Research Spotlight

Baylor Health Sciences Library brings to you each month the latest published research from the Baylor Scott & White community. Each newly published article features the researcher, the abstract, and link to the full text. For information on including your own research, please contact John Fullinwider, john.fullinwider@baylorhealth.edu. 214-828-8989.


Posted August 15th 2018

Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial.

James W. Fleshman M.D.

James W. Fleshman M.D.

Fleshman, J., M. E. Branda, D. J. Sargent, A. M. Boller, V. V. George, M. A. Abbas, W. R. Peters, Jr., D. C. Maun, G. J. Chang, A. Herline, A. Fichera, M. G. Mutch, S. D. Wexner, M. H. Whiteford, J. Marks, E. Birnbaum, D. A. Margolin, D. W. Larson, P. W. Marcello, M. C. Posner, T. E. Read, J. R. T. Monson, S. M. Wren, P. W. T. Pisters and H. Nelson (2018). “Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial.” Ann Surg Aug 3. [Epub ahead of print].

Full text of this article.

OBJECTIVE: To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. BACKGROUND: This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051. METHODS: The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months. RESULTS: The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4-84.9) and OPEN 83.2% (95% CI 78.3-88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN.Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21-2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85-3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40-3.79); positive distal margin (HR 2.53, 95% CI 1.30-3.77). CONCLUSION: Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.


Posted August 15th 2018

Additional arterial conduits in coronary artery bypass surgery: Finally coming of age.

Michael J. Mack M.D.

Michael J. Mack M.D.

Gaudino, M., M. J. Mack and D. P. Taggart (2018). “Additional arterial conduits in coronary artery bypass surgery: Finally coming of age.” J Thorac Cardiovasc Surg 156(2): 541-543.

Full text of this article.

At 50 years, CABG has entered a mature phase. It is now time to clarify the effect of procedural characteristics on clinical outcomes and to define the most appropriate strategy for each individual patient. Observational data have intrinsic biases and should only be considered hypothesis-generating. Randomized trials remain the only way to solve the conundrum of arterial grafts. International collaboration will be key to the success of this process. (Excerpt from text, p. 543; no abstract available.)


Posted August 15th 2018

A phase 1 trial of vadastuximab talirine combined with hypomethylating agents in patients with CD33 positive AML.

Moshe Y. Levy M.D.

Moshe Y. Levy M.D.

Fathi, A. T., H. P. Erba, J. E. Lancet, E. M. Stein, F. Ravandi, S. Faderl, R. B. Walter, A. S. Advani, D. J. DeAngelo, T. J. Kovacsovics, A. Jillella, D. Bixby, M. Y. Levy, M. M. O’Meara, P. A. Ho, J. Voellinger and A. S. Stein (2018). “A phase 1 trial of vadastuximab talirine combined with hypomethylating agents in patients with CD33 positive AML.” Blood Jul 25. [Epub ahead of print].

Full text of this article.

Treatment of acute myeloid leukemia (AML) among the elderly is challenging due to intolerance of intensive therapy and therapy-resistant biology. Hypomethylating agents (HMAs) are commonly used, with suboptimal outcomes. Vadastuximab talirine is a CD33 directed antibody conjugated to pyrrolobenzodiazepine (PBD) dimers. Preclinically, HMA followed by vadastuximab talirine produced upregulated CD33 expression, increased DNA incorporation by PBD, and enhanced cytotoxicity. A combination cohort in a phase 1 study (NCT01902329) assessed safety, tolerability, and activity of vadastuximab talirine with HMA. Those eligible had Eastern Cooperative Oncology Group (ECOG) status 0-1, previously untreated CD33 positive AML, and declined intensive therapy. Vadastuximab talirine was administered intravenously at 10 mug/kg on last day of HMA (azacitidine or decitabine) infusion, in four week cycles. Among 53 patients treated, median age was 75 years. Patients had adverse (38%) or intermediate (62%) cytogenetic risk. Median treatment duration was 19.3 weeks. No dose limiting toxicities were reported. Majority of adverse events were due to myelosuppression, with some causing therapy delays. Thirty- and 60 day mortality rates were 2% and 8%. The composite remission rate (complete remission [CR] and CR with incomplete blood count recovery [CRi]) was 70%. Fifty one percent of remissions were minimal residual disease (MRD) negative by flow cytometry. Similarly high remission rates were observed in patients with secondary AML, aged >/=75 years, and with adverse cytogenetic risk. Median relapse free survival and overall survival were 7.7 and 11.3 months, respectively.


