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Article ; Online: Semantically Ambiguous Language in the Teaching Operating Room.

Liu, Cynthia / McKenzie, Andrew / Sutkin, Gary

2021 Volume 78, Issue 6, Page(s) 1938–1947

Abstract: Objective: Teaching and training surgeons work hard in the OR to understand each other, yet miscommunication is an important cause of preventable adverse events in surgery. Our objective was to perform a formal semantic analysis of language in authentic ...

Abstract	Objective: Teaching and training surgeons work hard in the OR to understand each other, yet miscommunication is an important cause of preventable adverse events in surgery. Our objective was to perform a formal semantic analysis of language in authentic teaching surgical cases, identify the prevalence and typology of ambiguous or potentially ambiguous language, and describe their potential for miscommunication. Design: In this secondary analysis of qualitative data, we collaborated with a semanticist, categorizing linguistic phenomena often associated with miscommunication. We defined an ambiguous phenomenon as a string of language that could be reasonably interpreted in more than one way. We analyzed transcripts of 319 minutes of surgery, coding for 14 linguistic categories. Cohen's kappa was calculated. We determined the prevalence and rate of each linguistic category and chose illustrative examples. Participants and setting: Six surgical attendings, four fellows, and six residents, ranging from PGY1 to PGY4, at the University of Pittsburgh Medical Center, a tertiary medical center in Pittsburgh, Pennsylvania. Results: We found 3912 examples of potentially ambiguous language, 12.3 per minute. Percentage agreement between two expert raters was 76.3%. The most common phenomena were deixis (3.1 per minute), directional (2.6), anaphora (1.3), implicit instruction (1.3), and degree modifiers (0.7). Restatements/reframing occurred 1.4 times per minute. We identified 131 near misses associated with potentially ambiguous language. Cohen's kappa was 0.70 among expert semanticists. Conclusions: Potentially ambiguous language is common and has the potential to jeopardize safe teaching surgery. We postulate that the high amount of potentially ambiguous language use in the operating room places a burden on the training surgeon to comprehend surgical instruction.
MeSH term(s)	Communication ; Humans ; Internship and Residency ; Language ; Operating Rooms ; Surgeons/education ; Teaching
Language	English
Publishing date	2021-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2021.03.020
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Article: Epstein-Barr Virus-Positive Primary Central Nervous System Lymphoma in a 40-Year-Old Immunocompetent Patient.

Hajtovic, Sabastian / Liu, Cynthia / Diefenbach, Catherine M / Placantonakis, Dimitris G

Cureus

2021 Volume 13, Issue 1, Page(s) e12754

Abstract: Epstein-Barr virus-positive (EBV+) primary central nervous system lymphoma (PCNSL) is a clinical entity rarely reported in young immunocompetent patients. Here, we present the case of a 40-year-old female with no history of immunosuppression or ... ...

Abstract	Epstein-Barr virus-positive (EBV+) primary central nervous system lymphoma (PCNSL) is a clinical entity rarely reported in young immunocompetent patients. Here, we present the case of a 40-year-old female with no history of immunosuppression or immunodeficiency, who presented with a ring-enhancing lesion in the right basal ganglia. The tumor generated significant vasogenic edema and mass effect, causing midline shift, symptoms of increased intracranial pressure, and rapidly progressive neurologic dysfunction. She underwent gross total resection of the tumor through a tubular retractor. Her tumor was of the diffuse large B cell lymphoma (DLBCL) subtype of PCNSL and was positive for EBV. No immunodeficiency or extracranial disease was identified. After adjuvant therapy with high-dose methotrexate, rituximab, and temozolomide, she remains disease-free two years after initial presentation. EBV+ PCNSL, although rare in young immunocompetent adults, poses unique clinical challenges and may require surgical intervention in the acute setting in some cases.
Language	English
Publishing date	2021-01-17
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.12754
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Article ; Online: Immune-related adverse events after immune checkpoint inhibitor exposure in adult cancer patients with pre-existing autoimmune diseases.

