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Article: Mercury biomagnification in benthic, pelagic, and benthopelagic food webs in an Arctic marine ecosystem

Hilgendag, Isabel R. / Swanson, Heidi K. / Lewis, Christopher W. / Ehrman, Ashley D. / Power, Michael

Science of the total environment. 2022 Oct. 01, v. 841

2022

Abstract: Mercury (Hg) is a ubiquitous toxic metal that biomagnifies in food webs, and can reach high concentrations in top predators. Evaluating Hg biomagnification in Arctic marine food webs is critical for understanding Hg dynamics and estimating exposure to ... ...

Abstract	Mercury (Hg) is a ubiquitous toxic metal that biomagnifies in food webs, and can reach high concentrations in top predators. Evaluating Hg biomagnification in Arctic marine food webs is critical for understanding Hg dynamics and estimating exposure to understudied fish and wildlife consumed by humans. The majority of studies conducted on Hg biomagnification in the Arctic have focused on pelagic food webs. Benthic and benthopelagic food webs in Arctic marine ecosystems also support many species of subsistence and commercial importance, and data are lacking for these systems. In this study, we investigated food web structure and Hg biomagnification for the benthic, pelagic, and benthopelagic marine food webs of inner Frobisher Bay in Nunavut. Stable isotope ratios of carbon (δ¹³C) and nitrogen (δ¹⁵N), as well as total (THg) and methyl (MeHg) mercury concentrations were measured in fish, invertebrates, and zooplankton. Biomagnification in each food web was quantified with Trophic Magnification Slopes (TMS) and Trophic Magnification Factors (TMF). The highest TMS and TMF values were exhibited by the benthopelagic food web (TMS = 0.201; TMF = 1.59), followed by the pelagic food web (TMS = 0.183; TMF = 1.52), and lastly the benthic food web (TMS = 0.079; TMF = 1.20), with δ¹⁵N explaining 88%, 79%, and 9% of variation in Hg concentrations, respectively. TMS and TMF values were generally low compared to other Arctic marine food webs. Results from food web structure analyses indicated that the benthic food web had the greatest trophic diversity, trophic redundancy, and largest isotopic niche area of all food webs studied. Greater food web complexity may thus result in reduced MeHg biomagnification, but further study is required. Acquiring Hg and food web structure data is critical for predicting the effects of climate-induced environmental change on Hg dynamics, especially in the context of Arctic marine ecosystems.
Keywords	bioaccumulation ; carbon ; climatic factors ; fish ; marine ecosystems ; mercury ; nitrogen ; stable isotopes ; toxicity ; wildlife ; zooplankton ; Arctic region ; Nunavut
Language	English
Dates of publication	2022-1001
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2022.156424
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Article ; Online: The Relationship Between Patient-Specific Factors and Discharge Destination After COVID-19 Hospitalization.

Lewis, Christopher W / Gray, Elizabeth / Dreyer, Sean / Goodman, Daniel / Jayabalan, Prakash

American journal of physical medicine & rehabilitation

2022 Volume 102, Issue 7, Page(s) 611–618

Abstract: Objective: The aim of this study was to determine the discharge destinations and associated patient-specific factors among patients hospitalized with COVID-19.: Design: A retrospective cohort study was carried out at a single-site tertiary acute care ...

Abstract	Objective: The aim of this study was to determine the discharge destinations and associated patient-specific factors among patients hospitalized with COVID-19. Design: A retrospective cohort study was carried out at a single-site tertiary acute care hospital. Results: Among 2872 patients, discharge destination included home without services ( n = 2044, 71.2%), home with services ( n = 379, 13.2%), skilled nursing facility (117, 4.1%), long-term acute care hospital ( n = 39, 1.3%), inpatient rehabilitation facility ( n = 97, 3.4%), acute care facility ( n = 23, 0.8%), hospice services ( n = 20, 0.7%), or deceased during hospitalization ( n = 153, 5.3%). Adjusting by covariates, patients had higher odds of discharge to a rehabilitation facility (skilled nursing facility, long-term acute care hospital, or inpatient rehabilitation facility) than home (with or without services) when they were older (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.80-3.11; P < 0.001), had a higher Charlson Comorbidity Index score (3-6: OR, 2.36; 95% CI, 1.34-4.15; P = 0.003; ≥7: OR, 2.76; 95% CI, 1.56-4.86; P < 0.001), were intubated or required critical care (OR, 2.15; 95% CI, 1.48-3.13; P < 0.001), or had a longer hospitalization (3-7 days: OR, 12.48; 95% CI, 3.77-41.32; P < 0.001; 7-14 days: OR, 28.14; 95% CI, 8.57-92.43; P < 0.001). Patients were less likely to be discharged to a rehabilitation facility if they received remdesivir (OR, 0.44; 95% CI, 0.31-0.64; P < 0.001). Conclusions: Patient-specific factors associated with COVID-19 hospitalization should be considered by physicians when prognosticating patient rehabilitation.
MeSH term(s)	Humans ; Patient Discharge ; Retrospective Studies ; COVID-19/epidemiology ; Hospitalization ; Patients ; Skilled Nursing Facilities
Language	English
Publishing date	2022-11-30
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	219390-5
ISSN	1537-7385 ; 0002-9491 ; 0894-9115
ISSN (online)	1537-7385
ISSN	0002-9491 ; 0894-9115
DOI	10.1097/PHM.0000000000002159
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Article ; Online: Mercury biomagnification in benthic, pelagic, and benthopelagic food webs in an Arctic marine ecosystem.