Posted August 15th 2018

Chronic lymphocytic leukemia with proliferation centers in bone marrow is associated with younger age at initial presentation, complex karyotype and TP53 disruption.

Alireza Salem M.D.

Alireza Salem M.D.

Garces, S., J. D. Khoury, R. Kanagal-Shamanna, A. Salem, S. A. Wang, C. Y. Ok, S. Hu, K. P. Patel, M. J. Routbort, R. Luthra, G. Tang, E. J. Schlette, C. E. Bueso-Ramos, L. J. Medeiros and S. Loghavi (2018). “Chronic lymphocytic leukemia with proliferation centers in bone marrow is associated with younger age at initial presentation, complex karyotype and TP53 disruption.” Hum Pathol Aug 4. [Epub ahead of print].

Full text of this article.

The presence of expanded proliferation centers (PCs) in lymph nodes involved by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has been associated with adverse clinical outcomes, but the frequency and significance of PCs in bone marrow (BM) remains unclear. The study group included 36 patients with BM involvement by CLL in which PCs were present. We compared this group with 110 randomly selected BM samples involved by CLL without morphologically discernable PCs. Patients with PCs in BM were younger (median age, 53years [range,18-71] versus 58years [range, 31-82]; P=.007), more frequently experienced B-symptoms (27.8% versus 8.2%, P=.0076), more often had Rai stage IV disease (30.6% versus 17.3, P=.020), higher serum lactate dehydrogenase (P=.0037) and beta-2- microglobulin (P=.0001) levels, and lower median hemoglobin (P=.026) and platelet counts (P=.0422). TP53 alterations were more common in patients with PCs in BM (45.4% versus 18.7%; P=.0049) as was a complex karyotype (26.4% versus 9%; P=.019). There were no significant differences in the frequency of ZAP70 or CD38 positivity or IGHV mutation status. The median time to first treatment was shorter in patients with PCs in BM (7 versus 19months, P=.047) and the frequency of Richter syndrome was higher (14% versus 4%, P=.041). Patients with PCs in BM had significantly shorter overall survival compared with the control group (median 249.3 vs. undefined; P=.0241). These data suggest that identification of PCs in BM samples involved by CLL is associated with adverse prognostic features.


Posted August 15th 2018

The impact of informal leader nurses on patient satisfaction.

Kristen M. Tecson Ph.D.

Kristen M. Tecson Ph.D.

Douglas Lawson, T., K. M. Tecson, C. N. Shaver, S. A. Barnes and S. Kavli (2018). “The impact of informal leader nurses on patient satisfaction.” J Nurs Manag Jul 11. [Epub ahead of print].

Full text of this article.

BACKGROUND: The relationship between informal leaders, i.e., highly competent individuals who have influence over peers without holding formal leadership positions, and organisational outcomes has not been adequately assessed in health care. AIMS: We evaluated the relationships between informal leaders and experience, job satisfaction and patient satisfaction, among hospital nurses. METHODS: Floor nurses in non-leadership positions participated in an online survey and rated colleagues’ leadership behaviours. Nurses identified as informal leaders took an additional survey to determine their leadership styles via the Multifactor Leadership Questionnaire(TM) . Six months of patient satisfaction data were linked to the nursing units. RESULTS: A total of 3,456 (91%) nurses received peer ratings and 628 (18%) were identified as informal leaders. Informal leaders had more experience (13.2 +/- 10.9 vs. 8.4 +/- 9.7 years, p < 0.001) and higher job satisfaction than their counterparts (4.8 +/- 1.2 vs. 4.5 +/- 1.1, p = 0.007). Neither the proportion of informal leaders on a unit nor leadership style was associated with patient satisfaction (p = 0.53, 0.46, respectively). CONCLUSION: While significant relationships were not detected between patient satisfaction and styles/proportion of informal leaders, we found that informal leaders had more years of experience and higher job satisfaction. More work is needed to understand the informal leaders' roles in achieving organisational outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse informal leaders are unique resources and health care organisations should utilise them for optimal outcomes.