Pizuorno Machado, Antonio / Shatila, Malek / Liu, Cynthia / Wang, Jianbo / Altan, Mehmet / Zhang, Hao Chi / Thomas, Anusha / Wang, Yinghong

Journal of cancer research and clinical oncology

2023 Volume 149, Issue 9, Page(s) 6341–6350

Abstract: Purpose: Immune checkpoint inhibitor (ICI) therapy can predispose patients to immune-related adverse events (irAEs) and autoimmune disease (AD) flare-ups, but the characteristics of irAEs among patients with pre-existing ADs are largely unknown. We ... ...

Abstract	Purpose: Immune checkpoint inhibitor (ICI) therapy can predispose patients to immune-related adverse events (irAEs) and autoimmune disease (AD) flare-ups, but the characteristics of irAEs among patients with pre-existing ADs are largely unknown. We conducted this study to determine the clinical courses, irAEs, AD flares, treatment, and outcomes of patients with AD on ICIs. Methods: This was a retrospective study of adult cancer patients at a large cancer center who were diagnosed with ADs before undergoing ICI therapy. Patients' clinical courses, complications, treatments, and outcomes related to both ADs flares and irAEs were collected and analyzed. Results: The study included 197 patients. Most (55.4%) were women. Melanoma comprised the highest proportion (28.4%) of malignancies, and most (83.8%) patients received PD-1/PD-L1 inhibitors. Fifty (25.3%) patients developed a new irAE after starting ICI therapy, while 29 (14.7%) patients had an AD flare-up. Patients with inflammatory bowel disease had the highest incidence of AD flare-ups (31.7%), while patients with Hashimoto hypothyroidism had the highest incidence of new irAEs (39.2%). Patients with inflammatory bowel disease had more severe adverse events. In our cohort, patients with a new diagnosis of irAE were treated with immunosuppressive therapy. AD flares were managed similarly. With regard to irAE manifestations, the most common presentations were colitis (24 [12.1%] patients), hepatic transaminase elevations (8 [4%] patients), and pneumonitis (7 [3.5%] patients). Conclusion: Our findings suggest that patients with gastrointestinal and rheumatologic ADs had a higher incidence of AD flare-ups, while patients with Hashimoto hypothyroidism and neurologic ADs had a higher incidence of new irAEs. Patients with prior ADs experiencing flare-ups or new irAEs after ICI therapy tend to require aggressive immunosuppressive treatment. Thorough evaluation of baseline disease status, appropriate medical management before ICI therapy, and early recognition of inflammatory exacerbation may help ensure long-term success in treating and improving outcomes in these patients.
MeSH term(s)	Immune Checkpoint Inhibitors/adverse effects ; Immune Checkpoint Inhibitors/therapeutic use ; Autoimmune Diseases/complications ; Autoimmune Diseases/immunology ; Neoplasms/complications ; Neoplasms/drug therapy ; Humans ; Male ; Female ; Middle Aged ; Aged ; Symptom Flare Up
Chemical Substances	Immune Checkpoint Inhibitors
Language	English
Publishing date	2023-02-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	134792-5
ISSN	1432-1335 ; 0171-5216 ; 0084-5353 ; 0943-9382
ISSN (online)	1432-1335
ISSN	0171-5216 ; 0084-5353 ; 0943-9382
DOI	10.1007/s00432-023-04582-9
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Article: A Comprehensive Review of the Global Efforts on COVID-19 Vaccine Development.

Li, Yingzhu / Tenchov, Rumiana / Smoot, Jeffrey / Liu, Cynthia / Watkins, Steven / Zhou, Qiongqiong

ACS central science

2021 Volume 7, Issue 4, Page(s) 512–533

Abstract: This report examines various vaccine platforms including inactivated vaccines, protein-based vaccines, viral vector vaccines, and nucleic acid (DNA or mRNA) vaccines, and their ways of producing immunogens in cells. ...

Abstract	This report examines various vaccine platforms including inactivated vaccines, protein-based vaccines, viral vector vaccines, and nucleic acid (DNA or mRNA) vaccines, and their ways of producing immunogens in cells.
Language	English
Publishing date	2021-03-29
Publishing country	United States
Document type	News
ISSN	2374-7943
ISSN	2374-7943
DOI	10.1021/acscentsci.1c00120
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Article: A Rare Case of Metastatic Merkel Cell Carcinoma to the Stomach and Pancreas Presenting With Upper Gastrointestinal Bleeding and Obstructive Jaundice.

