and biochemical causes, but the exact molecular mechanisms of vitiligo development and progression, particularly those related to metabolic control, are poorly understood. In this study we characterized the human vitiligo cell line PIG3V and the normal human melanocyte line HEM-l by RNA sequencing, targeted metabolomics,...
Show moreVitiligo is a common chronic skin disorder characterized by loss of epidermal melanocytes and progressive depigmentation. Vitiligo has complex immune, genetic, environmental, and biochemical causes, but the exact molecular mechanisms of vitiligo development and progression, particularly those related to metabolic control, are poorly understood. In this study we characterized the human vitiligo cell line PIG3V and the normal human melanocyte line HEM-l by RNA sequencing, targeted metabolomics, and shotgun lipidomics. Melanocyte-enriched microRNA-211, a known metabolic switch in nonpigmented melanoma cells, was severely down-regulated in vitiligo cell line PIG3V and skin biopsy samples from vitiligo patients, whereas its predicted targets PPARGC1A, RRM2, and TAOK1 were reciprocally up-regulated. microRNA-211 binds to PGC1-α 3' untranslated region locus and represses it. Although mitochondrial numbers were constant, mitochondrial complexes I, II, and IV and respiratory responses were defective in vitiligo cells. Nanoparticle-coated microRNA-211 partially augmented the oxygen consumption rate in PIG3V cells. The lower oxygen consumption rate, changes in lipid and metabolite profiles, and increased reactive oxygen species production observed in vitiligo cells appear to be partly due to abnormal regulation of microRNA-211 and its target genes. These genes represent potential biomarkers and therapeutic targets in human vitiligo.
Show less
Date Issued: 2017-09-01
Identifier: FSU_pmch_28502800, 10.1016/j.jid.2017.04.025, PMC6233982, 28502800, 28502800, S0022-202X(17)31491-4
Format: Citation

Title: The New Classes of Synthetic Illicit Drugs Can Significantly Harm the Brain: A Neuro Imaging Perspective with Full Review of MRI Findings..
Creator: Creagh, S, Warden, D, Latif, M A, Paydar, A
Abstract/Description: Synthetic drugs contain substances that are pharmacologically similar to those found in traditional illicit drugs. Some of the most commonly abused synthetic drugs include synthetic marijuana, bath salts, ecstasy, N-bomb, methamphetamine and anabolic steroids. Many of them share the same chemical properties and physiologic responses with the drugs they mimic and may exaggerate the pathologic response in the brain leading to addiction. These drugs have detrimental (and often irreversible)...
Show moreSynthetic drugs contain substances that are pharmacologically similar to those found in traditional illicit drugs. Some of the most commonly abused synthetic drugs include synthetic marijuana, bath salts, ecstasy, N-bomb, methamphetamine and anabolic steroids. Many of them share the same chemical properties and physiologic responses with the drugs they mimic and may exaggerate the pathologic response in the brain leading to addiction. These drugs have detrimental (and often irreversible) effects on the brain and primarily affect the central nervous system by two mechanisms: 1) Neural hyper stimulation via increasing activation of certain neurotransmitters (norepinephrine, dopamine, and serotonin), 2) Cause significant reduction in CNS neural connectivity affecting various brain regions such as the basal ganglia, hippocampus, cerebellum, parietal lobe, and globus pallidus. Furthermore these drugs sometimes have severe, life-threatening adverse effects on the human body. A few structural MRI studies have been conducted in synthetic drug abusers to reveal the effects of these drugs on the brain parenchyma. This review article will describe the potential brain imaging findings in synthetic drug abusers as demonstrated by several case reports and the primary literature.
Show less
Date Issued: 2018-01-01
Identifier: FSU_pmch_30027157, PMC6048967, 30027157, 30027157
Format: Citation

