Lankenau Medical Center

About: Lankenau Medical Center is a healthcare organization based out in Philadelphia, Pennsylvania, United States. It is known for research contribution in the topics: Atrial fibrillation & Medicine. The organization has 436 authors who have published 414 publications receiving 7095 citations. The organization is also known as: Lankenau Hospital.

From TATA to NOTES, how taTME fits into the evolutionary surgical tree

Abstract: ‘‘Necessity...is the mother of... Invention.’’ Plato ‘‘A mind that is stretched by a new experience can never go back to its old dimensions.’’ Oliver Wendall Holmes Jr. Often an idea once planted, needs to be carefully nurtured and tended to in order to grow into a strong, vibrant being. This holds true in surgery and particularly in rectal cancer management, where perhaps more so than in any other field of oncology, oncologic outcomes and quality of life issues are so closely married. The article by Chouillard in this month’s journal describing a transanal NOTES total mesorectal excision (taTME) demonstrates elegantly the seed of an idea growing into a fruitful reality. The challenge of extirpating a low rectal cancer in the narrow confines of the bony pelvis while avoiding a permanent colostomy remains a daunting task for the surgeon. Local recurrence (LR) rates in the 20–40 % range in the 1970s–1980s [1] led to several essential advances in rectal cancer care. High-dose preoperative radiation therapy was employed to lower local failure rates [2]. Additionally, Heald heightened the focus on the primacy of proper surgical technique in the treatment of rectal cancer, coining the term total mesorectal excision (TME) and demonstrating its effect in improving LR rates [3]. During this same period, Dr Gerald Marks implemented the first program in the world of sphincter preservation surgery following high-dose preoperative radiation therapy [4]. Responding to the challenge of determining an adequate distal margin, in 1984 Dr Marks developed the technique of Transanal Abdominal TransAnal proctosigmoidectomy with coloanal anastomosis (TATA) [5]. The TATA procedure, unwittingly ushered in the era of taTME. But at this time the seed had just been placed into the soil. By starting transanally, Dr Marks postulated that a known distal margin could be safely achieved even for cancers in the distal 1/3 of the rectum, if the cancer was not growing into the levators. The TATA was born from the practical necessity to obtain a reliable distal margin in a cancer that was difficult to palpate after it had been downstaged significantly from preoperative therapy. Subsequently, others have used a derivation of this approach and termed it an intersphincteric resection. However, most performing the surgery in this fashion did so by doing the TME from above, taking it as low as possible and only going below to finish the transection and do the anastomosis. Commonly when we presented our TATA work, the criticism was that it was too bothersome for the surgical team to work transanally and then go above and back below to do the anastomosis. This left the TATA procedure with several dedicated acolytes but not large-scale adoption. As laparoscopic rectal surgery developed, questions arose which still persist today, regarding the technical difficulty of TME surgery laparoscopically. Problems with GIA stapler application and distal margins entered the discussion. In fact many surgeons still perform their rectal cancer work by doing the mobilization laparoscopically and the TME in an open fashion via a lower midline incision. Because of our referral patterns, many of the & J. H. Marks marksj@mlhs.org

A pilot study exploring rehabilitation nurses' perceptions of 12-hour shifts.

Abstract: Background. Understanding nurses' perceptions of shifts, especially 12-hour shifts, can help facilities to retain their nurses. Literature review. Limited studies of nurses' perceptions of the 12-hour shift have produced varying conclusions about what nurses perceive as its benefits. Purpose

Human papillomavirus vaccine uptake: what works and what can we do better?

