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385 results on '"Christ, Alexander B."'

1. What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Author

Kendal, Joseph K, Hamad, Christopher D, Abbott, Annalise G, Greig, Danielle, Trikha, Rishi, Christ, Alexander B, Wessel, Lauren E, Puloski, Shannon KT, Monument, Michael J, and Bernthal, Nicholas M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Cancer, Kidney Disease, Bioengineering, Rare Diseases, 6.4 Surgery, Humans, Prosthesis Design, Carcinoma, Renal Cell, Survivorship, Prosthesis Failure, Treatment Outcome, Risk Factors, Femoral Neoplasms, Bone Neoplasms, Kidney Neoplasms, Extremities, Retrospective Studies, Reoperation, bone neoplasms, endoprostheses, metastasis, orthopedic surgery, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

Background and objectivesGiven advances in therapies, endoprosthetic reconstruction (EPR) in metastatic bone disease (MBD) may be increasingly indicated. The objectives were to review the indications, and implant and patient survivorship in patients undergoing EPR for MBD.MethodsA review of patients undergoing EPR for extremity MBD between 1992 and 2022 at two centers was performed. Surgical data, implant survival, patient survival, and implant failure modes were examined.ResultsOne hundred fifteen patients were included with a median follow-up of 14.9 months (95% confidence interval [CI]: 9.2-19.3) and survival of 19.4 months (95% CI: 13.6-26.1). The most common diagnosis was renal cell carcinoma (34/115, 29.6%) and the most common location was proximal femur (43/115, 37.4%). Indications included: actualized fracture (58/115, 50.4%), impending fracture (30/115, 26.1%), and failed fixation (27/115, 23.5%). Implant failure was uncommon (10/115, 8.7%). Patients undergoing EPR for failed fixation were more likely to have renal or lung cancer (p = 0.006).ConclusionsEPRs were performed most frequently for renal cell carcinoma and in patients with a relatively favorable survival. EPR was indicated for failed previous fixation in 23.5% of cases, emphasizing the importance of predictive survival modeling. EPR can be a reliable and durable surgical option for patients with MBD.

Published
2023

2. Duloxetine for Postoperative Pain Control Following Knee or Hip Replacement: A Systematic Review and Meta-Analysis

Author

Jones, Ian A, Talehakimi, Arad, Murphy, Linda S, Wang, Jennifer C, Piple, Amit S, Christ, Alexander B, and Heckmann, Nathanael D

Subjects
Pharmacology and Pharmaceutical Sciences, Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Arthritis, Pain Research, Neurodegenerative, Chronic Pain, Neurosciences, Drug Abuse (NIDA only), Clinical Research, Substance Misuse, Musculoskeletal, Arthroplasty, Duloxetine, Pain catastrophizing, THA, TKA
Abstract

BackgroundDuloxetine is a Food and Drug Administration-approved selective norepinephrine reuptake inhibitor for treating depression, anxiety, fibromyalgia, and neuropathic and chronic musculoskeletal pain. This meta-analysis aims to evaluate the efficacy of duloxetine in reducing pain and postoperative opioid use following lower extremity total joint arthroplasty.MethodsA literature search was performed, identifying randomized controlled trials investigating duloxetine for pain management after total hip and total knee arthroplasty. Data from the visual analog scale (VAS) for pain during movement and at rest were extracted for postoperative days (PODs) 1, 3, 7, and 14, as well as postoperative week 6 and postoperative month 3. Opioid use data were obtained at 24, 48 and 72 hours. All data were analyzed using inverse variance with random effects and presented as weighted mean difference.ResultsEight unique studies were identified and included, 7 of which were analyzed quantitatively. Duloxetine decreased postoperative opioid consumption at 48 and 72 hours. For VAS for pain at rest, significantly reduced pain was reported by duloxetine-treated patients at POD 3, POD 7, and postoperative week 6. For VAS for pain at movement, significantly reduced pain was reported by duloxetine-treated patients at POD1, POD 3, POD 7, POD 14, postoperative week 6, and postoperative month 3.ConclusionsDuloxetine appears to decrease postoperative pain and opioid consumption following total joint arthroplasty. However, definitive conclusions are limited by small sample size and study heterogeneity. While there is a need for follow-up studies to determine the optimal dose, duration, and patient population, strong preliminary data provide robust support for future large-scale efficacy studies.

