Brand R.E.,University of Pittsburgh |
Nolen B.M.,University of Pittsburgh |
Zeh H.J.,University of Pittsburgh |
Allen P.J.,Sloan Kettering Cancer Center |
And 12 more authors.
Clinical Cancer Research | Year: 2011
Purpose: Serum-biomarker based screening for pancreatic cancer could greatly improve survival in appropriately targeted high-risk populations. Experimental Design: Eighty-three circulating proteins were analyzed in sera of patients diagnosed with pancreatic ductal adenocarcinoma (PDAC, n = 333), benign pancreatic conditions (n = 144), and healthy control individuals (n = 227). Samples from each group were split randomly into training and blinded validation sets prior to analysis. A Metropolis algorithm with Monte Carlo simulation (MMC) was used to identify discriminatory biomarker panels in the training set. Identified panels were evaluated in the validation set and in patients diagnosed with colon (n = 33), lung (n = 62), and breast (n = 108) cancers. Results: Several robust profiles of protein alterations were present in sera of PDAC patients compared to the Healthy and Benign groups. In the training set (n=160 PDAC, 74 Benign, 107 Healthy), the panel of CA 19-9, ICAM-1, and OPG discriminated PDAC patients from Healthy controls with a sensitivity/specificity (SN/SP) of 88/90%, while the panel of CA 19-9, CEA, and TIMP-1 discriminated PDAC patients from Benign subjects with an SN/SP of 76/90%. In an independent validation set (n=173 PDAC, 70 Benign, 120 Healthy), the panel of CA 19-9, ICAM-1 and OPG demonstrated an SN/SP of 78/94% while the panel of CA19-9, CEA, and TIMP-1 demonstrated an SN/SP of 71/89%. The CA19-9, ICAM-1, OPGpanel is selective for PDAC and does not recognize breast (SP = 100%), lung (SP = 97%), or colon (SP = 97%) cancer. Conclusions: The PDAC-specific biomarker panels identified in this investigation warrant additional clinical validation to determine their role in screening targeted high-risk populations. ©2010 AACR.
Radosevich A.J.,Northwestern University |
Rogers J.D.,Northwestern University |
Turzhitsky V.,Northwestern University |
Mutyal N.N.,Northwestern University |
And 6 more authors.
IEEE Journal on Selected Topics in Quantum Electronics | Year: 2012
Since the early 1980s, the enhanced backscattering (EBS) phenomenon has been well-studied in a large variety of nonbiological materials. Yet, until recently, the use of conventional EBS for the characterization of biological tissue has been fairly limited. In this study, we detail the unique ability of EBS to provide spectroscopic, polarimetric, and depth-resolved characterization of biological tissue using a simple backscattering instrument. We first explain the experimental and numerical procedures used to accurately measure and model the full azimuthal EBS peak shape in biological tissue. Next, we explore the peak shape and height dependencies for different polarization channels and spatial coherence of illumination. We then illustrate the extraordinary sensitivity of EBS to the shape of the scattering phase function using suspensions of latex microspheres. Finally, we apply EBS to biological tissue samples in order to measure optical properties and observe the spatial length scales at which backscattering is altered in early colon carcinogenesis. © 1995-2012 IEEE.
