Brieze R. Keeley

From the operating room to the courtroom

Malpractice litigation has increased in recent decades, contributing to higher health‐care costs. Characterization of complications leading to litigation is of special interest to practitioners of facial plastic surgery procedures because of the higher proportion of elective cases relative to other subspecialties. In this analysis, we comprehensively examine malpractice litigation in facial plastic surgery procedures and characterize factors important in determining legal responsibility, as this information may be of great interest and use to practitioners in several specialties.

Characterizing liability for cranial nerve injuries: A detailed analysis of 209 malpractice trials

The potential for adverse events with lasting functional effects makes cranial nerve (CN) injury a target for litigation. Our objective was to comprehensively examine records of malpractice trials and detail issues influencing outcomes.

Regional disparities and practice patterns in surgical approaches to pituitary tumors in the United States

Traditional microscopic and endoscopic transsphenoidal approaches (TSAs) are the most common surgical techniques in pituitary surgery. Examining regional practice patterns in pituitary surgery can provide valuable insights into which surgical strategies are most accessible, effective, and cost‐efficient. In this study we investigated regional variations in surgical approaches to pituitary tumors and evaluated evolving practice patterns in pituitary surgery.

Meat intake and risk of diverticulitis among men

Objective Diverticulitis is a common disease with a substantial clinical and economic burden. Besides dietary fibre, the role of other foods in the prevention of diverticulitis is underexplored. Design We prospectively examined the association between consumption of meat (total red meat, red unprocessed meat, red processed meat, poultry and fish) with risk of incident diverticulitis among 46 461 men enrolled in the Health Professionals Follow-Up Study (1986–2012). Cox proportional hazards models were used to compute relative risks (RRs) and 95% CIs. Results During 651 970 person-years of follow-up, we documented 764 cases of incident diverticulitis. Compared with men in the lowest quintile (Q1) of total red meat consumption, men in the highest quintile (Q5) had a multivariable RR of 1.58 (95% CI 1.19 to 2.11; p for trend=0.01). The increase in risk was non-linear, plateauing after six servings per week (p for non-linearity=0.002). The association was stronger for unprocessed red meat (RR for Q5 vs Q1: 1.51; 95% CI 1.12 to 2.03; p for trend=0.03) than for processed red meat (RR for Q5 vs Q1: 1.03; 95% CI 0.78 to 1.35; p for trend=0.26). Higher consumption of poultry or fish was not associated with risk of diverticulitis. However, the substitution of poultry or fish for one serving of unprocessed red meat per day was associated with a decrease in risk of diverticulitis (multivariable RR 0.80; 95% CI 0.63 to 0.99). Conclusions Red meat intake, particularly unprocessed red meat, was associated with an increased risk of diverticulitis. The findings provide practical dietary guidance for patients at risk of diverticulitis.

Clinical characteristics and outcomes of oropharyngeal carcinoma related to high-risk non–human papillomavirus16 viral subtypes

The majority of human papillomavirus (HPV)‐related oropharyngeal carcinomas (OPCs) are associated with HPV genotype 16; however, OPC can be associated with other high‐risk non‐HPV16 genotypes.

Prediagnostic serum levels of inflammatory biomarkers are correlated with future development of lung and esophageal cancer

This study tests the hypothesis that prediagnostic serum levels of 20 cancer‐associated inflammatory biomarkers correlate directly with future development of head and neck, esophageal, and lung cancers in a high‐risk prospective cohort. This is a nested case–control pilot study of subjects enrolled in the Golestan Cohort Study, an ongoing epidemiologic project assessing cancer trends in Golestan, Iran. We measured a panel of 20 21cytokines, chemokines, and inflammatory molecules using Luminex technology in serum samples collected 2 or more years before cancer diagnosis in 78 aerodigestive cancer cases and 81 controls. Data was analyzed using Wilcoxon rank sum test, odds ratios, receiver operating characteristic areas of discrimination, and multivariate analysis. Biomarkers were profoundly and globally elevated in future esophageal and lung cancer patients compared to controls. Odds ratios were significant for association between several biomarkers and future development of esophageal cancer, including interleukin‐1Rα (IL‐1Ra; 35.9), interferon α2 (IFN‐a2; 34.0), fibroblast growth factor‐2 (FGF‐2; 17.4), and granulocyte/macrophage colony‐stimulating factor (GM‐CSF; 17.4). The same pattern was observed among future lung cancer cases for G‐CSF (27.7), GM‐CSF (13.3), and tumor necrosis factor‐α (TNF‐a; 8.6). By contrast, the majority of biomarkers studied showed no significant correlation with future head and neck cancer development. This study provides the first direct evidence that multiple inflammatory biomarkers are coordinately elevated in future lung and esophageal cancer patients 2 or more years before cancer diagnosis.

Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men

Objectives:Diverticulitis is a common disease with high clinical burden. We evaluated the joint contribution of multiple lifestyle factors to risks of incident diverticulitis. We also estimated the proportion of diverticulitis preventable by lifestyle modifications.Methods:We prospectively examined the association between lifestyle factors (red meat, dietary fiber intake, vigorous physical activity (activity with metabolic equivalent ≥6), body mass index (BMI), and smoking) and risk of diverticulitis among participants in the Health Professionals Follow-Up Study.Results:We documented 907 incident cases of diverticulitis during 757,791 person-years. High intake of red meat, low intake of dietary fiber, low vigorous physical activity, high BMI, and smoking were independently associated with increased risks of diverticulitis (all P<0.05). Low-risk lifestyle was defined as average red meat intake <51 g per day, dietary fiber intake in the top 40% of the cohort (about 23 g per day), vigorous physical activity in the highest 50% among participants with non-zero vigorous physical activity (roughly 2 h of exercise weekly), normal BMI between 18.5–24.9 kg m−2, and never-smoker. There was an inverse linear relationship between number of low-risk lifestyle factors and diverticulitis incidence (P for trend<0.001). Compared with men with no low-risk lifestyle factors, the multivariable relative risks of diverticulitis were 0.71 (95% confidence interval (CI): 0.59–0.87) for men with 1 low-risk lifestyle factor; 0.66 (95% CI: 0.55–0.81) for 2 low-risk factors; 0.50 (95% CI: 0.40–0.62) for 3 low-risk factors; 0.47 (95% CI: 0.35–0.62) for 4 low-risk factors, and 0.27 (95% CI: 0.15–0.48) for 5 low-risk factors. Adherence to a low-risk lifestyle could prevent 50% (95% CI: 20–71%) of incident diverticulitis.Conclusions:Adherence to a low-risk lifestyle is associated with reduced incidence of diverticulitis.

Biologic Drugs and Malignancy: A Literature Review Examining the Impact of Concomitant Immunosuppressive Medications

The objective of this work was to conduct a systematic review of the frequency with which concomitant immunosuppressive medication(s) are used in patients receiving biologics who develop malignancy. We conducted a PubMed search using the term “malignancy” and specific cancers combined with “biologic” and specific biologic drug names to identify case reports and case series written in English documenting patients who were diagnosed with malignancy while being treated with a biologic agent. Demographic information, biologic medication including treatment indication, malignancy type, time to malignancy diagnosis, patient outcome, and information regarding concomitant usage of immunosuppressive medication(s) were recorded. A total of 210 patients from 78 case reports and 21 case series met inclusion criteria and were evaluated. Among patients who developed malignancy while on biologic therapy, 64.8% were simultaneously being treated with ≥1 other immunosuppressive medication. A median time of 12 months was observed between initiation of biologic therapy and development of disease in this cohort. Methotrexate (28.6%) and azathioprine (23.8%) were the most common concomitant therapies. When compared with patients receiving biologic monotherapy, patients who received biologics with other immunosuppressive medications experienced 3.21 times more deaths because of malignancy with an odds ratio of 2.12 (95% CI, 1.07–4.19). The risk of malignancy among patients receiving biologic therapy is significantly confounded by the prevalent use of concomitant immunosuppressive medication(s). This risk may be overestimated, particularly for patients who take biologic drugs as monotherapy.

Palliative Care Education in Cardiology

Advanced heart disease (AHD) represents a significant health burden worldwide. Due to an aging population and improved treatments for AHD, cardiologists will increasingly care for patients toward the end of life (EOL). Despite growing evidence that the integration of palliative care (PC) for

Abstract 890: Serum inflammatory biomarkers predict esophageal and lung cancer risk two years prior to diagnosis in a prospective cohort

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA Background: Cancer-associated inflammation drives the progression, growth, and metastasis of many established tumors, including those of the head & neck, esophagus, and lung. Limited evidence from non-aerodigestive cancers suggests that quantifiable immunologic dysfunction may precede the emergence of some clinically detectable tumors. The Golestan region of Iran provides a unique opportunity to further study the relationship between chronic inflammation and aerodigestive cancer risk, as it features a very high incidence of esophageal squamous cell carcinoma despite remarkably low prevalence of typical confounders, including tobacco and alcohol use. This study tests the hypothesis that a comprehensive panel of cancer-associated serum inflammatory biomarkers can accurately predict risk of head & neck, esophageal, and lung cancers in a prospective, high-risk cohort. Methods: This is a nested case-control pilot study of subjects enrolled in the Golestan Cohort Study, an ongoing epidemiologic project assessing cancer trends in Golestan, Iran. We measured a broad panel of cytokines, chemokines, and inflammatory molecules using Luminex® technology in serum samples collected two or more years before cancer diagnosis in 78 aerodigestive cancer cases and 81 controls. Data was analyzed using Wilcoxon rank-sum test, ROC areas of discrimination, and multivariate analysis. Results: Mean age of 159 study subjects was 60 years. Median levels (pg/ml) of several biomarkers were profoundly elevated in future esophageal and lung cancer patients, respectively, as compared to controls, including FGF-2 (341.9 and 306.7 versus 139.6, p 69% as compared to controls. Among data-linked controls, biomarker levels tended to be higher with older age, Turkmen ethnicity, and cigarette smoking, but these correlations were non-significant. Conclusions: This study provides the first direct evidence that multiple inflammatory biomarkers are coordinately elevated in future lung and esophageal cancer patients at least two years before cancer diagnosis, suggesting that baseline serum levels of certain cancer-associated biomarkers may represent a useful adjunctive screening measure to determine aerodigestive cancer risk. Citation Format: Brieze R. Keeley, Farhad Islami, Akram Pourshams, Hossein Poustchi, Jamie S. Pak, Paul Brennan, Hooman Khademi, Shu-hsia Chen, Eric M. Genden, Christian C. Abnet, Sanford M. Dawsey, Paolo Boffetta, Reza Malekzadeh, Andrew G. Sikora. Serum inflammatory biomarkers predict esophageal and lung cancer risk two years prior to diagnosis in a prospective cohort. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 890. doi:10.1158/1538-7445.AM2014-890