Coon A.B.,Rush University Medical Center |
Dickler A.,Little Company of Mary Hospital |
Kirk M.C.,Massachusetts General North Shore Cancer Center |
Liao Y.,Rush University Medical Center |
And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010
Purpose: For patients with left-sided breast cancers, radiation treatment to the intact breast results in high doses to significant volumes of the heart, increasing the risk of cardiac morbidity, particularly in women with unfavorable cardiac anatomy. We compare helical tomotherapy (TOMO) and inverse planned intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiotherapy using opposed tangents (3D-CRT) for reductions in cardiac volumes receiving high doses. Methods and Materials: Fifteen patients with left-sided breast cancers and unfavorable cardiac anatomy, determined by a maximum heart depth (MHD) of ≥1.0 cm within the tangent fields, were planned for TOMO and IMRT with five to seven beam angles, in addition to 3D-CRT. The volumes of heart and left ventricle receiving ≥35 Gy (V35) were compared for the plans, as were the mean doses to the contralateral breast and the volume receiving ≥20 Gy (V20) for the ipsilateral lung. Results: The mean MHD was 1.7 cm, and a significant correlation was observed between MHD and both heart and left ventricle V35. The V35s for IMRT (0.7%) and TOMO (0.5%) were significantly lower than for 3D-CRT (3.6%). The V20 for IMRT (22%) was significantly higher than for 3D-CRT (15%) or TOMO (18%), but the contralateral breast mean dose for TOMO (2.48 Gy) was significantly higher than for 3D-CRT (0.93 Gy) or IMRT (1.38 Gy). Conclusions: Both TOMO and IMRT can significantly reduce cardiac doses, with modest increases in dose to other tissues in left-sided breast cancer patients with unfavorable cardiac anatomy. © 2010 Elsevier Inc.
PubMed | Northwestern University, Lynn Sage Breast Center, Kendall Regional Medical Center, Little Company of Mary Hospital and 2 more.
Type: Journal Article | Journal: Surgical oncology | Year: 2016
The contralateral unaffected breast (CUB) of women with unilateral breast cancer provides a model for the study of breast tissue-based risk factors. Using random fine needle aspiration (rFNA), we have investigated hormonal and gene expression patterns related to atypia in the CUBs of newly diagnosed breast cancer patients.83 women underwent rFNA of the CUB. Cytologic analysis was performed using the Masood Score (MS), atypia was defined as MS>14. RNA was extracted using 80% of the sample. The expression of 20 hormone related genes was quantified using Taqman Low Density Arrays. Statistical analysis was performed using 2-tailed t tests and linear regression.Cytological atypia was more frequent in multiparous women (P=0.0392), and was not associated with any tumor-related features in the affected breast. Masood Score was higher with shorter interval since last pregnancy (R=0.204, P=0.0417), higher number of births (R=0.369, P=0.0006), and estrogen receptor (ER) negativity of the index cancer (R=-0.203, P=0.065). Individual cytologic features were associated with aspects of parity. Specifically, anisonucleosis was correlated with shorter interval since last pregnancy (R=0.318, P=0.0201), higher number of births (R=0.382, P=0.0004), and ER status (R=-0.314, P=0.0038). Eight estrogen-regulated genes were increased in atypical samples (P<0.005), including TFF1, AGT, PDZK1, PGR, GREB1, PRLR, CAMK2B, and CCND1.Cytologic atypia, and particularly anisonucleosis, is associated with recent and multiple births and ER negative status of the index tumor. Atypical samples showed increased expression of estrogen-related genes, consistent with the role of estrogen exposure in breast cancer development.
