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Barbera M, Perera D, Matton A, Mangialasche F, Rosenberg A, Middleton L, Ngandu T, Solomon A, Kivipelto M. Multimodal Precision Prevention - A New Direction in Alzheimer's Disease. J Prev Alzheimers Dis 2023; 10:718-728. [PMID: 37874092 DOI: 10.14283/jpad.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
At least 40% of all dementia has been linked to modifiable risk factors suggesting a clear potential for preventative approaches targeting these factors. Despite the recent promising findings from anti-amyloid monoclonal antibodies, a limited proportion of patients are expected to be eligible for these novel AD treatments. Given the heterogeneous nature of AD and the complex multi-level pathological processes leading to dementia (involving, e.g., shared risk factors, interaction of different pathology mechanisms, and their putative synergistic effects on cognition), targeting a single pathology may not be sufficient to halt or significantly impact disease progression. With exponentially increasing numbers of patients world-wide, in parallel to the unprecedented population ageing, new multimodal therapy approaches targeting several modifiable risk factors and disease mechanisms simultaneously are urgently required. Developing the next generation of combination therapies with lifestyle intervention and pharmacological treatments, implementing the right interventions for the right people at the right time, and defining accessible and sustainable strategies worldwide are crucial. Here, we summarize the state-of-the-art multimodal lifestyle-based approaches, especially findings and lessons learned from the FINGER trial, for prevention and risk reduction of cognitive impairment and dementia. We also discuss some emerging underlying biological mechanisms and the current development of precision prevention approaches. We present an example of a novel trial design combining healthy lifestyle changes with a repurposed putative disease-modifying drug and place this study in the context of the World-Wide FINGERS, the first interdisciplinary network of multimodal trials dedicated to the prevention and risk reduction of cognitive impairment and dementia.
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Affiliation(s)
- M Barbera
- Miia Kivipelto, Address: Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64 Solna, Sweden, , Phone: +46 73-994-0922
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Pearson A, Muzaffar J, Bellile E, Worden F, Chung C, Rosenberg A, Vokes E, Fidler M, Brenner J, Zhai Y, Fu T, Winkler R, Swiecicki P. Phase I/II study of a novel MDM-2 inhibitor (APG-115) in TP53 wild type salivary gland cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sindi S, Thunborg C, Rosenberg A, Andersen P, Andrieu S, Broersen LM, Coley N, Couderc C, Duval CZ, Faxen-Irving G, Hagman G, Hallikainen M, Håkansson K, Lehtisalo J, Levak N, Mangialasche F, Pantel J, Kekkonen E, Rydström A, Stigsdotter-Neely A, Wimo A, Ngandu T, Soininen H, Hartmann T, Solomon A, Kivipelto M. Multimodal Preventive Trial for Alzheimer's Disease: MIND-ADmini Pilot Trial Study Design and Progress. J Prev Alzheimers Dis 2022; 9:30-39. [PMID: 35098971 PMCID: PMC8783958 DOI: 10.14283/jpad.2022.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer’s disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. Objectives To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. Methods MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/ care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. Results Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. Conclusions For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).
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Affiliation(s)
- S Sindi
- Professor Miia Kivipelto, MD, PhD, Karolinska Institutet, Dept NVS, Division of Clinical Geriatrics, Center for Alzheimer Research QA32, Karolinska vägen 37 A, SE-171 64 Solna, Sweden; Mobile: +46 (0)73 99 409 22,
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Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. MA03.03 NBTXR3 Activated by SBRT Combined with Nivolumab or Pembrolizumab in Patients With Advanced Cancers: Phase I Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Altan M, Patnaik A, Barve M, Dunn L, Cobb P, Rosenberg A, Sharma S, Sukari A, Lee Z, Marcondes M, Zalevsky J, Tagliaferri M, Kotzin B, Sacco A. 1026TiP A phase Ib/II, open-label, multicenter, dose-escalation and dose-expansion study of NKTR-255 plus cetuximab as a salvage regimen in patients with solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rosenberg A, Agrawal N, Gooi Z, Blair E, Pearson A, Juloori A, Portugal L, Chin J, Cursio J, Lingen M, Haraf D, Vokes E. 867P A phase I trial of nab-paclitaxel-based induction followed by nab-paclitaxel-based concurrent chemotherapy and re-irradiation in previously treated head and neck squamous cell carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Vivar O, Shen C, Frakes J, Niu J, Rosenberg A, Weiss J, Caudell J, Jameson K, Said P, Seiwert T. PH-0053 NBTXR3 activated by SBRT combined with nivolumab or pembrolizumab in advanced cancers: phase I trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis 2021; 7:29-36. [PMID: 32010923 PMCID: PMC7222931 DOI: 10.14283/jpad.2019.41] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.