Elkafrawy, Ahmed / Numan, Laith / Albawaliz, Anas / Liu, Cynthia / Bahaj, Waled / Tawfik, Ossama / Hamid, Fadi

ACG case reports journal

2021 Volume 8, Issue 1, Page(s) e00523

Abstract: Merkel cell carcinoma (MCC) is a rare and aggressive primary neuroendocrine tumor of the skin. Gastrointestinal (GI) metastasis in MCC is uncommon. We present a case of MCC with metastasis to the stomach, duodenum, and pancreas presenting with melena and ...

Abstract	Merkel cell carcinoma (MCC) is a rare and aggressive primary neuroendocrine tumor of the skin. Gastrointestinal (GI) metastasis in MCC is uncommon. We present a case of MCC with metastasis to the stomach, duodenum, and pancreas presenting with melena and obstructive jaundice. A large, bleeding metastatic mass was identified in the duodenum. Hemostasis was achieved with coil embolization. Endoscopic retrograde cholangiopancreatography with stenting of the common bile duct was performed to relieve the obstruction. Close surveillance with positron emission tomography/computed tomography scan and possible GI endoscopy should be performed in cases with distant metastasis to identify and treat early GI tract lesions.
Language	English
Publishing date	2021-01-27
Publishing country	United States
Document type	Case Reports
ZDB-ID	2814825-3
ISSN	2326-3253
ISSN	2326-3253
DOI	10.14309/crj.0000000000000523
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Article ; Online: "But His Yelp Reviews Are Awful!": Analysis of General Surgeons' Yelp Reviews.

Liu, Cynthia / Uffenheimer, Meka / Nasseri, Yosef / Cohen, Jason / Ellenhorn, Joshua

Journal of medical Internet research

2019 Volume 21, Issue 4, Page(s) e11646

Abstract: Background: Patients use Web-based platforms to review general surgeons. However, little is known about the free-form text and structured content of the reviews or how they relate to the physicians' characteristics or their practices.: Objective: ... ...

Abstract	Background: Patients use Web-based platforms to review general surgeons. However, little is known about the free-form text and structured content of the reviews or how they relate to the physicians' characteristics or their practices. Objective: This observational study aimed to analyze the Web-based reviews of general surgeons on the west side of Los Angeles. Methods: Demographics, practice characteristics, and Web-based presence were recorded. We evaluated frequency and types of Yelp reviews and assigned negative remarks to 5 categories. Tabulated results were evaluated using independent t test, one-way analysis of variance, and Pearson correlation analysis to determine associations between the number of total and negative reviews with respect to practice structure and physician characteristics. Results: Of the 146 general surgeons, 51 (35%) had at least 1 review and 29 (20%) had at least 1 negative review. There were 806 total reviews, 679 (84.2%) positive reviews and 127 (15.8%) negative reviews. The negative reviews contained a total of 376 negative remarks, categorized into physician demeanor (124/376, 32.9%), clinical outcomes (81/376, 22%), office or staff (83/376, 22%), scheduling (44/376, 12%), and billing (44/376, 12%). Surgeons with a professional website had significantly more reviews than those without (P=.003). Surgeons in private practice had significantly more reviews (P=.002) and more negative reviews (P=.03) than surgeons who were institution employed. A strong and direct correlation was found between a surgeon's number of reviews and number of negative reviews (P<.001). Conclusions: As the most common category of complaints was about physician demeanor, surgeons may optimize their Web-based reputation by improving their bedside manner. A surgeon's Web presence, private practice, and the total number of reviews are significantly associated with both positive and negative reviews.
MeSH term(s)	Female ; Humans ; Male ; Patient Satisfaction/statistics & numerical data ; Surgeons ; Telemedicine/methods
Language	English
Publishing date	2019-04-30
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/11646
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Article ; Online: Non-Hodgkin Lymphoma with Synovial Involvement of the Knee.

