RESUMEN
BACKGROUND: Hymenoptera envenomation with honey bee (Apis mellifera) and paper wasp (Polistes spp.) may cause life-threatening anaphylaxis in dogs. In human patients, clinical history, intradermal testing (IDT) and measurement of allergen-specific serological immunoglobulin (Ig)E (sIgE) are used to support a diagnosis of Hymenoptera venom hypersensitivity. The utility of venom allergen-specific sIgE has not yet been evaluated for this purpose in dogs. OBJECTIVES: The objective of the study was to investigate the sensitivity (sn), specificity (sp) and positive predictive value (PPV) of honey bee and paper wasp serological titres using a commercially available sIgE assay [VARL (Veterinary Allergen Reference Laboratory) Liquid Gold] against clinical history for a diagnosis of Hymenoptera hypersensitivity in dogs. MATERIALS AND METHODS: Honeybee and paper wasp IgE serum titres were measured in 15 client-owned dogs with a diagnosis of Hymenoptera venom hypersensitivity based on a history of anaphylaxis, owner observation of Hymenoptera, and positive IDT to bee and/or wasp; and in 10 client-owned dogs with no known history of anaphylaxis or Hymenoptera exposure and a negative IDT to bee and wasp. RESULTS: Analysis of receiver operating characteristic (ROC) curves demonstrate that a VARL score cut-off of one of six for honeybee yields Sn, Sp and PPV of 40%, 60% and 60%, respectively, and two of six for wasp yields Sn, Sp and PPV of 25%, 78% and 60%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Owing to the poor sensitivity and PPV of sIgE assays for both bee and wasp hypersensitivity in dogs with known envenomation and anaphylaxis, the use of sIgE cannot be recommended as a tool for venom identification.
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Anafilaxia , Venenos de Abeja , Enfermedades de los Perros , Himenópteros , Hipersensibilidad , Mordeduras y Picaduras de Insectos , Hipersensibilidad al Veneno , Humanos , Perros , Animales , Anafilaxia/veterinaria , Inmunoglobulina E , Hipersensibilidad al Veneno/veterinaria , Venenos de Avispas , Mordeduras y Picaduras de Insectos/diagnóstico , Mordeduras y Picaduras de Insectos/veterinaria , Hipersensibilidad/diagnóstico , Hipersensibilidad/veterinaria , Alérgenos , Enfermedades de los Perros/diagnósticoRESUMEN
Colorectal cancer (CRC) is the third most common cancer in the USA and worldwide. In the USA, nearly one-third of CRC cases are anatomically classified as rectal cancer. Over the past few decades, continued refinement of multimodality treatment and the introduction of new therapeutic agents have enhanced curative treatment rates and quality of life outcomes. As treatments improve and the incidence of young onset rectal cancer rises, the number of rectal cancer survivors grows each year. This trend highlights the growing importance of rectal cancer survivorship. Multimodality therapy with systemic chemotherapy, chemoradiation, and surgery can result in chronic toxicities in multiple organ systems, requiring a multi-disciplinary care model with services ranging from appropriate cancer surveillance to management of long-term toxicities and optimization of modifiable risk factors. Here, we review the evidence on these long-term toxicities and provide management considerations from consensus guidelines. Specific topics include bowel dysfunction from radiation and surgery, oxaliplatin-induced neuropathy, accelerated bone degeneration, the impact of fluoropyrimidines on long-term cardiovascular health, urinary incontinence, sexual dysfunction, and psychosocial distress. Additionally, we review modifiable risk factors to inform providers and rectal cancer survivors of various lifestyle and behavioral changes that can be made to improve their long-term health outcomes.
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Supervivientes de Cáncer , Neoplasias del Recto , Disfunciones Sexuales Fisiológicas , Humanos , Calidad de Vida , Neoplasias del Recto/terapia , Neoplasias del Recto/complicaciones , Supervivencia , Disfunciones Sexuales Fisiológicas/epidemiologíaRESUMEN
This report describes a case of sterile pyogranuloma syndrome managed with immunomodulatory therapy and seed skin grafting. Seed skin grafting can be considered as part of a multimodal treatment approach for cutaneous defects caused by ulcerative immune-mediated diseases where secondary intention healing is delayed or contraindicated, and other forms of wound reconstruction may be prohibitive.