Title: Normalization of Diffuse ST-Depression with aVR Elevation After Rehydration in a Patient with Severe Aortic Stenosis.
Creator: Patel, Sachin R, Patel, Vikas J, Clark, Brittany, Rust, George
Abstract/Description: BACKGROUND Isolated ST elevation in lead aVR in combination with global ST depression with normalization after rehydration is a unique electrocardiographic pattern that is associated with a broad range of diagnoses. Its association with left main coronary artery disease and other acute coronary syndromes suggest the need for early and aggressive cardiac evaluation. CASE REPORT A 53-year-old man presented with altered mental status and loss of consciousness. He was unresponsive, hypotensive,...
Show moreBACKGROUND Isolated ST elevation in lead aVR in combination with global ST depression with normalization after rehydration is a unique electrocardiographic pattern that is associated with a broad range of diagnoses. Its association with left main coronary artery disease and other acute coronary syndromes suggest the need for early and aggressive cardiac evaluation. CASE REPORT A 53-year-old man presented with altered mental status and loss of consciousness. He was unresponsive, hypotensive, tachycardiac, and diaphoretic. An initial ECG showed diffuse ST depression with isolated ST elevation in lead aVR, and initial troponin levels were negative. After rehydration, a repeat ECG showed sinus rhythm without ischemic changes. An emergent echocardiogram showed severe aortic stenosis and global hypokinesis. Repeat troponin results were elevated. The patient had 2 subsequent cardiac arrests. Emergent cardiac catheterization showed an occluded right coronary artery with collaterals and complete occlusion of the LAD. Urgent intra-aortic balloon pump was placed, followed by coronary artery bypass graft, aortic valve replacement, and a placement of a left ventricular assist device. Despite maximal hemodynamic support, the patient died after cardiac arrest due to massive myocardial infarction. CONCLUSIONS Normalization of diffuse ST depression with isolated aVR ST elevation on electrocardiography with improvement in clinical and hemodynamic status through fluid resuscitation can mask a stuttering myocardial infarction given its association with left main coronary artery disease and partial right coronary artery occlusion.
Show less
Date Issued: 2017-05-22
Identifier: FSU_pmch_28529306, PMC5447663, 28529306, 28529306, 902510
Format: Citation

Title: Observed and Parent-Report Measures of Social Communication in Toddlers With and Without Autism Spectrum Disorder Across Race/Ethnicity.
Creator: Stronach, Sheri T, Wetherby, Amy M
Abstract/Description: This study investigated whether measures of early social communication vary among young children of diverse racial/ethnic status with and without autism spectrum disorder (ASD). Participants were 364 toddlers between ages 18 and 36 months with a diagnosis of ASD confirmed (n = 195) or ruled out (n = 169), from 3 racial/ethnic categories: non-Hispanic White (n = 226), non-Hispanic Black (n = 74), and Hispanic (n = 64). Group differences in social communication were examined using an...
Show moreThis study investigated whether measures of early social communication vary among young children of diverse racial/ethnic status with and without autism spectrum disorder (ASD). Participants were 364 toddlers between ages 18 and 36 months with a diagnosis of ASD confirmed (n = 195) or ruled out (n = 169), from 3 racial/ethnic categories: non-Hispanic White (n = 226), non-Hispanic Black (n = 74), and Hispanic (n = 64). Group differences in social communication were examined using an observational measure-the Communication and Symbolic Behavior Scales Behavior Sample (CSBS-BS; Wetherby & Prizant, 2002)-and a parent-report measure, the Early Screening for Autism and Communication Disorders (Wetherby, Woods, & Lord, 2007). Controlling for maternal education, children with ASD scored significantly lower on the CSBS-BS than children without, indicating poorer social communication skills, and higher on the Early Screening for Autism and Communication Disorders, indicating more ASD features. Racial/ethnic groups did not differ on 6 CSBS-BS clusters, but Non-Hispanic White toddlers scored significantly higher than both other groups on the Understanding cluster. There were no significant Diagnosis × Race/Ethnicity interactions. These findings indicate good agreement between observed and parent-report measures in this sample. Results suggest that the CSBS-BS and Early Screening for Autism and Communication Disorders could be viable tools in the detection process for toddlers with ASD in these racial/ethnic groups.
Show less
Date Issued: 2017-05-17
Identifier: FSU_pmch_28395297, 10.1044/2016_AJSLP-15-0089, PMC5544362, 28395297, 28395297, 2618572
Format: Citation