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Affiliation(s)
- A Rosenberg
- Miia Kivipelto, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, Phone: +46 (0)73 99 40 922,
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Drori Y, Pando R, Sefty H, Rosenberg A, Mendelson E, Keinan-Boker L, Shohat T, Mandelboim M, Glatman-Freedman A. Influenza vaccine effectiveness against laboratory-confirmed influenza in a vaccine-mismatched influenza B-dominant season. Vaccine 2020; 38:8387-8395. [PMID: 33243633 DOI: 10.1016/j.vaccine.2020.10.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 2017-2018 influenza season in Israel was characterized by the predominance of influenza B Yamagata, with a lesser circulation of influenza A(H1N1)pdm09 and influenza A(H3N2). We estimated vaccine effectiveness (VE) of the inactivated influenza vaccine which was selected for use that season. METHODS End-of-season VE and 95% confidence intervals (CI) against laboratory-confirmed influenza-like illness (ILI) were estimated by means of the test-negative design. Age-specific VE analysis was carried out using a moving age interval. RESULTS Specimen were obtained from 1,453 community ILI patients; 610 (42.0%) were influenza-positive, among which 69.7% were B, 17.2% A(H1N1)pdm09 and 13.4% A(H3N2). A 98.6% of molecularly characterized influenza B belonged to the Yamagata lineage. Of the sampled individuals, 1320 were suitable for VE analysis. Of those vaccinated, 90.6% received the inactivated trivalent influenza vaccine (TIV) containing a Victoria lineage influenza B-like virus. VE against influenza A differed by age, with the highest VE of 72.9% (95%CI 31.9-89.2%) observed in children 0.5-14 years old, while all ages VE was 46.6% (95%CI 10.4-68.2%). All ages VE against influenza B was 23.2% (95%CI -10.1-46.4%) with age-specific analysis showing non-significant VE estimates. Utilizing a moving age interval of 15 years, afforded a detailed age-specific insight into influenza VE against the influenza viruses circulating during the 2017-2018 season. CONCLUSIONS The moderate-high 2017-2018 influenza A VE among children and adolescents, supports seasonal influenza vaccination at a young age. The low VE against influenza B in Israel, is most likely the result of influenza B/TIV-mismatch.
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Affiliation(s)
- Y Drori
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - R Pando
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - H Sefty
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - A Rosenberg
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - E Mendelson
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - T Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Glatman-Freedman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ayub S, Al-Duwal Z, Sellers D, Rosenberg A. Primary Cutaneous Follicle Center Lymphoma (PCFCL) with Parotid Gland Involvement. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement.
Methods
First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases.
Results
Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared.
Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10.
Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases.
Conclusion
Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.
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Affiliation(s)
- S Ayub
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - Z Al-Duwal
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - D Sellers
- Pathology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
| | - A Rosenberg
- Dermatology, The MetroHealth System, Cleveland, Ohio, UNITED STATES
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Le X, Gluck I, Maurice-Dror C, Panwar A, Gold K, Berlin J, Dai T, Grewal J, Nagasaka M, Rosenberg A, Haigentz M, Le Tourneau C, Moreno I, McDevitt M, Patel M, Da Costa D, Lambert S, Li Y, Blaney M, Gillison M. 975TiP Phase Ib trial of ABBV-368 + tilsotolimod in combination with nab-paclitaxel and/or budigalimab (ABBV-181) in patients with recurrent/metastatic head and neck squamous cell carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Do W, Elzerman T, de Bree R, Rosenberg A, Forouzanfar T, Van Cann EM. Is low or high body mass index in patients operated for oral squamous cell carcinoma associated with the perioperative complication rate? Int J Oral Maxillofac Surg 2020; 50:591-597. [PMID: 32861557 DOI: 10.1016/j.ijom.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to analyse the effect of body mass index (BMI), both low and high values, on the perioperative complication rate in patients with oral squamous cell carcinoma (OSCC). The medical records of 259 patients operated between 2014 and 2017 for OSCC were reviewed. Univariate and multivariate analyses were performed. Sixty of the 259 patients developed 87 complications. Low or high BMI was not associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade. Low BMI, American Society of Anesthesiologists score 2 and 3, a longer operating time, and increased blood loss were associated with a longer hospital stay. Low BMI was associated with a longer hospital stay. Neither low nor high BMI was associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien-Dindo grade.
