Malignant fibrous histiocytoma: Changing perceptions and management challenges
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
2012; 67 (6): 1335-1341
Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. This review seeks to provide the practicing dermatologist with a contemporary understanding of MFH in order to guide management decisions. An extensive review of the literature was conducted using PubMed and OVID databases, searching for articles regarding MFH and undifferentiated pleomorphic sarcoma. The modern conception of MFH has changed extensively from clinical and pathologic standpoints. Limitations of the study included the reliability of past studies given the changing nature of MFH as a diagnostic entity. MFH represents an aggressive neoplasm with unique molecular, immunohistochemical, and behavioral characteristics. Practicing clinicians would benefit from a contemporary understanding of these tumors, particularly as a discussion of advances in the conception of MFH is largely absent in the dermatologic literature.
View details for DOI 10.1016/j.jaad.2012.04.013
View details for Web of Science ID 000312131200060
View details for PubMedID 22677489
- A UN summit on global mental health LANCET 2010; 376 (9740): 516-516
A new paradigm for incorporating the joint statement screening guidelines for retinopathy of prematurity into clinical practice: outcomes from a quaternary referral program.
Ophthalmic surgery, lasers & imaging retina
2013; 44 (5): 442-447
This study examines patient experience at a quaternary referral pediatric clinic with a retinopathy of prematurity (ROP) screening program that monitors infants at least on a weekly basis for any stage of ROP.Admission records of 399 prematurely born patients treated at the Byers Eye Institute outpatient ROP clinic were retrospectively reviewed. Patients were categorized according to ROP status and whether they completed, canceled, or failed to show up for scheduled examinations. Demographic information was collected from medical records.Of 1,823 scheduled ROP-related visits, 327 (17.9%) resulted in cancellations and 90 (4.9%) in no-shows, with 238 missed visits due to caregiver-related and 149 due to caregiver-unrelated reasons. Of 399 total patients, 142 (35.6%) canceled or failed to show up for at least one appointment because of caregiver-related reasons.More than one-third of patients with ROP canceled or missed appointments. The true risk of delay is difficult to assess because all patients requiring treatment received it prior to discharge from the hospital. To achieve maximal compliance with joint statement guidelines on ROP screening, patients should be scheduled for examination earlier than recommended. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:442-447.].
View details for DOI 10.3928/23258160-20130909-04
View details for PubMedID 24044706
Academic productivity and its relationship to physician salaries in the University of California Healthcare System.
Southern medical journal
2013; 106 (7): 415-421
To evaluate whether physicians with higher academic productivity, as measured by the number of publications in Scopus and the Scopus Hirsch index (h-index), earn higher salaries.This was a cross-sectional study. Participants were ophthalmologists, otolaryngologists, neurosurgeons, and neurologists classified as "top earners" (>$100,000 annually) within the University of California (UC) healthcare system in 2008. Bibliometric searches on Scopus were conducted to retrieve the total number of publications and Hirsch indices (h-index), a measure of academic productivity. The association between the number of publications and h-index on physicians' total compensation was determined with multivariate regression models after controlling for the four specialties (ophthalmology, otolaryngology, neurosurgery, and neurology), the five institutions (UC San Francisco, UC Los Angeles, UC San Diego, UC Irvine, and UC Davis), and academic rank (assistant professor, associate professor, and professor).The UC healthcare system departments reported 433 faculty physicians among the four specialties, with 71.6% (n = 310) earning more than $100,000 in 2008 and classifying as top earners. After controlling for the specialty, institution, and ranking, there was a significant association between the number of publications on salary (P < 0.000001). Scopus number of publications and h-index were correlated (P < 0.001). Scopus h-index was of borderline significance in predicting physician salary (P = 0.12). Physicians with higher Scopus publications had higher total salaries across all four specialties. Every 10 publications were associated with a 2.40% increase in total salary after controlling for specialty, institution, rank, and chair.Ophthalmologists, otolaryngologists, neurosurgeons, and neurologists in the UC healthcare system who are more academically productive receive greater remuneration.
View details for DOI 10.1097/SMJ.0b013e31829b9dae
View details for PubMedID 23820322
Reconsidering the Diagnostic and Prognostic Utility of LN-2 for Undifferentiated Pleomorphic Sarcoma and Atypical Fibroxanthoma
AMERICAN JOURNAL OF DERMATOPATHOLOGY
2013; 35 (2): 176-179
The topic of distinguishing atypical fibroxanthoma (AFX) from undifferentiated pleomorphic sarcoma (UPS), formerly malignant fibrous histiocytoma, is highly controversial. Although their clinical behavior is disparate, AFX and UPS commonly appear nearly identical on routine histopathologic examination. Although conceptually useful, subcategorization of UPS into superficial (confined to the dermis and subcutaneous tissue) and deep (involvement of fascia and deeper structures) types has not improved our ability to differentiate UPS from AFX. Numerous authors have purported LN-2 (CD74) immunopositivity as able to distinguish UPS from AFX and to predict those rare AFX likely to behave aggressively, although only a single prior study has been dedicated to evaluating this marker. We performed LN-2 staining of 14 AFX, 8 superficial UPS, and 65 deep UPS specimens using an identical protocol as described by prior authors. Of the 73 total UPS specimens, only 1 (1.4%) stained strongly with LN-2, as compared with 3 of 14 (21%) AFX (P = 0.012). One of 2 (50%) clinically aggressive AFX tumors that later exhibited both local recurrence and metastasis stained strongly for LN-2, whereas 2 of 12 (17%) of the more indolent tumors stained strongly with this marker (P = 0.40). Our data do not replicate prior reports of LN-2 as a sensitive and specific marker for UPS, or as indicative of prognosis for AFX, and therefore does not support the use of LN-2 as either a diagnostic or prognostic marker.