Hilgendag, Isabel R / Swanson, Heidi K / Lewis, Christopher W / Ehrman, Ashley D / Power, Michael

The Science of the total environment

2022 Volume 841, Page(s) 156424

Abstract	Mercury (Hg) is a ubiquitous toxic metal that biomagnifies in food webs, and can reach high concentrations in top predators. Evaluating Hg biomagnification in Arctic marine food webs is critical for understanding Hg dynamics and estimating exposure to understudied fish and wildlife consumed by humans. The majority of studies conducted on Hg biomagnification in the Arctic have focused on pelagic food webs. Benthic and benthopelagic food webs in Arctic marine ecosystems also support many species of subsistence and commercial importance, and data are lacking for these systems. In this study, we investigated food web structure and Hg biomagnification for the benthic, pelagic, and benthopelagic marine food webs of inner Frobisher Bay in Nunavut. Stable isotope ratios of carbon (δ
MeSH term(s)	Animals ; Bioaccumulation ; Ecosystem ; Environmental Monitoring ; Fishes ; Food Chain ; Mercury/analysis ; Water Pollutants, Chemical/analysis
Chemical Substances	Water Pollutants, Chemical ; Mercury (FXS1BY2PGL)
Language	English
Publishing date	2022-06-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2022.156424
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Article ; Online: Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis.

McEvoy, Aubriana M / Lachance, Kristina / Hippe, Daniel S / Cahill, Kelsey / Moshiri, Yasman / Lewis, Christopher W / Singh, Neha / Park, Song Y / Thuesmunn, Zoe / Cook, Maclean M / Alexander, Nora A / Zawacki, Lauren / Thomas, Hannah / Paulson, Kelly G / Nghiem, Paul

JAMA dermatology

2022 Volume 158, Issue 4, Page(s) 382–389

Abstract: Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). ... ...