Cet article décrit un cas de syndrome pyogranulome stérile géré avec un traitement immunomodulateur et une greffe de peau. La greffe de peau peut être considérée comme faisant partie d'une approche de traitement multimodal des défauts cutanés causés par des maladies ulcératives à médiation immunitaire où la cicatrisation secondaire est retardée ou contre-indiquée, et pour lesquelles d'autres formes de reconstruction de plaies peuvent être prohibitives.
Este artículo describe un caso de síndrome de piogranuloma estéril manejado con terapia inmunomoduladora e injerto de piel por ensemillado. El injerto de piel por ensemillado se puede considerar como parte de un enfoque de tratamiento multimodal para los defectos cutáneos causados por enfermedades ulcerativas inmunomediadas en las que la cicatrización por segunda intención se retrasa o está contraindicada, y otras formas de reconstrucción de heridas pueden ser prohibitivas.
Este relato descreve um caso de síndrome do piogranuloma estéril tratado com terapia imunomoduladora e enxerto de pele. Enxertia de pele pode ser considerada parte da terapia multimodal para defeitos cutâneos causados por doenças imunomediadas ulcerativas em que a cicatrização por segunda intenção é postergada ou contraindicada, e outras formas de reconstrução de feridas são proibitivas.
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Enfermedades de los Perros , Granuloma , Animales , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/cirugía , Perros , Granuloma/veterinaria , Terapia de Inmunosupresión/veterinaria , Piel , Trasplante de Piel/veterinaria , Síndrome , Cicatrización de HeridasRESUMEN
PURPOSE: There are over 1.3 million colorectal cancer (CRC) survivors in the USA, many of whom report lower health-related quality of life (HRQoL) years after treatment. This study aimed to explore the effect of digital health tools on HRQoL in CRC survivors. METHODS: We conducted a two-arm, randomized controlled trial of 42 subjects who had completed treatment for CRC. Participants in the intervention arm received a Fitbit Flex™ and daily text messages for 12 weeks. HRQoL was assessed as a secondary endpoint in both arms at enrollment and 12 weeks using the Medical Outcomes Study Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy-Colorectal (FACT-C). Survey score changes from enrollment to 12 weeks were compared between the two arms using independent t tests, and scores at enrollment and 12 weeks were compared using paired t tests. RESULTS: An increase in the FACT-C functional well-being subscale was observed in individuals in the intervention arm pre- to post-intervention (median difference, 2; interquartile range (IQR), 1, 4; P = .02). Although the between-group comparison was not statistically significant, no change in the functional well-being subscale was observed in the control arm (median difference, 0; IQR, 1, 1; P = .71). No other measures of HRQoL appeared to differ within arm across time points or between arms. CONCLUSION: A 12-week digital physical activity intervention may improve functional well-being among CRC survivors. Larger randomized studies are needed to determine if digital health tools improve functional well-being among CRC survivors and if this improvement can be sustained over time. TRIAL REGISTRATION: NCT02966054; registration date, November 17, 2016.
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Neoplasias Colorrectales , Envío de Mensajes de Texto , Neoplasias Colorrectales/terapia , Monitores de Ejercicio , Humanos , Proyectos Piloto , Calidad de Vida , SobrevivientesRESUMEN
OBJECTIVE: Current National Comprehensive Cancer Network guidelines for gastroenteropancreatic neuroendocrine tumors (GEPNETs) recommend complete (R0) surgical resection of the primary tumor and metastases, if feasible. However, large multicenter studies of recurrence patterns of GEPNETs after resection have not been performed. METHODS: Patients 18 years or older who presented to 7 participating National Comprehensive Cancer Network institutions between 2004 and 2008 with a new diagnosis of a small bowel, pancreas, or colon/rectum neuroendocrine tumor (NET) and underwent R0 resection of the primary tumor, and synchronous metastases, if present, were included in this analysis. Descriptive statistics and Kaplan-Meier estimates were used to calculate recurrence rates and time-associated end points, respectively. RESULTS: Of 294 patients with GEPNETs, 50% were male, 88% were White, and 99% had Eastern Cooperative Oncology Group performance status 0 to 1. The median age was 55 years (range, 20-90). The median follow-up time from R0 resection was 62.1 months. Recurrence rates were 18% in small bowel NETs (n = 110), 26% in pancreatic NETs (n = 141), and 10% in colon/rectum NETs (n = 50). The frequency of surveillance imaging was highly variable. CONCLUSIONS: R0 resection was associated with variable risk of recurrence across subtypes. Further research to inform refinement of guidelines for the appropriate duration of surveillance after R0 resection is needed.