News Article | November 10, 2016
New research from the University of Chicago Medicine shows a program that uses electronic medical records to connect Chicagoans with health resources in their community could be a model for other efforts nationally. That's according to new findings published Nov. 9 in the journal Health Affairs. The program called CommunityRx launched in 2012 with funding from a $5.9 million federal innovation award. The program works by generating customized "e-prescriptions" called a HealtheRx for patients who visit nearly three dozen health clinics, including UChicago Medicine's adult and pediatric emergency departments. Since it started, CommunityRx has generated more than 506,000 customized HealtheRx prescriptions for an estimated 200,000 or more patients. The Health Affairs study assessed the program's effectiveness by surveying 458 CommunityRx participants who received a HealtheRx prescription between 2012 and 2014. More than 83 percent reported the personalized referrals were "very useful." Nearly one in five visited a place they learned about through the program. And all but one of six partnering health care organizations (involving 30 of 33 clinical sites) participating in the project continued using CommunityRx after the study period ended. "To me, the most profound finding and one that motivated me to find a sustainable business model, was that more than half the participants surveyed used their HealtheRx to help connect someone else to community resources," said Stacy Tessler Lindau, MD, an associate professor of obstetrics and gynecology at the University of Chicago. "I'm fascinated by the idea that we might motivate people to take better care of themselves by offering them a tool that make it easy to help others." Lindau directed CommunityRx, was the study's lead author, and has founded a private social enterprise company that is commercializing the effort. CommunityRx connects patients with specific nearby places and community resources matched to their health needs. A person with diabetes might leave a checkup with an automatically created HealtheRx printout listing nearby locations for nutrition classes while someone with high blood pressure might get a prescription listing free area blood pressure screenings. The backbone of the project, which was required by its grant funding to also have a sustainable business plan, is a continuously updated database of community assets that is merged with a patient's electronic health record. The database inventory includes nearly 20,000 public-serving entities - from food banks to counseling centers - operating within a 107-square-mile area of Chicago's South Side. The exhaustive catalog is created and updated by a team of high school students who walk every block of the area each summer to document the region's businesses and organizations using a smartphone app. The Health Affairs study showed that more than 40 percent of the organizations listed in the HealtheRx database didn't have websites, so many patients wouldn't necessarily be able to learn about resource - often just blocks away from their home - unless they received the prescription from their doctor's office or clinic. The most commonly prescribed resources during the study period were food pantries, healthy eating classes, fresh fruits and vegetables and individual counseling. During the three-year study, the program generated more than 250,000 personalized "prescriptions" for about 113,000 people. The researchers acknowledge that their study relied on patients to self-report whether they utilized a resource, because the program's electronic interface was only connected to medical records, not the individual community service provider organizations. Additional authors of the study, "CommunityRx: A population health improvement innovation that connects clinics to communities," include Jennifer Makelarski, Emily Abramsohn, David G. Beiser, Veronica Escamilla, Jessica Jerome, Daniel Johnson, Abel N. Kho, Karen K. Lee, Timothy Long, and Doriane C. Miller. About the University of Chicago Medicine & Biological Sciences The University of Chicago Medicine, located in Chicago's Hyde Park neighborhood, is one of the nation's leading academic medical institutions. It comprises the Medical Center, Pritzker School of Medicine and the University of Chicago Biological Sciences Division. Twelve Nobel Prize winners in physiology or medicine have been affiliated with UChicago Medicine. The medical campus includes the Center for Care and Discovery, Bernard Mitchell Hospital, Comer Children's Hospital and Duchossois Center for Advanced Medicine and offers a full range of specialty-care services for adults and children through more than 40 institutes and centers including an NCI-designated Comprehensive Cancer Center. It has 805 licensed beds, nearly 850 attending physicians, about 2,500 nurses and over 1,100 residents and fellows. Off-campus affiliations and partnerships include Silver Cross Hospital for cancer care, Little Company of Mary Hospital for specialty pediatric care and Edward-Elmhurst Health for specialty pediatric care. Visit our research blog at sciencelife.uchospitals.edu and newsroom at uchospitals.edu/news. To make an appointment, call 1-888-824-0200. Twitter @UChicagoMed Facebook.com/UChicagoMed
News Article | October 28, 2016