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Affiliation(s)
- W Do
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Elzerman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands
| | - T Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, the Netherlands.
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Krebs E, Jayaraman S. The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center. Traffic Inj Prev 2020; 21:488-493. [PMID: 32678676 PMCID: PMC7500827 DOI: 10.1080/15389588.2020.1785623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU. METHODS SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016. RESULTS Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%). CONCLUSION Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.
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Affiliation(s)
- A Rosenberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Dworkin
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - V Nsengimana
- Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - E Kankindi
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - M Niyonsaba
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - J M Uwitonze
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - I Kabagema
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - T Dushime
- Service d'Aide Medicale Urgente, Rwanda Ministry of Health, Kigali, Rwanda
| | - E Krebs
- School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| | - S Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia
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Rosenberg A, Uwinshuti FZ, Dworkin M, Nsengimana V, Kankindi E, Niyonsaba M, Uwitonze JM, Kabagema I, Dushime T, Jayaraman S, Krebs E. Data-driven prehospital training to decrease motorcycle crash deaths in a Sub-Saharan African urban center. Traffic Inj Prev 2019; 20:S207-S208. [PMID: 32296289 PMCID: PMC7158746 DOI: 10.1080/15389588.2019.1665438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- A Rosenberg
- Virginia Commonwealth University Department of Surgery
| | - F Z Uwinshuti
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Dworkin
- Thomas Jefferson University, Sidney Kimmel Medical College
| | | | - E Kankindi
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - M Niyonsaba
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - J M Uwitonze
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - I Kabagema
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - T Dushime
- Service d'Aide Medicale Urgente- Rwanda Ministry of Health
| | - S Jayaraman
- Virginia Commonwealth University Department of Surgery
| | - E Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College
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Vandenbriele C, Azzu A, Gambaro A, Morosin M, Arachchillage D, Trimlett R, Rosenberg A, Ledot S, Patel B, Price S. P1716Dual antiplatelet therapy on veno arterial ECMO to bleed or not to bleed? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients presenting with INTERMACS-1 cardiogenic shock and necessitating VA-ECMO, often undergo coronary angiography and percutaneous coronary intervention (PCI). Therefore, a substantial subset of VA-ECMO patients will have an indication for dual antiplatelet therapy (DAPT) plus unfractionated heparin (UFH). According to atrial fibrillation registry data, bleeding incidence on DAPT combined with oral anticoagulation is significantly higher as compared to anticoagulation alone. Although it has been reported that the addition of low dose aspirin to UFH did not increase bleeding or transfusion in VenoVenous (VV)-ECMO patients, it remains to be elucidated whether the addition of DAPT to UFH on VA-ECMO-therapy enhances bleeding.
Methods
We report single center data for 100 VA-ECMO patients between 2011 and 2019. VA-ECMO-patients post-surgery were excluded. Patient demographics, blood product transfusions and reported/radiographically diagnosed bleeding or thrombotic complications were analysed. All VA-ECMO patients received UFH, aiming for an anti-Xa levels of at least 0,3 U/ml. Targets were hemoglobin 7 g/dl, fibrinogen 100 mg/dl (or 150 mg/dl when active bleeding) and platelet counts above 50/fL. DAPT-patients were on a low dose aspirin plus a P2Y12-inhibitor (clopidogrel or ticagrelor).
Results
51% Of the VA-ECMO-group received DAPT (59% clopidogrel and 41% ticagrelor). UFH-levels were comparable between both groups. Patients on DAPT were significantly older (DAPT 52.8 vs. Control 41.3; p<0.001) and predominantly male (DAPT 76% vs. Control 63%). Total bleedings (DAPT 52% vs. Control 55%; p=0,68) and major bleedings (BARC score of 3 or more; DAPT 41% vs. Control 45%; p=0,71) did not differ significantly. We observed a significant lower number of clinically or radiographically overt arterial/venous thromboses (DAPT 13.7% vs. Control 36.2%; p=0,02) in the DAPT-group. When comparing fresh frozen plasma (FFP), red blood cell and platelet pool transfusions between both groups, only FFP-tranfusion (DAPT 0.47 units/day vs. Control 1.18 units/day; p=0,047) intends to be lower for the DAPT-group.