Leonard S.A.,University of California at San Diego |
Caubet J.-C.,University of Geneva |
Kim J.S.,NorthShore University HealthSystems |
Groetch M.,Mount Sinai School of Medicine |
Nowak-Wegrzyn A.,Mount Sinai School of Medicine
Journal of Allergy and Clinical Immunology: In Practice | Year: 2015
Cow's milk (CM) and hen's egg allergies are among the most common food allergies in children. With evidence of increasing food allergy prevalence and more persistent disease, it has become vital to improve the management of CM and egg allergies. The ability to tolerate baked milk or egg, such as in a cake or muffin, has been associated with an increased chance of tolerance development. Studies report that about 70% of CM- and egg-allergic children can tolerate baked milk or egg and that incorporating baked milk or egg into the diet is well tolerated. Being able to add baked milk or egg into the diet can also increase quality of life by expanding the diet, boosting nutrition, and promoting inclusion in social activities. There is some debate over how baked milk and egg should be introduced, at home or in a supervised setting. Anaphylaxis and treatment with epinephrine during baked milk or egg challenges have been reported. Study of potential biomarkers to predict tolerability of baked milk and egg, such as serum specific IgE levels and skin prick test wheal diameters, is ongoing. Many parents can reliably report that their CM- or egg-allergic child is already consuming baked goods without symptoms. However, for those who cannot report such tolerance, the most prudent approach is to perform a supervised oral food challenge to determine the tolerability of baked milk and egg. The purpose of this article was to review the pathophysiology, clinical data, and safety of baked milk and egg and provide a practical guide to managing CM allergy and/or egg allergy. Recipes for baked milk and egg challenges and guidance on how to add baked milk and egg if tolerated to the child's regular diet are provided. © 2015 American Academy of Allergy, Asthma & Immunology.
Limthongkul W.,University of Chicago |
Karaikovic E.E.,University of Chicago |
Savage J.W.,Northwestern University |
Markovic A.,NorthShore University HealthSystems
Spine Journal | Year: 2010
Background context: During the last decade, vertebral augmentation techniques with cement (kyphoplasty and vertebroplasty) have revealed that 75% to 100% of individuals with osteoporotic vertebral compression fractures have good to moderate pain relief postoperatively, as well as adequate restoration of the vertebral body height. The volume of cement injected into a vertebra varied in different reports. To our knowledge, there are no studies that report on the physiological distribution of thoracic and lumbar vertebrae body volumes. Purpose: The purpose of this study was to quantitatively evaluate thoracic and lumbar vertebral body volumes. Study design/setting: Forty computed tomography (CT) scans of the thoracic and lumbar spines were used to measure a volume of each vertebral body. Methods: Forty CT scans with standard 2.5-mm bone window cuts of the thoracic and lumbar vertebrae (20 men and 20 women) were analyzed to measure the volumetric capacity of vertebral bodies using a BrainLAB Software (iPlan RT image 4.0) program. The software was tested for validity and reliability in two pilot studies. Mean and standard deviations for each vertebral body volume were calculated and recorded. The vertebral body working distance and the so-called "safe zone" were also measured to determine a size of a balloon to be used in kyphoplasty. Results: Vertebral body volume increased gradually from T1 to L4 with the exception of L5, which measured to be smaller than L4. The mean thoracic vertebrae volume was 15.0 cm3 (ranged in the absolute values from 5.2 to 39.5 cm3), and the mean lumbar vertebrae volume was 35 cm3 (ranged in the absolute values from 19.7 to 61.5 cm3). Men had larger volume vertebral bodies only in the lumbar spine compared with women. The average vertebral body working distances from T1 to T4 was 23.4±2.7 mm, from T5 to T9 was 30.3±3.6 mm, and from T10 to L5 was 35.5±3.9 mm. Conclusions: Knowing the physiological variability of vertebral body volumes may help prevent complications as a result of underaugmentation or overaugmentation with excessive amount of cement during kyphoplasty or vertebroplasty in osteoporotic compression fractures. We recommend using 10 mm balloons from T1 to T4, 15 mm balloons from T5 to T9, and 20 mm balloons from T10 to L5 for kyphoplasty. © 2010 Elsevier Inc. All rights reserved.
Thompson T.M.,University of Illinois at Chicago |
Leikin J.B.,NorthShore University HealthSystems |
Leikin J.B.,University of Chicago
Journal of Medical Toxicology | Year: 2015
We previously reported the financial data for the first 5 years of one of the author’s medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice—reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations. © 2014, American College of Medical Toxicology.
Sharpe S.M.,University of Chicago |
Talamonti M.S.,NorthShore University HealthSystems |
Wang E.,NorthShore University HealthSystems |
Bentrem D.J.,Northwestern University |
And 6 more authors.