Title: Ocular Sarcoidosis Limited to Retinal Vascular Ischemia and Neovascularization.
Creator: Dyer, Gawain, Rohl, Austin, Shaikh, Saad
Abstract/Description: A 59-year-old Caucasian male experienced progressive vision loss secondary to retinal vascular ischemia and neovascularization. At no time did he present with uveitis or vasculitis, and his serology tests were all negative. He was soon after diagnosed with sarcoidosis by hilar lymph node lung biopsy. Our patient demonstrates an atypical presentation of ocular sarcoidosis, manifesting solely as neovascularization and retinal vascular ischemia. Ophthalmologists should consider proliferative...
Show moreA 59-year-old Caucasian male experienced progressive vision loss secondary to retinal vascular ischemia and neovascularization. At no time did he present with uveitis or vasculitis, and his serology tests were all negative. He was soon after diagnosed with sarcoidosis by hilar lymph node lung biopsy. Our patient demonstrates an atypical presentation of ocular sarcoidosis, manifesting solely as neovascularization and retinal vascular ischemia. Ophthalmologists should consider proliferative sarcoid retinopathy in patients with neovascularization.
Show less
Date Issued: 2016-10-21
Identifier: FSU_pmch_27928517, 10.7759/cureus.839, PMC5119952, 27928517, 27928517
Format: Citation

Title: Optimal Unified Combination Rule In Application Of Dempster-shafer Theory To Lung Cancer Radiotherapy Dose Response Outcome Analysis.
Creator: He, Yanyan, Hussaini, M. Yousuff, Gong, Yutao U. T., Xiao, Ying
Abstract/Description: Our previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer...
Show moreOur previous study demonstrated the application of the Dempster-Shafer theory of evidence to dose/volume/outcome data analysis. Specifically, it provided Yager's rule to fuse data from different institutions pertaining to radiotherapy pneumonitis versus mean lung dose. The present work is a follow-on study that employs the optimal unified combination rule, which optimizes data similarity among independent sources. Specifically, we construct belief and plausibility functions on the lung cancer radiotherapy dose outcome datasets, and then apply the optimal unified combination rule to obtain combined belief and plausibility, which bound the probabilities of pneumonitis incidence. To estimate the incidence of pneumonitis at any value of mean lung dose, we use the Lyman-Kutcher-Burman (LKB) model to fit the combined belief and plausibility curves. The results show that the optimal unified combination rule yields a narrower uncertainty range (as represented by the belief-plausibility range) than Yager's rule, which is also theoretically proven.
Show less
Date Issued: 2016
Identifier: FSU_libsubv1_wos_000368341200002, 10.1120/jacmp.v17i1.5737
Format: Citation