View details for DOI 10.1097/DAD.0b013e318265fb9e
View details for Web of Science ID 000316941200009
View details for PubMedID 23000905
Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine
CURRENT EYE RESEARCH
2013; 38 (2): 283-291
To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.
View details for DOI 10.3109/02713683.2012.754902
View details for Web of Science ID 000314900400008
View details for PubMedID 23330739
The Evolving Conception and Management Challenges of Malignant Fibrous Histiocytoma
2012; 38 (12): 1922-1929
Malignant fibrous histiocytoma (MFH) is a rare and aggressive tumor. Mohs micrographic surgery (MMS) has been reported as an effective treatment, although most cases were published before advances in cytopathologic techniques led to reclassification of many tumors.To evaluate a contemporary cohort of individuals with MFH and analyze management practices.We reviewed all cases of MFH diagnosed at our institution from January 1995 to December 2010, evaluating 839 records to identify 36 patients undergoing management of tumors of the head and neck.Seventeen of the total 36 patients (47%; mean age 67) experienced tumor recurrence, and 10 (28%) developed metastases. Seven of nine patients initially treated with MMS (78%), and 10 of 24 (42%) treated with WLE experienced recurrence (p = .06). Patients treated with MMS had smaller tissue defects after surgery. The mean contemporary recurrence rate of MFH treated with MMS is significantly higher (58.8%) than the cumulative recurrence rate reported before 2000 (7.4%) (p < .001).Our study is consistent with reports of MFH as an aggressive neoplasm and describes the largest population treated with MMS in 3 decades. The changing conception of MFH, along with a propensity for in-transit metastases, may explain higher contemporary recurrence rates.
View details for DOI 10.1111/j.1524-4725.2012.02538.x
View details for Web of Science ID 000312217900003
View details for PubMedID 22882717
In Vivo Imaging of Immuno-Spin Trapped Radicals With Molecular Magnetic Resonance Imaging in a Diabetic Mouse Model
2012; 61 (10): 2405-2413
Oxidative stress plays a major role in diabetes. In vivo levels of membrane-bound radicals (MBRs) in a streptozotocin-induced diabetic mouse model were uniquely detected by combining molecular magnetic resonance imaging (mMRI) and immunotrapping techniques. An anti-DMPO (5,5-dimethyl-1-pyrroline N-oxide) antibody (Ab) covalently bound to an albumin (BSA)-Gd (gadolinium)-DTPA (diethylene triamine penta acetic acid)-biotin MRI contrast agent (anti-DMPO probe), and mMRI, were used to detect in vivo levels of DMPO-MBR adducts in kidneys, livers, and lungs of diabetic mice, after DMPO administration. Magnetic resonance signal intensities, which increase in the presence of a Gd-based molecular probe, were significantly higher within the livers, kidneys, and lungs of diabetic animals administered the anti-DMPO probe compared with controls. Fluorescence images validated the location of the anti-DMPO probe in excised tissues via conjugation of streptavidin-Cy3, which targeted the probe biotin moiety, and immunohistochemistry was used to validate the presence of DMPO adducts in diabetic mouse livers. This is the first report of noninvasively imaging in vivo levels of MBRs within any disease model. This method can be specifically applied toward diabetes models for in vivo assessment of free radical levels, providing an avenue to more fully understand the role of free radicals in diabetes.
View details for DOI 10.2337/db11-1540
View details for Web of Science ID 000309304600004
View details for PubMedID 22698922
- Atención al VIH y a la sífilis durante el embarazo (AVSE) en la población indígena y no indígena de México proyecto AVSE Chiapas CENSIDA 2011
CD45RO: A marker for BCR-mediated selection
SCANDINAVIAN JOURNAL OF IMMUNOLOGY
2007; 66 (2-3): 249-260
We previously showed that IgH sequence alone minimally influenced germinal centre (GC) B-cell survival fate. As end-stage effector B cells are typically more mutated than founder GC B cells, we worked to develop an assay that would enrich for populations of GC B cells with progressively increasing numbers of somatic mutations, which could potentially be used as an indicator of positive selection. We targeted CD45 as it has been shown to influence activation-induced cytidine deaminase (AID) expression. In this study, anti-CD77 and anti-CD45RO (RO) were used to subdivide CD19(+)IgD(-)CD38(+)CD77(+) centroblasts (CB) and CD19(+)IgD(-)CD38(+)CD77(-) centrocytes (CC) into three contiguous RO fractions (RO(-), RO(+/-) and RO(+)) and assessed whether mutation frequency and characteristics associated with selection varied with respect to increasing RO expression. Here, we show that the average number of mutations per IgV(H)4 transcript increased concordantly with RO for CC, but not for CB. CC also exhibited an RO-associated increase in replacement mutations. Comparative analysis of clonally related sequences revealed that increased mutations were not due to the exclusive persistence of surface RO on highly mutated cells. RO-expressing CC and CB pools showed increased signs of activation (CD69(+)) and were enriched for surface Ig(+) cells. BCR-crosslinking induced a significant increase in surface RO on total tonsillar and GC B cells, which collectively suggests that the RO-associated increase in mutations is attributable, at least in part, to the cycling of cells that may have recently undergone BCR-mediated selection, or are potentially in developmental transition between CC and CB stages.
View details for DOI 10.1111/j.1365-3083.2007.01985.x
View details for Web of Science ID 000248504100018
View details for PubMedID 17635802