Abstract	Importance: Merkel cell carcinoma (MCC) often behaves aggressively; however, disease-recurrence data are not captured in national databases, and it is unclear what proportion of patients with MCC experience a recurrence (estimates vary from 27%-77%). Stage-specific recurrence data that includes time from diagnosis would provide more precise prognostic information and contribute to risk-appropriate clinical surveillance. Objective: To estimate risk of stage-specific MCC recurrence and mortality over time since diagnosis. Design, setting, and participants: This prospective cohort study included 618 patients with MCC who were prospectively enrolled in a Seattle-based data repository between 2003 and 2019. Of these patients, 223 experienced a recurrence of MCC. Data analysis was performed July 2019 to November 2021. Main outcomes and measures: Stage-specific recurrence and survival, as well as cumulative incidence and Kaplan-Meier analyses. Results: Among the 618 patients included in the analysis (median [range] age, 69 [11-98] years; 227 [37%] female), the 5-year recurrence rate for MCC was 40%. Risk of recurrence in the first year was high (11% for patients with pathologic stage I, 33% for pathologic stage IIA/IIB, 30% for pathologic stage IIIA, 45% for pathologic stage IIIB, and 58% for pathologic stage IV), with 95% of recurrences occurring within the first 3 years. Median follow-up among living patients was 4.3 years. Beyond stage, 4 factors were associated with increased recurrence risk in univariable analyses: immunosuppression (hazard ratio [HR], 2.4; 95% CI, 1.7-3.3; P < .001), male sex (HR, 1.9; 95% CI, 1.4-2.5; P < .001), known primary lesion among patients with clinically detectable nodal disease (HR, 2.3; 95% CI, 1.4-4.0; P = .001), and older age (HR, 1.1; 95% CI, 1.0-1.3; P = .06 for each 10-year increase). Among 187 deaths in the cohort, 121 (65%) were due to MCC. The MCC-specific survival rate was strongly stage dependent (95% at 5 years for patients with pathologic stage I vs 41% for pathologic stage IV). Among patients presenting with stage I to II MCC, a local recurrence (17 arising within/adjacent to the primary tumor scar) did not appreciably diminish survival compared with patients who had no recurrence (85% vs 88% MCC-specific survival at 5 years). Conclusions and relevance: In this cohort study, the MCC recurrence rate (approximately 40%) was notably different than that reported for invasive melanoma (approximately 19%), squamous cell carcinoma (approximately 5%-9%), or basal cell carcinoma (approximately 1%-2%) following definitive therapy. Because more than 90% of MCC recurrences arise within 3 years, it is appropriate to adjust surveillance intensity accordingly. Stage- and time-specific recurrence data can assist in appropriately focusing surveillance resources on patients and time intervals in which recurrence risk is highest.
MeSH term(s)	Aged ; Carcinoma, Merkel Cell/diagnosis ; Carcinoma, Merkel Cell/pathology ; Cohort Studies ; Female ; Humans ; Male ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Retrospective Studies ; Skin Neoplasms/pathology
Language	English
Publishing date	2022-02-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2701761-8
ISSN	2168-6084 ; 2168-6068
ISSN (online)	2168-6084
ISSN	2168-6068
DOI	10.1001/jamadermatol.2021.6096
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Article ; Online: Narrow excision margins are appropriate for Merkel cell carcinoma when combined with adjuvant radiation: Analysis of 188 cases of localized disease and proposed management algorithm.

Tarabadkar, Erica S / Fu, Teresa / Lachance, Kristina / Hippe, Daniel S / Pulliam, Thomas / Thomas, Hannah / Li, Janet Y / Lewis, Christopher W / Doolittle-Amieva, Coley / Byrd, David R / Kampp, Jeremy T / Parvathaneni, Upendra / Nghiem, Paul

Journal of the American Academy of Dermatology

2020 Volume 84, Issue 2, Page(s) 340–347

Abstract: Background: Merkel cell carcinoma (MCC) management typically includes surgery with or without adjuvant radiation therapy (aRT). Major challenges include determining surgical margin size and whether aRT is indicated.: Objective: To assess the ... ...

Abstract	Background: Merkel cell carcinoma (MCC) management typically includes surgery with or without adjuvant radiation therapy (aRT). Major challenges include determining surgical margin size and whether aRT is indicated. Objective: To assess the association of aRT, surgical margin size, and MCC local recurrence. Methods: Analysis of 188 MCC cases presenting without clinical nodal involvement. Results: aRT-treated patients tended to have higher-risk tumors (larger diameter, positive microscopic margins, immunosuppression) yet had fewer local recurrences (LRs) than patients treated with surgery only (1% vs 15%; P = .001). For patients who underwent surgery alone, 7 of 35 (20%) treated with narrow margins (defined as ≤1.0 cm) developed LR, whereas 0 of 13 patients treated with surgical margins greater than 1.0 cm developed LR (P = .049). For aRT-treated patients, local control was excellent regardless of surgical margin size; only 1% experienced recurrence in each group (1 of 70 with narrow margins ≤1 cm and 1 of 70 with margins >1 cm; P = .56). Limitations: This was a retrospective study. Conclusions: Among patients treated with aRT, local control was superb even if significant risk factors were present and margins were narrow. We propose an algorithm for managing primary MCC that integrates risk factors and optimizes local control while minimizing morbidity.
MeSH term(s)	Aged ; Aged, 80 and over ; Carcinoma, Merkel Cell/diagnosis ; Carcinoma, Merkel Cell/mortality ; Carcinoma, Merkel Cell/pathology ; Carcinoma, Merkel Cell/therapy ; Critical Pathways/standards ; Dermatologic Surgical Procedures/methods ; Dermatologic Surgical Procedures/standards ; Dermatologic Surgical Procedures/statistics & numerical data ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging ; Practice Guidelines as Topic ; Radiotherapy, Adjuvant/standards ; Radiotherapy, Adjuvant/statistics & numerical data ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Skin Neoplasms/diagnosis ; Skin Neoplasms/mortality ; Skin Neoplasms/pathology ; Skin Neoplasms/therapy ; Time-to-Treatment/standards ; Time-to-Treatment/statistics & numerical data
Language	English
Publishing date	2020-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2020.07.079
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Article ; Online: Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients.