Title: Outcomes Associated With Robotic Approach To Pancreatic Resections.
Creator: Takahashi, Caitlin, Shridhar, Ravi, Huston, Jamie, Meredith, Kenneth
Abstract/Description: Minimally invasive techniques have improved post-operative outcomes, however, the majority of pancreatic surgery, known for its complexity, is still performed via open approaches. The development of robotics has improved dexterity which may allow for application in more complex surgeries. We queried a prospectively maintained robotic database to identify patients who underwent robotic pancreatic resection by a single surgeon between 2012 and 2016. Patient demographics and operative outcomes...
Show moreMinimally invasive techniques have improved post-operative outcomes, however, the majority of pancreatic surgery, known for its complexity, is still performed via open approaches. The development of robotics has improved dexterity which may allow for application in more complex surgeries. We queried a prospectively maintained robotic database to identify patients who underwent robotic pancreatic resection by a single surgeon between 2012 and 2016. Patient demographics and operative outcomes were compared using Mann-Whitney U, Kruskal Wallis and Pearson's Chi-square test as appropriate. We identified 119 patients; 65 Whipples [Robotic Whipple (RW)], 43 distal pancreatectomies, 4 total pancreatectomies, 6 pancreatic enucleations, and 1 robotic cyst gastrostomy with a median age of 71 [24-91], median body mass index (BMI) of 27.6 (16.8-40.2), and American society of anesthesiologists (ASA) of 3. The median estimated blood loss (EBL) was 125 [25-800] and loss of heterozygosity (LOH) 6 [1-34]. Mean operative time for RW decreased after 15 cases (578 vs. 457 minutes, P<0.004). Conversions to open occurred in 5 (4.2%) patients. In total of 117 (98.3%) patients underwent R0 resections and the median lymph node (LN) harvest was 16 [0-37]. The 30 and 90 days mortality was 1 (0.8%). Major complications (Clavien-Dindo grade 3-5) were seen in 16 (13.4%) cases (20.3%) but decreased steadily as volume increased (case 30). Pancreatic leaks occurred in 14 (11.8%): A, 8 (6.7%); B, 4 (3.4%); and C, 2 (1.7%). Robotic assisted approaches to pancreatic resections is feasible. However, it takes approximately 15 cases before a decrease in operative time and 30 cases before major complications are decreased. These trends in complications are associated with surgeon experience and volume are critical to consider in robotic pancreatic surgery.
Show less
Date Issued: 2018-10-01
Identifier: FSU_libsubv1_wos_000445720200022, 10.21037/jgo.2018.08.04
Format: Citation

Title: Outcomes of adjuvant radiotherapy and lymph node resection in elderly patients with pancreatic cancer treated with surgery and chemotherapy.
Creator: Frakes, Jessica, Mellon, Eric A, Springett, Gregory M, Hodul, Pamela, Malafa, Mokenge P, Fulp, William J, Zhao, Xiuhua, Hoffe, Sarah E, Shridhar, Ravi, Meredith, Kenneth L
Abstract/Description: We sought to determine the effects of post-operative radiation therapy (PORT) and lymph node resection (LNR) on survival in patients ≥70 years with pancreatic cancer treated with surgery and chemotherapy. An analysis of patients ≥70 years with surgically resected pancreatic cancer who received chemotherapy from the SEER database between 2004-2008 was performed to determine association of PORT and LNR on survival. We identified 961 patients who met inclusion criteria. There was a trend towards...
Show moreWe sought to determine the effects of post-operative radiation therapy (PORT) and lymph node resection (LNR) on survival in patients ≥70 years with pancreatic cancer treated with surgery and chemotherapy. An analysis of patients ≥70 years with surgically resected pancreatic cancer who received chemotherapy from the SEER database between 2004-2008 was performed to determine association of PORT and LNR on survival. We identified 961 patients who met inclusion criteria. There was a trend towards increased survival associated with PORT in all patients (P=0.052) and N1 patients (P=0.060) but no benefit in N0 patients (P=0.161). There was no difference in OS based on number of lymph nodes removed in all (P=0.741), N0 (P=0.588), and N1 (P=0.070) patients. MVA for all patients revealed that higher T stage, N1, and high grade tumors were prognostic for increased mortality, while there was decreased mortality with PORT and mild benefit with increased lymph nodes resected (P=0.084). PORT demonstrated no benefit in survival of pancreatic cancer patients ≥70 who are resected and treated with adjuvant chemotherapy. Future investigation will need to address age as a stratification factor for pancreatic cancer in the adjuvant setting.
Show less
Date Issued: 2017-10-01
Identifier: FSU_pmch_29184679, 10.21037/jgo.2017.08.05, PMC5674250, 29184679, 29184679, jgo-08-05-758
Format: Citation