DAPT (plus UFH) vs control (plus UFH)
Conclusions
Haemorrhage is frequent during extracorporeal support. However, in our cohort, DAPT on top of UFH in the treatment of VA-ECMO-supported ischemic cardiogenic shock does not increase the risk of major bleeding. Therefore, DAPT should not necessarily be witheld in the setting of VA-ECMO. Interestingly, our data support a lower incidence of overt thromboses and a trend towards less FFP-transfusion. These findings suggest DAPT-induced platelet inhibition being protective against both thrombotic events and posibly consumptive coagulopathy without paying a price for major bleeding.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Haematology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - B Patel
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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Vandenbriele C, Wilson J, Baker A, Azzu A, Gambaro A, Morosin M, Arachchillage D, Rosenberg A, Davies S, Trimlett R, Ledot S, Price S. P1718Veno-arterial ECMO versus Left Impella bleeding complications in cardiogenic shock patients on dual antiplatelet therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Selective groups of patients, presenting with INTERMACS-1 cardiogenic shock due to acute ischaemic heart failure, may benefit from mechanical circulatory support (MCS). Patients with biventricular failure, severe septic shock or oxygenation problems should be selected for VA-ECMO, although the left Impella-CP heart pump can be considered as a less invasive alternative in supporting predominantly left ventricular failure. Bleeding issues are a major concern in patients on MCS, especially in this group where triple anticoagulation therapy (unfractionated heparin (UFH) for prevention of pump thrombosis and dual antiplatelet therapy (DAPT) after coronary stenting) is necessitated. We aim to investigate the bleeding and transfusion rate in DAPT-patients on VA-ECMO versus Impella.
Methods
We report single center data for 51 VA-ECMO and 8 Impella patients between 2011 and 2019. Indication for MCS was acute ischaemic cardiogenic shock. Patient demographics, transfusions and reported/radiographically diagnosed bleeding (BARC-classification) complications were analyzed. All patients received UFH and low dose aspirin plus clopidogrel or ticagrelor. Impella flow was at least 2.5 L/min. Transfusion targets were Hb >7 g/dl, fibrinogen >100 mg/dl (or >150 mg/dl when active bleeding) and platelet count >50/fL.
Results
Impella patients were significantly older (VA-ECMO 52.8 vs. Impella 62.4; p=0.02) as compared to the VA-ECMO group. Anti-Xa-levels and length of the MCS-run (mean 7.9 VA-ECMO vs. 6.4 days Impella) were comparable in both groups. Occurrences of minor bleeds was comparable between both groups (mainly oozing from the insertion site in the ImpellaTM group 63% vs. VA-ECMO 72%; p>0.05) but major bleedings with BARC score of 3 or more were significantly lower in the Impella group (13% vs. VA-ECMO 65%; p=0.005). Platelet and red blood cell transfusions were significantly lower in the Impella group (0.1 units of platelets per day vs. 1.1 units of platelets per day on VA-ECMO; p=0.002 and 0.8 units of RBCs per day vs. 2.6 units of RBCs per day on VA-ECMO; p=0.02).
Bleeding/transfusion VA-ECMO vs Impella
Conclusions
Bleeding is a frequent complication of MCS. However, in our cohort, triple anticoagulation in acute cardiogenic shock due to ischaemic left ventricle failure resulted in a lower major bleeding rate when support was given by the left Impella device as compared with VA-ECMO therapy group. As a result, platelet and red blood cell transfusions were lower in the Impella group. These findings are likely to be partly explained by the increased number and size of cannulas in VA-ECMO, as well as the increased risk of haemolysis and consumptive coagulopathy due to the complexity and extensive foreign body surface of the ECMO-circuit. We conclude that Impella support should be considered as a safer option than VA-ECMO with regards to bleeding in patients with ischaemic left ventricular failure who require DAPT and MCS as a bridge to recovery or other definitive therapy.
