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Paraneoplastic Leukocytosis and Thrombocytosis as Prognostic Biomarkers in Non-small Cell Lung Cancer

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中国肺癌杂志 2016年第11期19卷 725-730页

作者： Prajwal BODDU Dana VILLLINES Mebea AKLILU Department of Internal Medicine Advocate Illinois Masonic Medical Center Department of Clinical Research Advocate Illinois Masonic Hospital Hematology/Oncology Advocate Creticos Cancer Center

Background and Objectives: Search for inexpensive laboratory markers have identified associations between blood counts and lung cancer outcomes. In this study, we evaluated the prognostic value of paraneoplastic leukocytosis(p-Leukocytosis) and paraneoplastic thrombocytosis(p-Thrombocytosis) in patients with non-small cell lung cancer(NSCLC). We also studied their relation to the expression of commonly detected molecular markers. Methods: We conducted a retrospective chart review on 571 consecutive NSCLC patients over a 10 year period. Blood counts were recorded at the time of cancer diagnosis. Kaplan-Meier survival curves were used to compare overall survival(OS) between patients with and without p-Leukocytosis(or) p-Thrombocytosis(p-Leuko/Thrombocytosis). Cox regression was used to determine if leukocytosis/thrombocytosis was a predictor of OS in ***: Patients with p-Leukocytosis and p-Thrombocytosis had a significantly poorer survival compared patients with normal blood counts(P<0.001). In a multivariate survival analysis, both continued to correlate even when adjusted for histology, gender, stage and chemotherapy(P<0.01, 0.03 respectively). Stage I and II NSCLC with p-Leuko/Thrombocytosis did not perform poorly compared to stage I/II NSCLC patients without paraneoplasia. Patients with the combined leukothrombocytosis syndrome did not have worse outcomes compared to those with either paraneoplastic syndrome alone. Conclusions: p-Leuko/Thrombocytosis is an accessible laboratory parameter of prognostic value in NSCLC. Evidence of p-Leuko/Thrombocytosis portends poor survival. The role of various cytokines in tumor pathobiology provides a rationale for identifying cytokine factors responsible for the paraneoplasia and administering anti-cytokine therapies alongside traditional chemotherapy in an attempt to improve survival outcomes in these subset of patients.

关键词： Paraneoplastic Leukothrombocytosis Paraneoplastic leukocytosis Paraneoplastic thrombocytosis Lung neoplasms Prognosis Cytokine Epidermal growth factor receptor

Gestational Weight Gain in Obese Patients and Adverse Pregnancy Events

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Health 2014年第12期6卷 1420-1428页

作者： Shelly H. Tien Dana Villines Barbara V. Parilla Department of Obstetrics and Gynecology Advocate Illinois Masonic Medical Center Chicago USA Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Advocate Illinois Masonic Medical Center Chicago USA Department of Research Advocate Illinois Masonic Medical Center Chicago USA

Objectives: To examine pre-pregnancy obesity and gestational weight gain as predictors for adverse pregnancy outcomes in a predominantly non-white obstetric resident clinic population. Methods: Prenatal charts for patients with pre-pregnancy obesity cared for at our resident clinic from January 1, 2008 through December 31, 2010 were reviewed. Adverse maternal outcomes were grouped into a “Composite Morbidity Index” (CMI-M) and included gestational diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, dystocia, operative delivery, Cesarean section for arrest disorders, wound infection and disruption, and thromboembolic events. Fetal events, similarly categorized into a composite adverse fetal index (CMI-F), included macrosomia, Apgar at 5 minutes (≤3), NICU admission, congenital anomalies and intrauterine fetal demise. Results: 627 women with a singleton pregnancy and a pre-pregnancy body mass index (BMI) of 30 and greater were included in the analysis. As measured by the composite morbidity index, women with Class III obesity at their first prenatal visit were more likely to have at least one or more maternal and fetal complications compared to women with Class II or Class I obesity. For adverse maternal outcomes (CMI-M), 40.2%, 33.8%, and 27.4% of women within each respective obesity class experienced an adverse event (p = 0.027). Applying the CMI-F, fetal complications were observed in 28.2%, 18%, and 13.9% of Class III, II, and I obesity (p = 0.003). Total gestational weight gain per week was significantly greater for patients with one or more maternal complications (p = 0.045). Conclusion: Among an obese, resident clinic population comprised primarily of women of ethnic minorities, pre-pregnancy body mass index was the strongest indicator for adverse maternal and fetal outcomes.