Title: A Peculiar Adenocarcinoma.
Creator: Patel, Ameet, Patel, Anjan
Date Issued: 2018-05-01
Identifier: FSU_libsubv1_wos_000431868700024, 10.1001/jamaoncol.2017.3989
Format: Citation

Title: Pleural effusion: An uncommon manifestation of nitrofurantoin-induced pulmonary injury..
Creator: Davis, Jared W, Jones, Lynn S
Abstract/Description: Nitrofurantoin has been documented as a cause of acute, sub-acute, and chronic pulmonary injury. This is a case of an 82 year-old female who presented with multiple episodes of respiratory symptoms due to recurrent pleural effusions after beginning nitrofurantoin therapy for urinary tract infection prophylaxis. Due to the rarity of pleural effusion as an adverse reaction to nitrofurantoin, the diagnosis was overlooked at first. This led to the patient undergoing multiple invasive procedures...
Show moreNitrofurantoin has been documented as a cause of acute, sub-acute, and chronic pulmonary injury. This is a case of an 82 year-old female who presented with multiple episodes of respiratory symptoms due to recurrent pleural effusions after beginning nitrofurantoin therapy for urinary tract infection prophylaxis. Due to the rarity of pleural effusion as an adverse reaction to nitrofurantoin, the diagnosis was overlooked at first. This led to the patient undergoing multiple invasive procedures and accruing unnecessary healthcare cost before the diagnosis was made. This case demonstrates the need for physicians to remain mindful of rare adverse reactions from medications and maintain a high index of clinical suspicion with any patient presenting with a respiratory complaint while taking nitrofurantoin.
Show less
Date Issued: 2016-07-20
Identifier: FSU_pmch_27625984, 10.1016/j.rmcr.2016.07.009, PMC5010639, 27625984, 27625984, S2213-0071(16)30064-8
Format: Citation

Title: Post-endovascular aneurysm repair (EVAR) testicular ischemia: A rare complication..
Creator: Thomas, Eric, Parra, Brett L, Patel, Shonak
Abstract/Description: Endovascular aneurysm repair (EVAR) is a common modality of treating abdominal aortic aneurysms (AAA). Common complications include endoleak, bleeding, infection, contrast related injuries, and ischemia. We present the case of a patient who experienced a testicular infarction following repair of an infrarenal AAA. We also discuss the implications for this complication and review the available literature for similar cases and treatment options.
Date Issued: 2017-07-08
Identifier: FSU_pmch_28721336, 10.1016/j.eucr.2017.06.013, PMC5503881, 28721336, 28721336, S2214-4420(17)30140-7
Format: Citation