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Bases de Datos Factuales/estadística & datos numéricos , Neoplasias Intestinales/cirugía , Tumores Neuroendocrinos/cirugía , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Neoplasias Pancreáticas/cirugía , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Intestinales/patología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Tumores Neuroendocrinos/patología , Evaluación de Resultado en la Atención de Salud/métodos , Neoplasias Pancreáticas/patología , Neoplasias Gástricas/patología , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Diet is associated with colorectal cancer survival. Yet, adherence to nutrition guidelines is low among colorectal cancer survivors. METHODS: We conducted a pilot trial among colorectal cancer survivors to evaluate a 12-week remote dietary intervention. Participants received print materials and were randomized (1:1) to intervention (website, text messages) or wait-list control. Primary outcomes included feasibility and acceptability. We also explored change in diet from 0 to 12 and 24 weeks and change from 0 to 12 weeks in anthropometry and circulating biomarkers (Trial Registration: NCT02965521). RESULTS: We randomized 50 colorectal cancer survivors (25 intervention, 25 control). Retention was 90% at 12 weeks and 84% at 24 weeks. Participants had a median age of 55 years and were 66% female, 70% non-Hispanic white, and 96% had a college degree. The intervention arm responded to a median 15 (71%) of 21 text messages that asked for a reply [interquartile range (IQR) = 8, 19] and visited the website a median of 13 (15%) days (IQR = 1, 33) of the 84 study days. CONCLUSIONS: We developed a Web-based dietary intervention for colorectal cancer survivors. Our pilot results suggest that colorectal cancer survivors may engage more with text messages than a study website. Research to improve tailoring of text messages, while maintaining scalability, is needed. IMPACT: Remote dietary interventions using text messages may be feasible for colorectal cancer survivors.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias Colorrectales/dietoterapia , Intervención basada en la Internet/estadística & datos numéricos , Envío de Mensajes de Texto , Neoplasias Colorrectales/mortalidad , Estudios Cruzados , Registros de Dieta , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Proyectos Piloto , Resultado del TratamientoRESUMEN
OBJECTIVES: Gallium (Ga)-DOTATOC is a somatostatin analog used to detect neuroendocrine tumors (NETs). Ki-67 proliferation index (Ki-67 PI) has been established as a prognostic factor in NETs. We aimed to evaluate whether a correlation exists between Ki-67 PI and somatostatin receptor positron emission tomography (SSTR-PET) uptake. METHODS: We retrospectively reviewed 238 DOTATOC PET scans between 2014 and 2016. Patients were excluded if DOTATOC PET was performed more than 365 days from the date of biopsy. Maximum standardized uptake values (SUVmax) of SSTR-PET from biopsied lesions were measured and correlated with Ki-67 PI using the Pearson correlation coefficient. RESULTS: Among 110 lesions from 90 patients, DOTATOC PET had 92.7% sensitivity and 100% specificity (102 true positives, 8 false negatives) for detection of NETs. Among 63 lesions from 54 patients with Ki-67 PI available, there were 27 grade 1 lesions [median Ki-67 PI, 1.0%; interquartile range (IQR), 1.0-2.0], 30 grade 2 lesions (median, Ki-67 PI 7.5%; IQR, 5-10), and 6 grade 3 lesions (median Ki-67 PI, 30%; IQR, 26-34). There was a correlation between Ki-67 PI and SUVmax (r = -0.3, P = 0.018). CONCLUSIONS: Our analysis demonstrates an inverse correlation between Ki-67 PI and SUVmax in NETs. Somatostatin receptor-PET provides additional information that can help guide management of NETs.