The International Association of HealthCare Professionals is pleased to welcome Martins A. Adeoye, MD, Psychiatrist, to their prestigious organization with his upcoming publication in The Leading Physicians of the World. He is a highly trained and qualified psychiatrist with a vast expertise in all facets of his work. Dr. Adeoye has been in practice for more than 24 years and is currently serving patients as a Psychiatrist at the Elemental Center For Personal Development. Furthermore, he is affiliated with the University of Illinois Hospital Medical Center, Edward Hospital, Advocate Christ Medical Center, the Little Company of Mary Hospital, and Linden Oaks Hospital. Dr. Adeoye gained his Medical Degree in 1992 from the University of Ibadan in Nigeria. After moving to the United States, an internship was completed at the University of Illinois. Dr. Adeoye remained at this University to complete his residency in Psychiatry, where he served as Chief Resident, followed by his fellowship in Child and Adolescent Psychiatry. Dr. Adeoye holds dual board certification in both Psychiatry and in Child and Adolescent Psychiatry, and is recognized as an expert in the management and treatment of autism and mood disorders. He maintains professional memberships with the American Psychiatric Association, the American Academy of Clinical Psychiatrists, and the Academy of Clinical and Applied Psychoanalysis. Dr. Adeoye attributes his success to being diligent and focused, with a desire to help people. When he is not working, he enjoys traveling and photography. Learn more about Dr. Adeoye by reading his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics. Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review. FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise. A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life. For more information about FindaTopDoc, visit http://www.findatopdoc.com
Dickler A.,Little Company of Mary Hospital |
Puthawala M.Y.,Rhode Island Hospital |
Thropay J.P.,Beverly Oncology and Imaging Centers |
Bhatnagar A.,Cancer Treatment Services International |
Schreiber G.,Swedish Covenant Hospital
Radiation Oncology | Year: 2010
Background: A modified form of high dose rate (HDR) brachytherapy has been developed called Axxent Electronic Brachytherapy (EBT). EBT uses a kilovolt X-ray source and does not require treatment in a shielded vault or a HDR afterloader unit. A multi-center clinical study was carried out to evaluate the success of treatment delivery, safety and toxicity of EBT in patients with endometrial cancer.Methods: A total of 15 patients with stage I or II endometrial cancer were enrolled at 5 sites. Patients were treated with vaginal EBT alone or in combination with external beam radiation.Results: The prescribed doses of EBT were successfully delivered in all 15 patients. From the first fraction through 3 months follow-up, there were 4 CTC Grade 1 adverse events and 2 CTC Grade II adverse events reported that were EBT related. The mild events reported were dysuria, vaginal dryness, mucosal atrophy, and rectal bleeding. The moderate treatment related adverse events included dysuria, and vaginal pain. No Grade III or IV adverse events were reported. The EBT system performed well and was associated with limited acute toxicities.Conclusions: EBT shows acute results similar to HDR brachytherapy. Additional research is needed to further assess the clinical efficacy and safety of EBT in the treatment of endometrial cancer. © 2010 Dickler et al; licensee BioMed Central Ltd.
Ivanov O.,Little Company of Mary Hospital |
Dickler A.,Little Company of Mary Hospital |
Lum B.Y.F.,Little Company of Mary Hospital |
Pellicane J.V.,Virginia Breast Center |
Francescatti D.S.,Rush University Medical Center
Annals of Surgical Oncology | Year: 2011
Background: Accelerated partial breast irradiation (APBI) is emerging as a valid alternative to whole-breast radiation therapy (WBRT) in breast-conserving therapy (BCT) for early-stage breast cancer. Axxent electronic brachytherapy (EBX) is a form of portable, balloon-based APBI that utilizes an electronic source of kilovoltage irradiation delivery with minimal shielding requirements. As such, EBX becomes a logical and convenient modality for delivery of intraoperative radiation therapy (IORT). We report 1-year results and clinical outcomes of a trial that utilizes EBX to deliver IORT for patients with early-stage breast cancer. Methods: Eleven patients were enrolled on an institutional review board (IRB)-approved protocol. Inclusion criteria were patient age >45 years, unifocal tumors with infiltrating ductal or ductal carcinoma in situ (DCIS) histology, tumors >3 cm, and uninvolved lymph nodes. Preloaded radiation plans were used to deliver radiation prescription dose of 20 Gy to the balloon surface. Results: The mean time for radiation delivery was 22 min; the total mean procedure time was 1 h 39 min. All margins of excision were negative on final pathology. At mean follow-up of 12 months, overall cosmesis was excellent in 10 of 11 patients. No infection, fat necrosis, desquamation, rib fracture or cancer recurrence has been observed. There was no evidence of fibrosis at last follow-up. Conclusion: IORT utilizing EBX is emerging as a feasible, well-tolerated alternative to postsurgical APBI. Further research and longer follow-up data on EBX and other IORT methods are needed to establish the clinical efficacy and safety of this treatment. © 2010 Society of Surgical Oncology.
Visser H.G.,University of the Free State |
Roodt A.,University of the Free State |
Volmink A.-L.,University of the Free State |
Kemp G.,Little Company of Mary Hospital
Acta Crystallographica Section E: Structure Reports Online | Year: 2011
In the title compound, [Re(C5H4F3O 2)(C5H5N)(CO)3], the ReI atom is six-coordinated owing to bonding by three carbonyl ligands arranged in a fac configuration, two O atoms from the bidentate 1,1,1-trifluoro-acetyl- acetonate ligand and an N atom from a pyridine ligand. In the crystal, the molecules pack in layers, diagonally, in a head-to-tail fashion across the ab plane. These layers are stabilsed by intermolecular C - H⋯O and C - H⋯F hydrogen bonds. © Visser et al. 2011.