Abstract: Human papillomavirus (HPV), a sexually transmitted infection, is the main cause of cervical cancer worldwide [1]. The most common route of transmission is vaginal or anal intercourse [1], but HPV may also cause anal, oral, and throat cancer [2]. There are more than 100 strains of HPV; new screening efforts are focusing on the more high-risk HPV types (16/18), reinforcing the concept that cervical cancer is preventable [1, 3]. Efforts are already in place to reduce HPV-related cancer with 2 vaccines recommended as primary prevention [4]. The first is Gardasil (Merck & Co., Whitehouse Station, NJ), a quadrivalent vaccine that protects against HPV types 6, 11, 16, and 18 [1, 5]. It was approved by the Food and Drug Administration in 2006 for use in females between the ages of 9 and 26 years (expanded to males in 2009) [1]. The second is Cervarix (GlaxoSmithKline Biologicals, Rixensart, Belgium), a bivalent vaccine that targets HPV types 16 and 18, approved in 2009 for females between the ages of 10 and 25 years [1]. Immunization rates remain inconsistent nationwide, ranging from 6% to 75% in adolescent girls and 4% to 79% in women 18 to 26 years of age [1]. The vaccine uptake rates are even lower in young men, at less than 2% [6]. Legislation promoting HPV vaccination before school entry has been met with resistance [7]. This article discusses various interventions and highlights which ones have been most successful in increasing HPV vaccine uptake, with a focus on young women.

Comparison of longitudinal change in sST2 vs BNP to predict major adverse cardiovascular events in asymptomatic patients in the community.

Abstract: Biomarker-based preventative and monitoring strategies are increasingly used for risk stratification in cardiovascular (CV) disease. The aim of this study was to investigate the utility of longitudinal change in B-type natriuretic peptide (BNP) and sST2 concentrations for predicting incident major adverse CV events (MACE) (heart failure, myocardial infarction, arrhythmia, stroke/transient ischaemic attack and CV death) in asymptomatic community-based patients with risk factors but without prevalent MACE at enrolment. The study population consisted of 282 patients selected from the longitudinal STOP-HF study of asymptomatic patients with risk factors for development of MACE. Fifty-two of these patients developed a MACE. The study was run in two phases comprising of an initial investigative cohort (n = 195), and a subsequent 2:1 (No MACE: MACE) propensity matched verification cohort (n = 87). BNP and sST2 were quantified in all patients at two time points a median of 2.5 years apart. Results highlighted that longitudinal change in sST2 was a statistically significant predictor of incident MACE, (AUC 0.60). A one-unit increment in sST2 change from baseline to follow up corresponded to approximately 7.99% increase in the rate of one or more incident MACE, independent of the baseline or follow-up concentration. In contrast, longitudinal change value of BNP was not associated with MACE. In conclusion, longitudinal change in sST2 but not BNP was associated with incident MACE in asymptomatic, initially event-free patients in the community. Further work is required to evaluate the clinical utility of change in sST2 in risk prediction and event monitoring in this setting.

Machine learning-based prediction of response to PARP inhibition across cancer types

Abstract: PARP inhibitors (PARPi) are FDA approved for the treatment of BRCA1/2 deficient breast and ovarian cancer, but a growing body of pre-clinical evidence suggests the drug class holds therapeutic potential in other cancer types, independent of BRCA1/2 status. Large-scale pharmacogenomic datasets offer the opportunity to develop predictors of response to PARPi’s in many cancer types, expanding their potential clinical applicability. Response to the PARPi olaparib was used to identify a multi-gene PARPi response signature in a large in vitro dataset including multiple cancer types, such as breast, ovarian, pancreatic, lung cancer, osteosarcoma and Ewing sarcoma, using machine learning approaches. The signature was validated on multiple independent in vitro datasets, also testing for response to another PARPi, rucaparib, as well as two clinical datasets using the cisplatin response as a surrogate for PARPi response. Finally, integrative pharmacogenomic analysis was performed to identify drugs which may be effective in PARPi resistant tumors. A PARPi response signature was defined as the 50 most differentially transcribed genes between PARPi resistant and sensitive cell lines from several different cancer types. Cross validated predictors generated with LASSO logistic regression using the PARPi signature genes accurately predicted PARPi response in a training set of olaparib treated cell lines (80-89%), an independent olaparib treated in vitro dataset (66-77%), and an independent rucaparib treated in vitro dataset (80-87%). The PARPi signature also significantly predicted in vitro breast cancer response to olaparib in another separate experimental dataset. The signature also predicted clinical response to cisplatin and survival in human ovarian cancer and osteosarcoma datasets. Robust transcriptional differences between PARPi sensitive and resistant tumors accurately predict PARPi response in vitro and cisplatin response in vivo for multiple tumor types with or without known BRCA1/2 deficiency. These signatures may prove useful for predicting response in patients treated with PARP inhibitors.