关键词： Gestational Weight Gain Obesity and Pregnancy Obesity and Adverse Pregnancy Outcomes

Computed tomography scan imaging in diagnosing acute uncomplicated pancreatitis: Usefulness vs cost

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World Journal of Gastroenterology 2019年第9期25卷 1080-1087页

作者： Shana Kothari Michael Kalinowski Matthew Kobeszko Tarek Almouradi Department of Internal Medicine University of Illinois at Chicago - Advocate Christ Medical Center Department of Gastroenterology Advocate Christ Medical Center

BACKGROUND Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis(AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography(CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis(AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of *** To assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for *** In this Institutional Review Board-approved retrospective, single-center study,we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases(ICD-9) code for AP(577.0) and ICD-10 codes for different etiological AP(K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria(presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal).Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest *** utilization and cost of imaging in these patients were *** Between January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients(31%) met our inclusion criteria for AUP(201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients(51.85%) underwent CT imaging. One patient(0.47%) had evidence of pancreatic necrosis, one patient had cyst formation(0.47%), and the remaining208 patients(99.05%) had either normal CT

关键词： Acute pancreatitis Diagnostic criteria Computed tomography imaging utilization Quality improvement Healthcare expenditure Emergency department

Optical coherence tomography use in idiopathic intracranial hypertension

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Annals of Eye Science 2020年第1期5卷 45-54页

作者： Kiran Malhotra Tanyatuth Padungkiatsagul Heather E.Moss advocate illinois masonic Medical Center ChicagoILUSA Department of Ophthalmology Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand Department of Ophthalmology Stanford UniversityPalo AltoCAUSA Department of Neurology and Neurological Sciences Stanford UniversityPalo AltoCAUSA

Idiopathic intracranial hypertension(IIH)is a condition in which elevated pressure in the cerebrospinal fluid can lead to optic nerve head(ONH)dysfunction and subsequent visual *** are currently limited in their ability to monitor and manage this condition,as clinical symptoms and exam findings are often delayed in response to changes in intracranial *** order to find other biomarkers of disease,researchers are using imaging modalities such as optical coherence tomography(OCT)to observe microscopic changes in the eye in this *** can create 2-dimensional and 3-dimensional high definition images of the retina of the ONH and has been used to study various conditions such as glaucoma and multiple *** studies have used OCT in IIH as well,and they have shown that certain retinal layers and the ONH change in thickness and shape in both the short and long term with intracranial pressure *** is a promising modality for clinical and scientific evaluation of IIH as it is a noninvasive and practical tool to obtain in depth *** review will discuss how OCT can be used to assess a patient with IIH,both before and after treatment,along with its limitations and future applications.

关键词： Optical coherence tomography(OCT) idiopathic intracranial hypertension(IIH) pseudotumor cerebri

Strategies to prevent preterm birth and cerebral palsy: Compliance with current recommendations

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Open Journal of Obstetrics and Gynecology 2014年第2期4卷 71-74页

作者： Amanda Meyer Nancy Cipparrone Andrea Buras Barbara V. Parilla Department of Obstetrics and Gynecology Advocate Lutheran General Hospital Park Ridge Illinois USA Russell Institute for Research & Innovation Advocate Lutheran General Hospital Park Ridge Illinois USA