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Affiliation(s)
- C Vandenbriele
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - J Wilson
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Baker
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Azzu
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - M Morosin
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - D Arachchillage
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - A Rosenberg
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Davies
- Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom
| | - R Trimlett
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Ledot
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
| | - S Price
- Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom
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18
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Shrivastava G, Jarboe J, Ahmed A, Conway S, Pretell J, Wolfson A, Freedman L, Rosenberg A, Trent J, Yechieli R. Pathologic Response Rates after Neoadjuvant Therapy For Sarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Rosenberg A, Kircher S, Hahn E, Rademaker A, Bilimoria K, Wayne J, Agulnik M. Perceptions of clinical trial enrollment in patients with bone and soft tissue sarcoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Santucci NR, Hyman PE, Karpinski A, Rosenberg A, Garguilo D, Rein LE, Amado-Feeley A, Stoops E, Herdes RE, van Tilburg MAL. Development and validation of a childhood self-efficacy for functional constipation questionnaire. Neurogastroenterol Motil 2018; 30. [PMID: 28980378 DOI: 10.1111/nmo.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Children with functional constipation fear painful bowel movements leading to stool withholding behavior. Self-efficacy is the belief that an individual can accomplish a given goal. If children with constipation avoid defecation because they think that they are unable defecate comfortably, this low self-efficacy may prevent treatment success. The aim of the current study was to develop and validate a constipation specific self-efficacy scale. METHODS The self-efficacy for functional constipation questionnaire (SEFCQ) was developed by the authors and evaluated by 10 children and seven experts. Ninety-nine healthy children and 122 children with functional constipation completed the SEFCQ and three other questionnaires measuring related constructs. KEY RESULTS Minor changes were made in wording based on feedback from experts and children. Factor analysis showed two scales, a 7 item Action scale (Cronbach's α = 0.88) and a 7 item Emotion scale (Cronbach α = 0.86). The SEFCQ total scale correlated positively with general self-efficacy (r = .32, P < .001) and quality of life (r = .20; P < .01) and negatively with anxiety (r = -.15; P < .05). Scores on the SEFCQ were higher in children without functional constipation compared to those with functional constipation (53.33 + 3.38 vs 39.34 + 7.19, P < .001). CONCLUSIONS & INFERENCES We developed a constipation specific self-efficacy questionnaire with good initial internal reliability, excellent face validity and adequate content validity. A low self-efficacy for defecation, may make the child resist their physical urge to defecate and hence, the need for further studies to assess its effect on treatment outcomes.
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Affiliation(s)
- N R Santucci
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - P E Hyman
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Karpinski
- School of Administration, Kent State University, Kent, OH, USA
| | - A Rosenberg
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - D Garguilo
- Department of Pediatric Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - L E Rein
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - A Amado-Feeley
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - E Stoops
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - R E Herdes
- Pediatric Gastroenterology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - M A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
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21
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Check J, Rosenberg A, Check D, DiAntonio A, Rui H, Cohen R, DiAntonio G. Serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF) which is found in high levels during pregnancy is not higher in women with progesterone (P) receptor (R) positive vs. negative breast cancer. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3315.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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22
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Swain DW, Carter MD, Wilson JR, Ryan PM, Wilgen JB, Hosea J, Rosenberg A. Loading and Asymmetry Measurements and Modeling for the National Spherical Torus Experiment Ion Cyclotron Range of Frequencies System. Fusion Science and Technology 2017. [DOI: 10.13182/fst03-a297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D. W. Swain
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - M. D. Carter
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. R. Wilson
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
| | - P. M. Ryan
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. B. Wilgen
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-8071
| | - J. Hosea
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
| | - A. Rosenberg
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08544
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23
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Check JH, Rosenberg A, Check DL, DiAntonio A, Rui H, Cohen R, DiAntonio G. Serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF) which is found in high levels during pregnancy is not higher in women with progesterone (P) receptor (R) positive vs. negative breast cancer. CLIN EXP OBSTET GYN 2017; 44:187-189. [PMID: 29746019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine if serum levels of the immunomodulatory protein, the progesterone induced blocking factor (PIBF), which is present in high levels during normal pregnancy, is present in higher levels in women with breast cancer positive for progesterone receptors. The study would also determine whether the presence or absence of the estrogen receptor in any way modifies PIBF expression. MATERIALS AND METHODS PIBF using a research ELISA was evaluated in the follicular phase in 21 women with receptor status as follows: seven with estrogen receptor (ER)+ and progesterone receptor (PR)+, seven with ER- and PR+, and seven with ER+ and PR. RESULTS The results showed no differences in serum PIBF in the three groups. The serum PIBF levels were no different than historical controls in the follicular phase. CONCLUSIONS Measurement of serum PIBF does not seem to be an important marker to use to either detect women with breast cancer or to help determine tumor virulence or potential specific therapies. If PIBF plays a role in helping cancer cells to escape immune surveillance, it seems that the intracytoplasmic PIBF would be the form most likely operative.