American Journal of Surgery | Year: 2015
Background The oncologic equivalence of laparoscopic distal pancreatectomy (LDP) to open pancreatectomy (ODP) for ductal adenocarcinoma (DAC) is not established. Methods The National Cancer Data Base was used to compare perioperative outcomes following LDP and ODP for DAC between 2010 and 2011. Results One hundred forty-five patients underwent LDP; 625 underwent ODP. Compared with ODP, patients undergoing LDP were older (68 ± 10.1 vs 66 ± 10.5 years, P =.027), more likely treated in academic centers (70% vs 59%, P =.01), and had shorter hospital stays (6.8 ± 4.6 vs 8.9 ± 7.5 days, P <.001). Demographic data, lymph node count, 30-day unplanned readmission, and 30-day mortality were identical between groups. Multivariable regression identified a lower probability of prolonged length of stay with LDP (odds ratio.51, 95% confidence interval.327 to.785, P =.0023). There was no association between surgical approach and node count, readmission, or mortality. Conclusion LDP for DAC provides shorter postoperative lengths of stay and rates of readmission and 30-day mortality similar to OPD without compromising perioperative oncologic outcomes. © 2015 Elsevier Inc. All rights reserved.
Chen J.L.,Northshore University Healthsystems
International Journal of Pediatric Otorhinolaryngology | Year: 2015
Introduction: There is evidence for temporary hearing loss in neonates immediately after birth because of residual liquid derived from amniotic fluid in the ME cavity.This study examines whether a referred newborn hearing screen (NBHS) with subsequent testing confirming normal hearing can be attributed to persistence of middle ear effusion and predict poor Eustachian tube function manifested as recurrent otitis media or otitis media with effusion in the first year of life. The aims of the present study are to investigate the following: (1) whether infants who fail a neonatal hearing screen and subsequently pass are more likely to experience recurrent otitis media or otitis media with effusion, (2) whether these infants are more likely to obtain tympanostomy tubes. Methods: This retrospective cohort study examined newborns who referred their NBHS and were subsequently noted to have normal hearing and a control group comprised of newborns who passed their NBHS. Univariate and multivariate analysis was performed on the data collected as well as generation mean cumulative function plots. Results: The baseline characteristics of the case and control groups are not statistically significant with regards to gender, number of otitis media (OM), delivery mode, or the need for tubes in the follow up period. Within the refer group, those with bilateral refers were twice as likely to have otitis media than those with a unilateral refer (p=. 0.012). The logistic regression model for odds of subsequent otitis media was not statistically significant for bilateral or unilateral refer though the logistic regression model for odds of tubes demonstrated a statistically significant increased risk in bilateral refer patients. With time to event analysis, it was seen that bilateral refer patients are more likely to have OM than control and unilateral refer patients. Conclusion: There is no difference in the incidence of subsequent OM between those infants who passed the NBHS versus those who initially referred and then passed subsequent audiology examination. However there was a difference in the number of otitis media between those infants who referred bilaterally versus those who referred unilaterally. © 2015 Elsevier Ireland Ltd.
Mutyal N.N.,Northwestern University |
Radosevich A.,Northwestern University |
Tiwari A.K.,NorthShore University Healthsystems |
Stypula Y.,Northwestern University |
And 4 more authors.