Objective: Magnesium sulfate (MgSO4) administration to patients with preterm delivery has been associated with a decrease in cerebral palsy. At our institution, a protocol was established regarding the administration of magnesium sulfate for patients in preterm labor at less than 32 weeks of gestation. Despite this protocol, not all eligible patients received this therapy. The purpose of this study was to investigate potential barriers to MgSO4 administration. Methods: A retrospective chart review was performed of those patients who received the diagnosis of “Early Onset Delivery” or “preterm labor” from January through December of 2010, to see what therapies were offered and received. Results: 119 patients met initial criteria. Of those, 68 patients had preterm labor less than 32 weeks. 15 of the 68 patients (22%) received MgSO4. Of those patients that did not receive MgSO4, only 6 delivered <32 weeks. Five were considered eligible. One patient had a relative contraindication to therapy. There were no demographic differences between those patients that received MgSO4, and those that were eligible and did not. Potential barriers included short time frame from presentation to delivery, treatment not considered by healthcare provider, and unanticipated delivery. No patient declined therapy. Conclusions: At our institution, the rate of MgSO4 administration for neuroprotection to eligible candidates was 75%. The subgroup of patients where MgSO4 was not administered in eligible candidates was unanticipated delivery (4), and premature rupture of membranes (1). A 4 gram load of MgSO4 should be attempted prior to delivery of eligible patients, as this strategy has also been shown to be of benefit.

关键词： Magnesium Sulfate Neuroprotection Preterm Delivery

What Prevents Eligible Patients from Receiving Progesterone Therapy to Prevent Recurrent Preterm Birth

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Open Journal of Obstetrics and Gynecology 2014年第7期4卷 395-398页

作者： Amanda Meyer Nancy Cipparrone Andrea Buras Barbara V. Parilla The Department of Obstetrics and Gynecology advocate Lutheran General Hospital Park Ridge Illinois USA The Russell Institute for Research & Innovation advocate Lutheran General Hospital Park Ridge Illinois USA

Objective: The use of intramuscular 17-alpha-hydroxyprogesterone caproate (17-OHPC) has been shown to be beneficial for the prevention of preterm birth (PTB) in women with a prior history. Not all patients with a prior preterm birth receive 17-OHPC. The purpose of this study was to investigate potential barriers to receiving this therapy. Methods: A retrospective chart review of those patients at our institution who received the diagnosis of “previous preterm delivery” in 2010 and 2011 was performed to see whether they were offered and received 17-OHPC. Patients were considered eligible if they had a prior delivery at less than 36 weeks of gestation secondary to idiopathic preterm labor. For those patients that were deemed eligible but did not receive therapy, an explanation was sought. Results: Sixty-six charts were reviewed in detail. Forty-three patients were considered eligible to receive 17-OHPC. The remaining had medical indications for delivery including premature rupture of membranes (PROM) (15), intrauterine growth restriction (IUGR) (1), and hypertension (2). Of the 43 patients deemed eligible, 17 did not receive 17-OHPC. Of these, eight patients were not offered therapy, 2 patients declined therapy, 3 patients presented with therapy after 28 weeks (too late), and 4 received a prophylactic cerclage as their only therapy. There were no significant differences between the two groups. Conclusion: In an effort to increase 17-OHPC use among eligible patients, we must continually identify physician biases and patient barriers that prevent utilization of this intervention. In addition, patients who deliver preterm should be told the importance of presenting early in subsequent pregnancies in order to receive the full benefits of this therapy.

关键词： Progesterone Preterm Birth Preterm Delivery 17-Alpha-Hydroxy Progesterone Caproate

An attending physician float shift for the improvement of physician productivity in a crowded emergency department

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World Journal of Emergency Medicine 2013年第1期4卷 10-14页

作者： Muhammad Umer Nasim Chintan Mistry Robert Harwood Erik Kulstad Laura Tommaso Department of Emergency Medicine Advocate Christ Medical CenterOak LawnILUSA advocate Lutheran General hospital Park RidgeIllinois 60068USA

BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the *** address this problem,we added a "float shift" to our winter schedule solely to care for *** sought to quantify the effect of this float shift,hypothesizing greater physician ***:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift *** calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of *** then compared the mean number of patients seen per shift in February with ***:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,*** number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float ***:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.