Prins A.,Little Company of Mary Hospital
South African Journal of Clinical Nutrition | Year: 2015
A central venous incident (CVI) is the second leading cause of death worldwide, and is associated with permanent disabilities.There are many nutrition and lifestyle modifiable risk factors for a CVI. These include diabetes, and hypercholesterolaemia and hypertension, all of which are largely preventable, and involve effective, low-cost treatment. Malnutrition in CVI patients ranges from 6-62%, and often worsens during hospitalisation owing to multiple factors, including dysphagia, the inadequate intake of food, inactivity and metabolic changes in the clinical setting. When malnutrition is present in patients who have an acute CVI, the increased risk of poor functional outcomes relates to complications such as gastrointestinal bleeding, pressure ulcers, and urinary tract and respiratory infections. These are associated with higher mortality and increased length of stay in hospital, and contribute to decreased quality of life and impaired rehabilitative outcomes. Screening and nutritional assessment is vital on admission. The Mini Nutritional Assessment and Patient-Generated Subjective Global Assessment have been validated in this patient population. The energy and protein requirements of stroke patients are poorly defined. There is some evidence for the supplementation of antioxidants, but the efficacy thereof depends on their ability to cross the blood-brain-barrier. Large-scale studies are necessary to assess the effect on neurocognitive recovery. Meeting requirements in this patient population is a challenge because of dysphagia, as well as neurological and cognitive deficiencies, and is best achieved with the support of a multidisciplinary team. Early enteral nutrition improves survival, while oral nutrition supplements improve nutrient intake and quality of life. © SAJCN.
Shah A.P.,Rush University Medical Center |
Strauss J.B.,Rush University Medical Center |
Kirk M.C.,Rush University Medical Center |
Chen S.S.,Rush University Medical Center |
Dickler A.,Little Company of Mary Hospital
Physica Medica | Year: 2010
Introduction: Electron beam radiation is the modality most often used to deliver an operative bed boost to breast cancer patients after completing whole breast radiation. However, electrons can potentially provide inadequate coverage. The MammoSite breast brachytherapy applicator may provide dosimetric advantages in the delivery of an operative bed boost and its role in this setting is not yet defined. Materials and methods: The study population consisted of 15 patients with early stage breast cancer treated with partial breast irradiation (PBI) using the MammoSite device. For each patient, a theoretical boost plan using electrons and a second theoretical boost plan using the MammoSite applicator were created. To assess the adequacy of each boost plan, the PTV V90, PTV V95, and PTV V100 were calculated. To assess dose to normal tissues, the ipsilateral breast V50, ipsilateral lung V30, and heart V20 were calculated. Results: The mean PTV V100 for the MammoSite boost was 95.5%, compared to 77.4% for the electron boost (p<0.001). The mean PTV V95 was 97.8%, compared to 93.3% for the electron boost (p=0.02). The mean PTV V90, mean breast V50, mean lung V30, and mean heart V20 were not statistically different for MammoSite compared to electrons. Conclusions: A tumor bed boost using the MammoSite breast brachytherapy applicator provides superior target coverage and delivers similar doses to the ipsilateral breast and lung compared to a boost delivered with electrons. More investigation into the role of balloon brachytherapy in the delivery of a breast boost is warranted. © 2009 Associazione Italiana di Fisica Medica.
PubMed | Little Company of Mary Hospital
Type: Journal Article | Journal: Medical physics | Year: 2016
The stromal-epithelial-cell interactions that are responsible for directing normal breast-tissue development and maintenance play a central role in the progression of breast cancer. In the present study, we developed three-dimensional (3-D) cell co-cultures used to study cancerous mammary cell responses to fractionated radiotherapy. In particular, we focused on the role of the reactive stroma in determining the therapeutic ratio for postsurgical treatment.Cancerous human mammary epithelial cells were cultured in a 3-D collagen matrix with human fibroblasts stimulated by various concentrations of transforming growth factor beta 1 (TGF-1). These culture samples were designed to model the post-lumpectomy mammary stroma in the presence of residual cancer cells. We tracked over time the changes in medium stiffness, fibroblast-cell activation (conversion to cancer activated fibroblasts (CAF)), and proliferation of both cell types under a variety of fractionated radiotherapy protocols. Samples were exposed to 6 MV X-rays from a linear accelerator in daily fraction sizes of 90, 180 and 360 cGy over five days in a manner consistent with irradiation exposure during radiotherapy.We found in fractionation studies with fibroblasts and CAF that higher doses per fraction may be more effective early on in deactivating cancer-harboring cellular environments. Higher-dose fraction schemes inhibit contractility in CAF and prevent differentiation of fibroblasts, thereby metabolically uncoupling tumor cells from their surrounding stroma. Yet, over a longer time period, the higher dose fractions may slow wound healing and increase ECM stiffening that could stimulate proliferation of surviving cancer cells.The findings suggest that dose escalation to the region with residual disease can deactivate the reactive stroma, thus minimizing the cancer promoting features of the cellular environment. Large-fraction irradiation may be used to sterilize residual tumor cells and inhibit activation of intracellular transduction pathways that are promoted during the post-surgical woundhealing period. NIH award R01CA138882.