Kim, Brandon / Raphael, Bruce / Liu, Cynthia / Golden, Brian D

Bulletin of the Hospital for Joint Disease (2013)

2019 Volume 77, Issue 4, Page(s) 275–278

Abstract: Musculoskeletal involvement occurs in approximately 25% of patients diagnosed with non-Hodgkin lymphoma (NHL). Skeletal involvement is typically secondary, with primary lymphoma of the bone being much rarer. We describe a case in which a 52-year-old man ... ...

Abstract	Musculoskeletal involvement occurs in approximately 25% of patients diagnosed with non-Hodgkin lymphoma (NHL). Skeletal involvement is typically secondary, with primary lymphoma of the bone being much rarer. We describe a case in which a 52-year-old man initially presented features suggestive of Lyme arthritis in his left knee. A synovial biopsy performed as part of a synovectomy procedure revealed a proliferative synovium with dense lymphoplasmacytic B cell infiltrate, suggestive of NHL. An inguinal lymph node biopsy was also performed but did not produce results pathologically similar to those of the left knee synovial biopsy.
MeSH term(s)	Arthroscopy ; Diagnosis, Differential ; Humans ; Knee Joint/pathology ; Knee Joint/surgery ; Lyme Disease/diagnosis ; Lyme Disease/microbiology ; Lymphoma, Non-Hodgkin/pathology ; Lymphoma, Non-Hodgkin/surgery ; Male ; Middle Aged ; Predictive Value of Tests ; Synovectomy ; Synovial Membrane/pathology ; Treatment Outcome
Language	English
Publishing date	2019-11-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	390411-8
ISSN	2328-5273 ; 1936-9727 ; 1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
ISSN (online)	2328-5273 ; 1936-9727
ISSN	1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
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Article ; Online: Heat shock protein 90 inhibitors suppress pyroptosis in THP-1 cells.

Zhou, Zhou / Li, Xiuzhen / Qian, Yisong / Liu, Cynthia / Huang, Xiaotian / Fu, Mingui

The Biochemical journal

2020 Volume 477, Issue 20, Page(s) 3923–3934

Abstract: Pyroptosis is a recently discovered inflammatory form of programmed cell death which is mostly triggered by infection with intracellular pathogens and critically contributes to inflammation. Mitigating pyroptosis may be a potential therapeutic target in ... ...

Abstract	Pyroptosis is a recently discovered inflammatory form of programmed cell death which is mostly triggered by infection with intracellular pathogens and critically contributes to inflammation. Mitigating pyroptosis may be a potential therapeutic target in inflammatory diseases. However, small chemicals to reduce pyroptosis is still elusive. In the present study, we screened 155 chemicals from a microbial natural product library and found Geldanamycin, an HSP90 inhibitor, profoundly rescued THP-1 cells from pyroptosis induced by LPS plus Nigericin treatment. Consistently, other HSP90 inhibitors, including Radicicol, 17-DMAG and 17-AAG, all ameliorated pyroptosis in THP-1 cells by suppressing the inflammasome/Caspase-1/GSDMD signal pathway in pyroptosis. HSP90 inhibition compromised the protein stability of NLRP3, a critical component of the inflammasome. Moreover, up-regulated HSP70 may also contribute to this effect. HSP90 inhibition may thus be a potential therapeutic strategy in the treatment of inflammatory diseases in which pyroptosis plays a role.
MeSH term(s)	Benzoquinones/pharmacology ; Caspase 1/metabolism ; Cell Survival/drug effects ; HSP72 Heat-Shock Proteins/metabolism ; HSP90 Heat-Shock Proteins/antagonists & inhibitors ; HSP90 Heat-Shock Proteins/genetics ; HSP90 Heat-Shock Proteins/metabolism ; Humans ; Inflammasomes/drug effects ; Inflammasomes/metabolism ; Inflammation/drug therapy ; Inflammation/metabolism ; Intracellular Signaling Peptides and Proteins/metabolism ; Lactams, Macrocyclic/pharmacology ; Lipopolysaccharides/toxicity ; Macrolides/pharmacology ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism ; Nigericin/toxicity ; Phosphate-Binding Proteins/metabolism ; Proteasome Endopeptidase Complex/drug effects ; Proteasome Endopeptidase Complex/metabolism ; Protein Stability ; Pyroptosis/drug effects ; Signal Transduction/drug effects ; THP-1 Cells ; Up-Regulation
Chemical Substances	Benzoquinones ; GSDMD protein, human ; HSP72 Heat-Shock Proteins ; HSP90 Heat-Shock Proteins ; Inflammasomes ; Intracellular Signaling Peptides and Proteins ; Lactams, Macrocyclic ; Lipopolysaccharides ; Macrolides ; NLR Family, Pyrin Domain-Containing 3 Protein ; NLRP3 protein, human ; Phosphate-Binding Proteins ; 17-(dimethylaminoethylamino)-17-demethoxygeldanamycin (001L2FE0M3) ; tanespimycin (4GY0AVT3L4) ; Caspase 1 (EC 3.4.22.36) ; Proteasome Endopeptidase Complex (EC 3.4.25.1) ; monorden (I60EH8GECX) ; Nigericin (RRU6GY95IS) ; geldanamycin (Z3K3VJ16KU)
Language	English
Publishing date	2020-06-12
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2969-5
ISSN	1470-8728 ; 0006-2936 ; 0306-3275 ; 0264-6021
ISSN (online)	1470-8728
ISSN	0006-2936 ; 0306-3275 ; 0264-6021
DOI	10.1042/BCJ20200351
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Article ; Online: Human T cell lymphotropic virus type-1 associated lymphoma presenting as an intramuscular mass of the calf.