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24
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Rosenberg A, Wee S, Schroeder E, Bunsawat K, Grigoriadis G, Fernhall B, Baynard T. OR-02 EFFECT OF ACUTE ISOKINETIC RESISTANCE EXERCISE ON SYSTEMIC ARTERIAL HEMODYNAMICS AND CEREBRAL BLOOD FLOW DYNAMICS: IS THERE A MISMATCH? Artery Res 2016. [DOI: 10.1016/j.artres.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Ciesla L, Okine M, Rosenberg A, Dossou KSS, Toll L, Wainer IW, Moaddel R. Development and characterization of the α3β4α5 nicotinic receptor cellular membrane affinity chromatography column and its application for on line screening of plant extracts. J Chromatogr A 2015; 1431:138-144. [PMID: 26774122 DOI: 10.1016/j.chroma.2015.12.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/24/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
The α3β4α5 nAChR has been recently shown to be a useful target for smoking cessation pharmacotherapies. Herein, we report on the development and characterization of the α3β4α5 nicotinic receptor column by frontal displacement chromatography. The binding affinity of the nicotine and minor alkaloids found in tobacco smoke condensates were determined for both the α3β4 and α3β4α5 nicotinic receptors. It was demonstrated that while no subtype selectivity was observed for nicotine and nornicotine, anabasine was selective for the α3β4α5 nicotinic receptor. The non-competitive inhibitor binding site was also studied and it was demonstrated while mecamylamine was not selective between subtypes, buproprion showed subtype selectivity for the α3β4 nicotinic receptor. The application of this methodology to complex mixtures was then carried out by screening aqueous-alcoholic solutions of targeted plant extracts, including Lycopodium clavatum L. (Lycopodiaceae) and Trigonella foenum graecum L. (Fabaceae) against both the α3β4 and α3β4α5 nAChRs.
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Affiliation(s)
- L Ciesla
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States; Department of Inorganic Chemistry, Medical University of Lublin, Chodzki 4A, 20-093 Lublin, Poland
| | - M Okine
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States
| | - A Rosenberg
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States
| | - K S S Dossou
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States
| | - L Toll
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL 34990, United States
| | - I W Wainer
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States
| | - R Moaddel
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, United States.
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Beadie G, Brindza M, Flynn RA, Rosenberg A, Shirk JS. Refractive index measurements of poly(methyl methacrylate) (PMMA) from 0.4-1.6 μm. Appl Opt 2015; 54:F139-43. [PMID: 26560600 DOI: 10.1364/ao.54.00f139] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Using a transmission-spectrum-based method, the refractive index of a 50 μm thick sample of poly(methyl methacrylate) (PMMA) was measured as a function of wavelength. To mitigate the effects of nonplane-parallel surfaces, the sample was measured at 16 different locations. The technique resulted in the measurement of index at several thousand independent wavelengths from 0.42 to 1.62 μm, with a relative RMS accuracy <0.5×10(-4) and absolute accuracy <2×10(-4).
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27
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Guzman J, Kerr T, Ward L, Ma J, Oen K, Boire G, Feldman B, Scuccimarri R, Houghton K, Bruns A, Dancey P, Rosenberg A, Tucker L. SAT0507 Growth and Weight Gain in Children with Juvenile Idiopathic Arthritis: Results from the Reacch-Out Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Rosenberg A, Maksymowych W, Gui Y, Marotta A. AB1029 Serum 14-3-3ETA is Present in JIA and is not Associated with RF+ Polyarthritis: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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29
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Desai B, Rockne R, Bridge C, Corwin D, Crisman J, Helenowski I, Kokkinos E, Peters C, Rosenberg A, Sharfman D, Gondi V, Swanson K. RT-07 * APPLICATION OF A GROWTH-RATE BASED RESPONSE METRIC TO RECURRENT MALIGNANT GLIOMAS TREATED WITH LARGE-VOLUME RE-IRRADIATION USING PROTON BEAM THERAPY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou270.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Mackie FE, Kainer G, Adib N, Boros C, Elliott EJ, Fahy R, Munro J, Murray K, Rosenberg A, Wainstein B, Ziegler JB, Singh-Grewal D. The national incidence and clinical picture of SLE in children in Australia – a report from the Australian Paediatric Surveillance Unit. Lupus 2014; 24:66-73. [DOI: 10.1177/0961203314552118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives The objectives of this paper are to prospectively determine the incidence of paediatric systemic lupus erythematosus (pSLE) in Australia as well as describe the demographics, clinical presentation and one-year outcome. Study design Newly diagnosed cases of pSLE were ascertained prospectively from October 2009 to October 2011 through the Australian Paediatric Surveillance Unit (a national monthly surveillance scheme for notification of childhood rare diseases) as well as national subspecialty groups. Questionnaires were sent to notifying physicians at presentation and at one year. Results The annual incidence rate was 0.32 per 105 children aged less than 16 years. The incidence was significantly higher in children of Asian or Australian Aboriginal and Torres Strait Islander parents. Approximately one-third of children underwent a renal biopsy at presentation and 7% required dialysis initially although only one child had end-stage kidney disease (ESKD) at one-year follow-up. Conclusion The incidence of pSLE in Australia is comparable to that worldwide with a significantly higher incidence seen in children of Asian and Australian Aboriginal and Torres Strait Islander backgrounds. Renal involvement is common but progression to ESKD, at least in the short term, is rare.