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Tumores Neuroendocrinos/metabolismo , Compuestos Organometálicos/farmacocinética , Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacocinética , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Índice Mitótico , Clasificación del Tumor , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Receptores de Somatostatina/metabolismo , Estudios RetrospectivosRESUMEN
OBJECTIVES: The objective of this study was to describe the periprocedural management of patients with well-differentiated neuroendocrine tumors with hepatic metastases who underwent liver-directed procedures. METHODS: We performed a retrospective review of patients with metastatic neuroendocrine tumors who underwent liver resection, ablation, or embolotherapy at a single center from 2012 to 2016. The primary outcome was occurrence of documented carcinoid crisis (CC) or hemodynamic instability (HDI), defined as 10 minutes or more of systolic blood pressure less than 80 or greater than 180 mm Hg, or pulse greater than 120 beats per minute. RESULTS: We identified 75 patients who underwent liver resection/ablation (n = 38) or embolotherapy (n = 37). Twenty-four patients (32%) experienced CC or HDI (CC/HDI); CC occurred in 3 patients. No clinicopathologic or procedural factors, including procedure type, octreotide or long-acting somatostatin analog use, and history of carcinoid syndrome, were associated with CC/HDI. Grades 2 to 4 complications were reported in 42% of patients who experienced CC/HDI versus in 16% of patients who did not experience CC/HDI (P < 0.05). CONCLUSIONS: A significant portion of patients developed CC/HDI, and these patients were more likely to develop severe postprocedural complications. Periprocedural octreotide use was not associated with lower CC/HDI occurrence, but continued use is advised given its safety profile until additional studies definitively demonstrate lack of benefit.
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Embolización Terapéutica/métodos , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Tumores Neuroendocrinos/cirugía , Atención Perioperativa/métodos , Adulto , Anciano , Antineoplásicos Hormonales/efectos adversos , Antineoplásicos Hormonales/uso terapéutico , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/etiología , Embolización Terapéutica/efectos adversos , Femenino , Hemodinámica/efectos de los fármacos , Hepatectomía/efectos adversos , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/terapia , Octreótido/efectos adversos , Octreótido/uso terapéutico , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Atención Perioperativa/efectos adversos , Estudios RetrospectivosRESUMEN
BACKGROUND: Over 1.3 million people live with colorectal cancer in the United States. Physical activity is associated with lower risk of colorectal cancer recurrence and mortality. Interventions are needed to increase physical activity in colorectal cancer survivors. METHODS: We conducted a 2-arm non-blinded pilot randomized controlled trial at the University of California, San Francisco among 42 individuals who had completed curative-intent treatment for colorectal cancer to determine the feasibility and acceptability of a 12-week (84 days) physical activity intervention using a Fitbit Flex™ and daily text messages. Participants were randomized 1:1 to receive the intervention with print educational materials or print educational materials alone. We explored the impact of the intervention versus usual care on physical activity using ActiGraph GT3X+ accelerometers pre-/post-intervention. RESULTS: We screened 406 individuals and randomized 42 to intervention (n = 21) or control (n = 21) groups. During the 12-week study, the intervention arm wore their Fitbits a median of 74 days [88% of days in study period, interquartile range: 23-83 days] and responded to a median of 34 (out of 46) text messages that asked for a reply (interquartile range: 13-38 text messages). Among the 16 intervention participants who completed the feedback survey, the majority (88%) reported that the intervention motivated them to exercise and that they were satisfied with their experience. No statistically significant difference in change in moderate-to-vigorous physical activity was found from baseline to 12 weeks between arms. CONCLUSION: A 12-week physical activity intervention with a Fitbit and text messages was feasible and acceptable among colorectal cancer patients after curative treatment. Larger studies are needed to determine whether the intervention increases physical activity. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT02966054 . Registered 17 November 2016, retrospectively registered.