PLoS ONE | Year: 2013
We previously reported the utility of Low-Coherence Enhanced Backscattering (LEBS) Spectroscopy in detecting optical changes in uninvolved rectal mucosa, changes that are indicative of the presence of advanced colorectal adenomas elsewhere in the colon (field carcinogenesis). We hypothesized that the alterations in optical signatures are due to structural changes in colonocytes. To elucidate those colonocyte changes, we used LEBS and an early time point in an animal model of colorectal field carcinogenesis - rats treated with azoxymethane (AOM). Changes in LEBS markers in intact mucosa from AOM-treated rats could be at least partially attributed to changes in colonocytes. To investigate the molecular mechanisms underlying the colonocyte abnormalities in premalignant colon, we took a candidate approach. We compared expression profiles of genes implicated directly or indirectly in cytoskeletal dysregulation in colorectal tissues from saline-treated versus AOM-treated rats. Our data suggest that a number of genes known to affect colon tumorigenesis are up-regulated in colonocytes, and genes previously reported to be tumor suppressors in metastatic cancer are down-regulated in colonocytes, despite the colonocytes being histologically normal. To further understand the role of the cytoskeleton in generating changes in optical markers of cells, we used pharmacological disruption (using colchicine) of the cytoskeleton. We found that differences in optical markers (between AOM- and control-treated rats) were negated by the disruption, suggesting cytoskeletal involvement in the optical changes. These studies provide significant insights into the micro-architectural alterations in early colon carcinogenesis, and may enable optimization of both bio-photonic and molecular risk stratification techniques to personalize colorectal cancer screening. © 2013 Mutyal et al.
Lo R.,University of Chicago |
Donaldson C.,Northshore University Healthsystems
Ultrasound Quarterly | Year: 2013
INTRODUCTION: Color Doppler ultrasound (CDUS) is currently preferred to screen for renal artery stenosis (RAS); however, a wide range of sensitivities and specificities have been reported. We wanted to identify potential factors contributing to this wide range and to improve CDUS screening for RAS. We noted RAS was overcalled when the peak systolic velocity (PSV) was found in the mid-main renal artery, and we sought to determine whether this was a consistent source of error. METHODS: We reviewed the medical records of patients at Northshore University Healthsystems with a positive RAS examination by CDUS from 2009 to 2012, defined as a PSV greater than 200 cm/s and/or a renal artery-to-aorta ratio greater than 3.5. Patients were included who had an elevated PSV in the mid-main renal artery and had a confirmatory imaging study (angiography, magnetic resonance angiography, or computed tomography angiography). RESULTS: Of the 16 arteries demonstrating a PSV in the mid-renal artery, 15 did not have significant stenosis on the subsequent study. The 1 true positive was a patient with fibromuscular dysplasia. DISCUSSION: This study demonstrates a high false-positive rate (94%) when the PSV is in the mid-main renal artery. We suspect this pattern is due to the tortuous mid-main renal artery causing falsely elevated velocities that meet criteria for RAS. Fibromuscular dysplasia may also produce the same pattern and should be distinguished from vessel tortuosity. If the false-positive rate of Doppler ultrasound can be decreased, fewer patients will be subjected to an unnecessary follow-up study and possibly invasive procedures. Copyright © 2013 by Lippincott Williams & Wilkins.
Mott M.L.,University of Chicago |
Gorawara-Bhat R.,University of Chicago |
Marschke M.,NorthShore University HealthSystems |
Levine S.,University of Chicago
Journal of Palliative Medicine | Year: 2014
Background: Despite an increase in the content of palliative medicine curricula in medical schools, students are rarely exposed to end-of-life (EOL) care through real-patient experiences during their preclinical education. Objective: To evaluate the utility and impact of exposure to EOL care for first year medical students (MS-1s) through a hospice volunteer experience. Methods: Patients and Families First (PFF), a hospice volunteer training program in EOL care, was piloted on three cohorts of MS-1s as an elective. Fifty-five students received 3 hours of volunteer training, and were then required to conduct at least two consecutive hospice visits on assigned patients to obtain course credit. Students' reflective essays on their experiences were analyzed using qualitative methodology and salient themes were extracted by two investigators independently and then collaboratively. Results: The following five themes were identified from students' reflective essays: perceptions regarding hospice patients; reactions regarding self; normalcy of EOL care at home; impact of witnessing death and dying; and suggestions for improving EOL care education for medical students. Conclusion: Hospice volunteering during preclinical years may provide valuable experiential training for MS-1s in caring for seriously ill patients and their families by fostering personal reflection and empathic skills, thereby providing a foundation for future patient encounters during clinical training. © Mary Ann Liebert, Inc.