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Affiliation(s)
- F E Mackie
- Department of Nephrology, Sydney Children’s Hospital and University of NSW, Australia
| | - G Kainer
- Department of Nephrology, Sydney Children’s Hospital and University of NSW, Australia
| | - N Adib
- Queensland Paediatric Rheumatology Services, Australia
| | - C Boros
- Discipline of Paediatrics, University of Adelaide and Rheumatology, Women and Children’s Health Network, Adelaide, Australia
| | - E J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia
| | - R Fahy
- Department of Paediatrics, Alice Springs Hospital, Australia
| | - J Munro
- Rheumatology Unit, Royal Children’s Hospital, Melbourne, Australia
| | - K Murray
- Princess Margaret Hospital for Children, Perth, Australia
| | - A Rosenberg
- Department of Nephrology, Sydney Children’s Hospital and University of NSW, Australia
| | - B Wainstein
- Department of Immunology, Sydney Children’s Hospital, Australia
| | - J B Ziegler
- Department of Immunology, Sydney Children’s Hospital, Australia
| | - D Singh-Grewal
- Department of Rheumatology, Sydney Children’s Hospital Network, Australia
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31
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Rockne R, Bacchus I, Bridge C, Brown P, Corwin D, Desai B, Hendrickson K, Kim M, Kokkinos E, Mehta M, Marymont M, Rockhill J, Rosenberg A, Trister A, Williams C, Williamson R, Young L, Swanson K. An Evaluation of Multi-Institutional Data-Transfer to Facilitate Personalized Computational Modeling. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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32
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Tupper S, Rosenberg A, Stinson J, Baerg K. 198: Physical Activity Prescribing By Community Paediatricians for Children with Chronic Pain: A Vignette Based Study. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Rosenberg A, Lane A, Kappus R, Wee S, Baynard T, Fernhall B. PO-30 CAROTID STRAIN DOES NOT EXPLAIN SEX DIFFERENCES IN BLOOD PRESSURE. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Simone B, Jin L, Dan T, Savage J, Minassian H, Lim M, Rosenberg A, Palazzo J, Simone N. Caloric Restriction Coupled With Radiation Increases Overall Survival in a Metastatic Breast Cancer Model. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Twilt M, Sheikh S, Cellucci T, Chedeville G, Kirton A, Mineyko A, Schmelig H, Pohl D, Roth J, Cabral D, Huber A, Rosenberg A, Schiff N, Benseler S. Recognizing childhood inflammatory brain diseases in Canada. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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36
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Hayward D, Wild E, Lee J, Rosenberg A, Prabhu V. Myoepithelioma of the Skull Base and Orbit: Case Report, Immunohistopathology and Surgical Considerations. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Finney E, Hoover M, Parkman K, Rosenberg A, Giangrandi L, Post S. How Are Registered Dietitians Screening for Nutritional Risk? J Acad Nutr Diet 2012. [DOI: 10.1016/j.jand.2012.