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Supervivientes de Cáncer , Neoplasias Colorrectales/terapia , Ejercicio Físico/fisiología , Monitores de Ejercicio , Autocuidado/métodos , Envío de Mensajes de Texto , Acelerometría/métodos , Acelerometría/psicología , Adulto , Anciano , Supervivientes de Cáncer/psicología , Neoplasias Colorrectales/fisiopatología , Neoplasias Colorrectales/psicología , Ejercicio Físico/psicología , Terapia por Ejercicio/métodos , Terapia por Ejercicio/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación/fisiología , Proyectos Piloto , Autocuidado/psicologíaRESUMEN
BACKGROUND: East Africa is one of the fastest growing regions in the world and faces a rising burden of cancer; however, few people are equipped to effectively conduct research in this area. MATERIALS AND METHODS: A 31-item questionnaire was distributed to current trainees and recent graduates of the Master in Medicine in Clinical Oncology Program at Muhimbili University of Health and Allied Sciences in Tanzania. Areas that were assessed included (a) demographic information, (b) prior research training, (c) prior and current research activities, (d) attitudes toward the importance of research, and (e) supports and barriers to inclusion of research in an oncology career path. RESULTS: A total of 30 individuals responded to the survey, of whom 53% (n = 16) were male and 70% (n = 21) identified as current trainees. Among the majority of respondents, attitudes toward research were strongly favorable. Although only 37% (n = 11) reported receiving any formal training in research methodology, 87% (n = 26) reported intentions to incorporate research into their careers. The absence of protected time for research and lack of access to research funding opportunities were identified by a majority of respondents as critical barriers. CONCLUSION: A majority of current or recent oncology trainees in Tanzania desire to incorporate research into their careers, but most also lack adequate training in research methodology and longitudinal mentorship. Our future collaboration will focus on creation of appropriate research training curriculums and fostering an environment that catalyzes interprofessional development and transforms and extends context-specific cancer research in East Africa. IMPLICATIONS FOR PRACTICE: Current and recent oncology trainees in East Africa expressed a high enthusiasm for research, driven by a sense of urgency related to the burden from cancer that the region faces. This highlights the need for cancer research training and mentorship in this setting. This work hypothesizes that African principal investigators can operate effectively if proper attention is given to selection and provision of high-quality foundational didactic training to learn the theory and implementation of research as well as to the development of an environment conducive to mentoring.
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Investigación Biomédica/tendencias , Oncología Médica/tendencias , Neoplasias/epidemiología , Actitud del Personal de Salud , Investigación Biomédica/educación , Femenino , Humanos , Masculino , Oncología Médica/educación , Neoplasias/genética , Encuestas y Cuestionarios , Tanzanía/epidemiologíaRESUMEN
BACKGROUND/AIM: Sickness behaviors are the behavioral alterations animals exhibit during the course of an infection, often accompanied by reduced reproductive activity. Adopting sickness behaviors may aid in overcoming the infection, by diverting energy from routine activities towards enhancement of the immune system. Nonetheless, sickness behaviors are plastic, being influenced by specific environmental and social circumstances. Here, we tested whether the presentation of a novel female to males suffering from a simulated infection could impact the behavioral effects of sickness, the reproductive axis, or both. METHODS: Male zebra finches were housed in isolation and injected intramuscularly with lipopolysaccharide or saline. Behaviors were recorded before (3 h before injection) and after (3.5 h after injection) addition of a novel female to the cage for 30 min. Four hours after injection, we collected the brain and testis for the analysis of important reproductive axis modulators, gonadotropin-releasing hormone, and gonadotropin-inhibitory hormone, and to quantify gene expression of a proinflammatory cytokine involved in the regulation of sickness behaviors [interleukin (IL)-1ß]. Testosterone was quantified in the plasma. RESULTS: The presence of a novel female diminished sickness behaviors and induced alterations in the reproductive axis within 30 min, with no associated changes in brain gene expression of IL-1ß. Social environment itself altered brain gene expression of IL-1ß. CONCLUSIONS: Male zebra finches prioritize the opportunity to mate versus investment in recovery from an infection, as determined by reduced expression of sickness behaviors when a potential mate was present. The behavioral effects of IL-1ß appear to be context dependent in this species.