Title: Post-translationally modified muscle-specific ubiquitin ligases as circulating biomarkers in experimental cancer cachexia.
Creator: Mota, Roberto, Rodríguez, Jessica E, Bonetto, Andrea, O'Connell, Thomas M, Asher, Scott A, Parry, Traci L, Lockyer, Pamela, McCudden, Christopher R, Couch, Marion E, Willis,...
Show moreMota, Roberto, Rodríguez, Jessica E, Bonetto, Andrea, O'Connell, Thomas M, Asher, Scott A, Parry, Traci L, Lockyer, Pamela, McCudden, Christopher R, Couch, Marion E, Willis, Monte S
Show less
Abstract/Description: Cancer cachexia is a severe wasting syndrome characterized by the progressive loss of lean body mass and systemic inflammation. Up to 80% of cancer patients experience cachexia, with 20-30% of cancer-related deaths directly linked to cachexia. Despite efforts to identify early cachexia and cancer relapse, clinically useful markers are lacking. Recently, we identified the role of muscle-specific ubiquitin ligases Atrogin-1 (MAFbx, FBXO32) and Muscle Ring Finger-1 in the pathogenesis of cardiac...
Show moreCancer cachexia is a severe wasting syndrome characterized by the progressive loss of lean body mass and systemic inflammation. Up to 80% of cancer patients experience cachexia, with 20-30% of cancer-related deaths directly linked to cachexia. Despite efforts to identify early cachexia and cancer relapse, clinically useful markers are lacking. Recently, we identified the role of muscle-specific ubiquitin ligases Atrogin-1 (MAFbx, FBXO32) and Muscle Ring Finger-1 in the pathogenesis of cardiac atrophy and hypertrophy. We hypothesized that during cachexia, the Atrogin-1 and MuRF1 ubiquitin ligases are released from muscle and migrate to the circulation where they could be detected and serve as a cachexia biomarker. To test this, we induced cachexia in mice using the C26 adenocarcinoma cells or vehicle (control). Body weight, tumor volume, and food consumption were measured from inoculation until ~day 14 to document cachexia. Western blot analysis of serum identified the presence of Atrogin-1 and MuRF1 with unique post-translational modifications consistent with mono- and poly- ubiquitination of Atrogin-1 and MuRF1 found only in cachectic serum. These findings suggest that both increased Atrogin-1 and the presence of unique post-translational modifications may serve as a surrogate marker specific for cachexia.
Show less
Date Issued: 2017-09-01
Identifier: FSU_pmch_28979816, PMC5622228, 28979816, 28979816
Format: Citation

Title: Psoriasiform eruption on the face and extremities associated with nivolumab therapy.
Creator: Om, Amit, Cardon, Brandon, Cohen, George
Date Issued: 2018-04-04
Identifier: FSU_pmch_29693074, 10.1016/j.jdcr.2017.11.014, PMC5911810, 29693074, 29693074, S2352-5126(17)30292-8
Format: Citation

Department of Clinical Sciences (58)	+ -
Department of Statistics (2)	+ -
Department of Psychology (1)	+ -

Humans (11)	+ -
Female (8)	+ -
Male (7)	+ -
Middle Aged (4)	+ -
Retrospective Studies (3)	+ -

Adolescent (2)	+ -
Adult (2)	+ -
Autism Spectrum Disorder/diagnosis (2)	+ -
Autism Spectrum Disorder/psychology (2)	+ -
Child, Preschool (2)	+ -
Follow-Up Studies (2)	+ -
Infant (2)	+ -
Risk Factors (2)	+ -
Sensitivity and Specificity (2)	+ -
Young Adult (2)	+ -
Adolescent Health Services/standards (1)	+ -
African Americans (1)	+ -
African Continental Ancestry Group/psychology (1)	+ -
Aged (1)	+ -
Anal Canal/pathology (1)	+ -
Angina, Stable/etiology (1)	+ -
Anus Diseases/complications (1)	+ -
Anus Diseases/epidemiology (1)	+ -
Anus Diseases/pathology (1)	+ -
Anus Diseases/virology (1)	+ -
Aortic Valve Stenosis/diagnostic imaging (1)	+ -
Aortic Valve Stenosis/physiopathology (1)	+ -
Autism Spectrum Disorder/ethnology (1)	+ -
Bulimia Nervosa/blood (1)	+ -
Bulimia Nervosa/therapy (1)	+ -

text (58)	+ -
journal article (48)	+ -

Shridhar, Ravi (9)	+ -
Meredith, Kenneth (7)	+ -
Oviedo, Rodolfo J (6)	+ -
Shaikh, Saad (6)	+ -
Huston, Jamie (5)	+ -

Search In

Search this Collection

Pages

Pages

Sort Results By:

Narrow results by:

Collection

Topical Subject

Genre

Type of Resource

Language

Creator

Format

Found In

Owner

Search In

Related Links

Search this Collection

Pages

Pages

Sort Results By:

Narrow results by:

Collection

Topical Subject

Genre

Type of Resource

Language

Creator

Format

Found In

Owner