Published
2023

38. HPMA-Copolymer Nanocarrier Targets Tumor-Associated Macrophages in Primary and Metastatic Breast Cancer.

Author

Zimel, Melissa N, Horowitz, Chloe B, Rajasekhar, Vinagolu K, Christ, Alexander B, Wei, Xin, Wu, Jianbo, Wojnarowicz, Paulina M, Wang, Dong, Goldring, Steven R, Purdue, P Edward, and Healey, John H

Subjects
Macrophages, Animals, Humans, Mice, Breast Neoplasms, Neoplasm Metastasis, Disease Models, Animal, Methacrylates, Polymers, Female, Cancer, Breast Cancer, Biotechnology, Oncology and Carcinogenesis, Pharmacology and Pharmaceutical Sciences, Oncology & Carcinogenesis
Abstract

Polymeric nanocarriers such as N-(2-hydroxypropyl) methacrylamide (HPMA) copolymers deliver drugs to solid tumors and avoid the systemic toxicity of conventional chemotherapy. Because HPMA copolymers can target sites of inflammation and accumulate within innate immune cells, we hypothesized that HPMA copolymers could target tumor-associated macrophages (TAM) in both primary and metastatic tumor microenvironments. We verified this hypothesis, first in preliminary experiments with isolated bone marrow macrophage cultures in vitro and subsequently in a spontaneously metastatic murine breast cancer model generated from a well-established, cytogenetically characterized 4T1 breast cancer cell line. Using our standardized experimental conditions, we detected primary orthotopic tumor growth at 7 days and metastatic tumors at 28 days after orthotopic transplantation of 4T1 cells into the mammary fat pad. We investigated the uptake of HPMA copolymer conjugated with Alexa Fluor 647 and folic acid (P-Alexa647-FA) and HPMA copolymer conjugated with IRDye 800CW (P-IRDye), following their retroorbital injection into the primary and metastatic tumor-bearing mice. A significant uptake of P-IRDye was observed at all primary and metastatic tumor sites in these mice, and the P-Alexa647-FA signal was found specifically within CD11b+ TAMs costained with pan-macrophage marker CD68. These findings demonstrate, for the first time, a novel capacity of a P-Alexa647-FA conjugate to colocalize to CD11b+CD68+ TAMs in both primary and metastatic breast tumors. This underscores the potential of this HPMA nanocarrier to deliver functional therapeutics that specifically target tumor-promoting macrophage activation and/or polarization during tumor development. Mol Cancer Ther; 16(12); 2701-10. ©2017 AACR.

Published
2017

41. Postoperative outcomes and trends in computer-navigated and robotic-assisted total hip arthroplasty.

Author

Piple, Amit S, Wang, Jennifer C, Hill, William, Chen, Matthew S, Gettleman, Brandon S, Liu, Kevin C, Heckmann, Nathanael D, and Christ, Alexander B

Subjects
SURGICAL robots, RISK assessment, TOTAL hip replacement, MORPHINE, PROSTHESIS-related infections, TREATMENT effectiveness, MULTIVARIATE analysis, DESCRIPTIVE statistics, COMPUTER-assisted surgery, SURGICAL complications, JOINT dislocations, OPIOID analgesics, STATISTICS, POSTOPERATIVE period, BLOOD transfusion, PERIPROSTHETIC fractures, DISEASE risk factors
Abstract

Introduction: As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA. Methods: The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1. Results: Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA. Discussion: CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption. [ABSTRACT FROM AUTHOR]

Published
2024
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