Gorelik, Natalia / T Hoda, Syed / Petchprapa, Catherine / Liu, Cynthia / Adler, Ronald

Skeletal radiology

2020 Volume 49, Issue 7, Page(s) 1167–1174

Abstract: Adult T cell leukemia/lymphoma (ATLL) is a mature T cell neoplasm caused by the human oncogenic retrovirus human T lymphotropic virus type-1 (HTLV-1). While several musculoskeletal manifestations have been described in ATLL, skeletal muscle involvement ... ...

Abstract	Adult T cell leukemia/lymphoma (ATLL) is a mature T cell neoplasm caused by the human oncogenic retrovirus human T lymphotropic virus type-1 (HTLV-1). While several musculoskeletal manifestations have been described in ATLL, skeletal muscle involvement is unusual, with only four cases reported in the English-language literature. We present a rare case of ATLL manifesting as an intra-muscular calf mass in a 58-year-old man who immigrated to the USA from West Africa. While skeletal muscle involvement by lymphoma is uncommon, it remains important to consider within the differential diagnosis when there are suggestive imaging findings because it entails important technical biopsy considerations as well as treatment implications. This case report also raises awareness of ATLL presenting outside of typical HTLV-1 endemic areas, related to current population migration patterns. ATLL should therefore be considered in patients with appropriate risk factors.
MeSH term(s)	Biopsy, Large-Core Needle ; Diagnosis, Differential ; Fluorodeoxyglucose F18 ; Human T-lymphotropic virus 1 ; Humans ; Leg ; Leukemia-Lymphoma, Adult T-Cell/diagnostic imaging ; Leukemia-Lymphoma, Adult T-Cell/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Neoplasms/diagnostic imaging ; Muscle Neoplasms/drug therapy ; Positron Emission Tomography Computed Tomography ; Radiopharmaceuticals ; Ultrasonography, Doppler
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2020-02-19
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	527592-1
ISSN	1432-2161 ; 0364-2348
ISSN (online)	1432-2161
ISSN	0364-2348
DOI	10.1007/s00256-020-03392-1
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Article: Role of C-Reactive Protein in Predicting the Severity and Response of Immune-Mediated Diarrhea and Colitis in Patients with Cancer.

Liu, Cynthia / Shatila, Malek / Mathew, Antony / Machado, Antonio Pizuorno / Thomas, Austin / Zhang, Hao Chi / Thomas, Anusha S / Faleck, David / Funchain, Pauline / Philpott, Jessica / Grivas, Petros / Obeid, Michel / Carbonnel, Franck / Wang, Yinghong

Journal of Cancer

2023 Volume 14, Issue 10, Page(s) 1913–1919

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2023-06-26
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2573318-7
ISSN	1837-9664
ISSN	1837-9664
DOI	10.7150/jca.84261
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