Singh, Neha / Alexander, Nora A / Lachance, Kristina / Lewis, Christopher W / McEvoy, Aubriana / Akaike, Gensuke / Byrd, David / Behnia, Sanaz / Bhatia, Shailender / Paulson, Kelly G / Nghiem, Paul

Journal of the American Academy of Dermatology

2020 Volume 84, Issue 2, Page(s) 330–339

Abstract: Background: Merkel cell carcinoma (MCC) guidelines derive from melanoma and do not recommend baseline cross-sectional imaging for most patients. However, MCC is more likely to have metastasized at diagnosis than melanoma.: Objective: To determine how ...

Abstract	Background: Merkel cell carcinoma (MCC) guidelines derive from melanoma and do not recommend baseline cross-sectional imaging for most patients. However, MCC is more likely to have metastasized at diagnosis than melanoma. Objective: To determine how often baseline imaging identifies clinically occult MCC in patients with newly diagnosed disease with and without palpable nodal involvement. Methods: Analysis of 584 patients with MCC with a cutaneous primary tumor, baseline imaging, no evident distant metastases, and sufficient staging data. Results: Among 492 patients with clinically uninvolved regional nodes, 13.2% had disease upstaged by imaging (8.9% in regional nodes, 4.3% in distant sites). Among 92 patients with clinically involved regional nodes, 10.8% had disease upstaged to distant metastatic disease. Large (>4 cm) and small (<1 cm) primary tumors were both frequently upstaged (29.4% and 7.8%, respectively). Patients who underwent positron emission tomography-computed tomography more often had disease upstaged (16.8% of 352), than those with computed tomography alone (6.9% of 231; P = .0006). Limitations: This was a retrospective study. Conclusions: In patients with clinically node-negative disease, baseline imaging showed occult metastatic MCC at a higher rate than reported for melanoma (13.2% vs <1%). Although imaging is already recommended for patients with clinically node-positive MCC, these data suggest that baseline imaging is also indicated for patients with clinically node-negative MCC because upstaging is frequent and markedly alters management and prognosis.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy/statistics & numerical data ; Carcinoma, Merkel Cell/diagnosis ; Carcinoma, Merkel Cell/secondary ; Carcinoma, Merkel Cell/therapy ; Child ; Female ; Humans ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Lymphatic Metastasis/diagnosis ; Lymphatic Metastasis/therapy ; Male ; Middle Aged ; Neoplasm Staging/standards ; Neoplasm Staging/statistics & numerical data ; Positron Emission Tomography Computed Tomography/standards ; Positron Emission Tomography Computed Tomography/statistics & numerical data ; Practice Guidelines as Topic ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; SEER Program/statistics & numerical data ; Skin Neoplasms/diagnosis ; Skin Neoplasms/pathology ; Skin Neoplasms/therapy ; Young Adult
Language	English
Publishing date	2020-07-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2020.07.065
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Article ; Online: Patterns of distant metastases in 215 Merkel cell carcinoma patients: Implications for prognosis and surveillance.

Lewis, Christopher W / Qazi, Jamiluddin / Hippe, Daniel S / Lachance, Kristina / Thomas, Hannah / Cook, Maclean M / Juhlin, Ilsa / Singh, Neha / Thuesmunn, Zoe / Takagishi, Seesha R / McEvoy, Aubriana / Doolittle-Amieva, Coley / Bhatia, Shailender / Paulson, Kelly G / O'Malley, Ryan B / Wang, Carolyn L / Nghiem, Paul

Cancer medicine

2019 Volume 9, Issue 4, Page(s) 1374–1382

Abstract: Approximately one-third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood ... ...