关键词： Crowding Physician staffing Boarding patients Float shift

Semaglutide’s Trail of Success in Weight Loss Management and HbA1c Reduction: A Systematic Review

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Health 2023年第10期15卷 1070-1083页

作者： Shayne Q. Paff Mariam Sahibzada Jacqueline Olivo Olivo Medical and Wellness Centers Chicago Illinois USA Universidad Autonoma de Guadalajara Jalisco Mexico School of Public Health Baylor University Waco Texas USA Ayub Medical College Abbottabad Pakistan Royal College of Surgeons in Ireland Dublin Ireland Universidad San Luis Gonzaga Ica Peru University of illinois Chicago Illinois USA masonic advocate illinois hospital Chicago Illinois USA Saint Francis hospital Evanston Illinois USA

Introduction: Obesity is a preventable health condition, yet it remains a complex relapsing global health conundrum, triggering an array of comorbidities, including diabetes, dyslipidemia, hypertension, and mental health decline. This review intends to highlight the success of semaglutide for its therapeutic intervention for weight loss management in diabetics and non-diabetics and HbA1c reduction in type 2 diabetics. Methods: We searched and systematically reviewed the literature from within the past ten years on semaglutide utilization for weight loss and HbA1c reduction. Databases investigated included PMC, JAMA, Nature Medicine, and The Lancet, resulting in four original research articles that were systematically reviewed. Web consultations with WHO, CDC, and Healthy People 2030 were conducted to ascertain epidemiological obesity and diabetes data. AAFP and USPSTF references were included for obesity management and preventive care guidelines. Results: Based on results from systematically reviewing four original research studies, semaglutide can effectively reduce elevated weight and HbA1c, using the once-weekly subcutaneous injection formulation. A composite average percent weight loss of 8.27% (16 - 20 pounds) and an average HbA1c percent reduction rate of 1.07% (3 - 4 points) were attained. There were no major adverse events reported from any of the four original research studies related to the drug. Discussion: With evidence from several studies after its FDA approval, semaglutide delivers a promise for weight loss management and HbA1c reduction for appropriate patient populations. Clinician and patient education on its proper use should be continuously revisited.

关键词： Preventive Care Obesity Management Diabetes Management Chronic Disease Adjunct Therapy Weight Loss Management

Unilateral Diaphragmatic Agenesis with Lung Cyst Herniating into the Abdomen Precluding Diaphragmatic Hernia in an Adult

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World Journal of Cardiovascular Surgery 2016年第11期6卷 171-175页

作者： Binay Krishna Sarkar Krishnendu Chakravorty Ashis Halder Paresh Banerjee Saroja Bharati Department of Cardiovascular & Thoracic Surgery Nil Ratan Sircar Medical College & Hospital Kolkata India Rush University Medical Center Chicago IL USA University of illinois College of Medicine Chicago IL USA advocate Children’s hospital and advocate Christ Medical Center Oak Lawn IL USA

Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated diaphragmatic hernia which has not been documented previously. Case Presentation: We report a case of previously undiagnosed complete absence of a hemidiaphragm in a 62-year-old male who presented with recurrent respiratory infection, episodes of nausea and postprandial fullness. Computed Tomography scan showed a large cyst in relation to the lower lobe of left lung. During surgery, he was found to have complete absence of a left hemidiaphragm and a large cyst arising from the lower lobe of left lung occupied the common thoracoabdominal space. Abdominal viscera were found displaced downwards and fixed in a thick fibrous membrane. There was no herniation of abdominal organs into the thoracic cavity after excision of the cyst. The left lung could be fully expanded and chest was closed after putting a chest drain. Diaphragmatic agenesis did not require any additional procedure. The cyst was excised with closure of bronchocystic opening. The patient had an uneventful recovery. Conclusions: The association of lung cyst with diaphragmatic agenesis (presented in the adulthood) is rare. It has precluded a diaphragmatic hernia and survived the patient acting as a protective barrier. The significance of lung cyst in presence of diaphragmatic agenesis lies in the absence of associated diaphragmatic hernia which has not been documented previously.

关键词： Lung Cyst Absent Hemidiaphragm Recurrent Respiratory Infection