Abstract	Approximately one-third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood differs depending on the metastatic site. Such data could inform imaging/surveillance practices and improve prognostic accuracy. Multivariate and competing-risk analyses were performed on a cohort of 215 MCC patients with distant metastases, 31% of whom had two or more initial sites of distant metastasis. At time of initial distant metastasis in the 215 patients, metastatic sites (n = 305) included non-regional lymph nodes (present in 41% of patients), skin/body wall (25%), liver (23%), bone (21%), pancreas (8%), lung (7%), and brain (5%). Among the 194 patients who presented with MCC limited to local or regional sites (stage I-III) but who ultimately developed distant metastases, distant progression occurred in 49% by 1 year and in 80% by 2 years following initial diagnosis. Primary MCC locations differed in how likely they were to metastasize to specific organs/sites (P < .001). For example, liver metastases were far more likely from a head/neck primary (43% of 58 patients) versus a lower limb primary (5% of 39 patients; P < .0001). Skin-only distant metastasis was associated with lower MCC-specific mortality as compared to metastases in multiple organs/sites (HR 2.7; P = .003), in the liver (HR 2.1; P = .05), or in distant lymph nodes (HR 2.0; P = .045). These data reflect outcomes before PD1-pathway inhibitor availability, which may positively impact survival. In conclusion, primary MCC location is associated with a pattern of distant spread, which may assist in optimizing surveillance. Because it is linked to survival, the site of initial distant metastasis should be considered when assessing prognosis.
MeSH term(s)	Aged ; Carcinoma, Merkel Cell/diagnosis ; Carcinoma, Merkel Cell/epidemiology ; Carcinoma, Merkel Cell/secondary ; Carcinoma, Merkel Cell/virology ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Lymph Nodes ; Lymphatic Metastasis/diagnosis ; Lymphatic Metastasis/pathology ; Male ; Merkel cell polyomavirus/isolation & purification ; Middle Aged ; Neoplasm Staging ; Polyomavirus Infections/diagnosis ; Polyomavirus Infections/epidemiology ; Polyomavirus Infections/virology ; Prognosis ; Retrospective Studies ; Risk Assessment/methods ; Skin Neoplasms/mortality ; Skin Neoplasms/pathology ; Survival Analysis ; Treatment Outcome ; Tumor Virus Infections/diagnosis ; Tumor Virus Infections/epidemiology ; Tumor Virus Infections/virology
Language	English
Publishing date	2019-12-27
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2045-7634
ISSN (online)	2045-7634
DOI	10.1002/cam4.2781
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Article: Merkel Cell Carcinoma Patients Presenting Without a Primary Lesion Have Elevated Markers of Immunity, Higher Tumor Mutation Burden, and Improved Survival.

Vandeven, Natalie / Lewis, Christopher W / Makarov, Vladimir / Riaz, Nadeem / Paulson, Kelly G / Hippe, Daniel / Bestick, Amy / Doumani, Ryan / Marx, Tessa / Takagishi, Seesha / Chan, Timothy A / Choi, Jaehyuk / Nghiem, Paul

Clinical cancer research : an official journal of the American Association for Cancer Research

2017 Volume 24, Issue 4, Page(s) 963–971

Abstract: Purpose: ...

Abstract	Purpose:
MeSH term(s)	Aged ; Biomarkers, Tumor/genetics ; Biomarkers, Tumor/immunology ; Biomarkers, Tumor/metabolism ; Carcinoma, Merkel Cell/genetics ; Carcinoma, Merkel Cell/immunology ; Carcinoma, Merkel Cell/therapy ; Female ; Humans ; Immunotherapy/methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Mutation ; Skin/immunology ; Skin/metabolism ; Skin/pathology ; Skin Neoplasms/genetics ; Skin Neoplasms/immunology ; Skin Neoplasms/therapy ; Survival Analysis ; Tumor Burden/genetics ; Tumor Burden/immunology ; Whole Exome Sequencing
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2017-12-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1225457-5
ISSN	1557-3265 ; 1078-0432
ISSN (online)	1557-3265
ISSN	1078-0432
DOI	10.1158/1078-0432.CCR-17-1678
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Article: Valvular flow abnormalities are often identified by a resting focused Doppler examination performed at the time of stress echocardiography.

Gaur, Abhishek / Yeon, Susan B / Lewis, Christopher W / Manning, Warren J

The American journal of medicine

2003 Volume 114, Issue 1, Page(s) 20–24

Abstract: Background: Patients are usually referred for stress echocardiography to assess whether there is inducible myocardial ischemia. At some centers, a focused Doppler examination is also performed. We sought to determine the clinical value of this ... ...

Abstract	Background: Patients are usually referred for stress echocardiography to assess whether there is inducible myocardial ischemia. At some centers, a focused Doppler examination is also performed. We sought to determine the clinical value of this additional study by examining how often valvular flow abnormalities were identified that might affect clinical care. Methods: We reviewed 1272 consecutive stress echocardiogram reports from a 1-year period, including 1223 tests that contained focused Doppler data. Important Doppler findings were defined as at least moderate mitral regurgitation, at least mild aortic regurgitation, any aortic or mitral valve stenosis, or any resting left ventricular outflow tract gradient. Results: Overall, focused Doppler identified an important Doppler abnormality in 214 patients (17%). At least moderate mitral regurgitation was identified in 67 patients (5%) and at least mild aortic regurgitation was identified in 163 patients (13%). In addition, aortic stenosis (n = 14; 1%), mitral stenosis (n = 5; 0.4%), and resting outflow tract gradient (n = 2; 0.2%) were noted. A prior echocardiogram had been performed at our institution in 317 patients (26%). For this subset, a new important Doppler finding, a two-step change in regurgitant grade, or a one-step change in stenosis severity was noted in 28 patients (9%). Among patients who had a previous study, the prevalence of new findings was the same (9%) in those who had been studied within the previous year as in those whose previous study had been performed more than 2 years before. Conclusion: Focused Doppler documents valvular flow abnormalities in 17% of patients referred for stress echocardiography, thereby enhancing the potential overall value of the test. The frequency of new findings was independent of the time interval from the previous Doppler study. These data should be considered when clinicians choose a stress imaging modality.
MeSH term(s)	Aged ; Aortic Valve Insufficiency/diagnostic imaging ; Echocardiography, Doppler, Color ; Echocardiography, Stress ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnostic imaging ; Myocardial Ischemia/diagnostic imaging ; Severity of Illness Index ; Ventricular Dysfunction, Left/diagnostic imaging
Language	English
Publishing date	2003-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/s0002-9343(02)01381-5
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Article ; Online: Single-fraction radiation therapy in patients with metastatic Merkel cell carcinoma.

Iyer, Jayasri G / Parvathaneni, Upendra / Gooley, Ted / Miller, Natalie J / Markowitz, Elan / Blom, Astrid / Lewis, Christopher W / Doumani, Ryan F / Parvathaneni, Kaushik / Anderson, Austin / Bestick, Amy / Liao, Jay / Kane, Gabrielle / Bhatia, Shailender / Paulson, Kelly / Nghiem, Paul

Cancer medicine

2015 Volume 4, Issue 8, Page(s) 1161–1170

Abstract: Merkel cell carcinoma (MCC) is an aggressive, polyomavirus-associated cancer with limited therapeutic options for metastatic disease. Cytotoxic chemotherapy is associated with high response rates, but responses are seldom durable and toxicity is ... ...

Abstract	Merkel cell carcinoma (MCC) is an aggressive, polyomavirus-associated cancer with limited therapeutic options for metastatic disease. Cytotoxic chemotherapy is associated with high response rates, but responses are seldom durable and toxicity is considerable. Here, we report our experience with palliative single-fraction radiotherapy (SFRT) in patients with metastatic MCC. We conducted retrospective analyses of safety and efficacy outcomes in patients that received SFRT (8 Gy) to MCC metastases between 2010 and 2013. Twenty-six patients were treated with SFRT to 93 MCC tumors located in diverse sites that included skin, lymph nodes, and visceral organs. Objective responses were observed in 94% of the measurable irradiated tumors (86/92). Complete responses were observed in 45% of tumors (including bulky tumors up to 16 cm). "In field" lesion control was durable with no progression in 77% (69/89) of treated tumors during median follow-up of 277 days among 16 living patients. Clinically significant toxicity was seen in only two patients who had transient side effects. An exploratory analysis suggested a higher rate of in-field progression in patients with an immunosuppressive comorbidity or prior recent chemotherapy versus those without (30% and 9%, respectively; P = 0.03). Use of SFRT in palliating MCC patients was associated with an excellent in field control rate and durable responses at treated sites, and with minimal toxicity. SFRT may represent a convenient and appealing alternative to systemic chemotherapy for palliation, for which most patients with oligometastatic MCC are eligible. SFRT may also synergize with emerging systemic immune stimulants by lowering tumor burden and enhancing presentation of viral/tumor antigens.
MeSH term(s)	Aged ; Aged, 80 and over ; Bone Neoplasms/secondary ; Carcinoma, Merkel Cell/mortality ; Carcinoma, Merkel Cell/pathology ; Carcinoma, Merkel Cell/radiotherapy ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Palliative Care/methods ; Radiotherapy/adverse effects ; Radiotherapy/methods ; Radiotherapy Planning, Computer-Assisted ; Retrospective Studies ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2045-7634
ISSN (online)	2045-7634
DOI	10.1002/cam4.458
Database	MEDical Literature Analysis and Retrieval System OnLINE

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