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shi H, Wen J, LI Z, Elsayed M, Kamal K, LI Z, Wen J, Shi H, El Shal A, Youssef D, Caubet C, Lacroix C, Benjamin B, Bandin F, Bascands JL, Monsarrat B, Decramer S, Schanstra J, Laetitia DB, Ulinski T, Aoun B, Ozdemir K, Dincel N, Sozeri B, Mir S, Dincel N, Berdeli A, Mir S, Akyigit F, Mizerska-Wasiak M, Panczyk-Tomaszewska M, Szymanik-Grzelak H, Roszkowska-Blaim M, Jamin A, Dehoux L, Monteiro RC, Deschenes G, Bouts A, Davin JC, Dorresteijn E, Schreuder M, Lilien M, Oosterveld M, Kramer S, Gruppen M, Pintos-Morell G, Ramaswami U, Parini R, Rohrbach M, Kalkum G, Beck M, Carter M, Antwi S, Callegari J, Kotanko P, Levin NW, Rumjon A, Macdougall IC, Turner C, Booth CJ, Goldsmith D, Sinha MD, Camilla R, Camilla R, Loiacono E, Donadio ME, Conrieri M, Bianciotto M, Bosetti FM, Peruzzi L, Conti G, Bitto A, Amore A, Coppo R, Mizerska-Wasiak M, Roszkowska-Blaim M, Maldyk J, Chou HH, Chiou YY, Bochniewska V, Jobs K, Jung A, Fallahzadeh Abarghooei MH, Zare J, Sedighi Goorabi V, Derakhshan A, Basiratnia M, Fallahzadeh Abarghooei MA, Hosseini Al-Hashemi G, Fallahzadeh Abarghooei F, Kluska-Jozwiak A, Soltysiak J, Lipkowska K, Silska M, Fichna P, Skowronska B, Stankiewicz W, Ostalska-Nowicka D, Zachwieja J, Girisgen L, Sonmez F, Yenisey C, Kis E, Cseprekal O, Kerti A, Szabo A, Salvi P, Benetos A, Tulassay T, Reusz G, Makulska I, Szczepanska M, Drozdz D, Zwolnska D, Sozeri B, Berdeli A, Mir S, Tolstova E, Anis L, Ulinski T, Alber B, Edouard B, Gerard C, Seni K, Dunia Julienne Hadiza T, Christian S, Benoit T, Francois B, Adama L, Rosenberg A, Munro J, Murray K, Wainstein B, Ziegler J, Singh-Grewal D, Boros C, Adib N, Elliot E, Fahy R, Mackie F, Kainer G, Polak-Jonkisz D, Zwolinska D, Laszki-Szczachor K, Zwolinska D, Janocha A, Rusiecki L, Sobieszczanska M, Garzotto F, Ricci Z, Clementi A, Cena R, Kim JC, Zanella M, Ronco C, Polak-Jonkisz D, Zwolinska D, Purzyc L, Zwolinska D, Makulska I, Szczepanska M, Peco-Antic A, Kotur-Stevuljevic J, Paripovic D, Scekic G, Milosevski-Lomic G, Bogicevic D, Spasojevic-Dimitrijeva B, Hassan R, El-Husseini A, Sobh M, Ghoneim M, Harambat J, Bonthuis M, Van Stralen KJ, Ariceta G, Battelino N, Jahnukainen T, Sandes AR, Combe C, Jager KJ, Verrina E, Schaefer F, Espindola R, Bacchetta J, Cochat P, Stefanis C, Leroy S, Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, Gurgoze M, Bressan S, Smolkin V, Tuerlinkx D, Stefanidis C, Vaos G, Leblond P, Gungor F, Gendrel D, Chalumeau M, Rumjon A, Macdougall IC, Turner C, Rawlins D, Booth CJ, Simpson JM, Sinha MD, Arnaud G, Arnaud G, Anne M, Stephanie T, Flavio B, Veronique FB, Stephane D, Mumford L, Marks S, Ahmad N, Maxwell H, Tizard J, Vidal E, Amigoni A, Varagnolo M, Benetti E, Ghirardo G, Brugnolaro V, Murer L, Aoun B, Christine G, Alber B, Ulinski T, Aoun B, Decramer S, Bandin F, Ulinski T, Degi A, Degi A, Kerti A, Kis E, Cseprekal O, Szabo AJ, Reusz GS, Ghirardo G, Vidoni A, Vidal E, Benetti E, Ramondo G, Miotto D, Murer L. Paediatric nephrology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Balash Y, Gurevich T, Neudorfer M, Naftaliev E, Shabtai H, Rosenberg A, Ezra A, Korczyn A, Giladi N, Kesler A. 2.115 PERIPAPILLARY RETINAL NERVE FIBER LAYER THICKNESS IN PATIENTS WITH PARKINSON'S DISEASE AND MULTIPLE SYSTEM ATROPHY. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Moaddel R, Rosenberg A, Spelman K, Frazier J, Frazier C, Nocerino S, Brizzi A, Mugnaini C, Wainer IW. Development and characterization of immobilized cannabinoid receptor (CB1/CB2) open tubular column for on-line screening. Anal Biochem 2011; 412:85-91. [PMID: 21215722 PMCID: PMC3053438 DOI: 10.1016/j.ab.2010.12.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 12/20/2010] [Accepted: 12/28/2010] [Indexed: 01/23/2023]
Abstract
Cannabinoid receptors, CB1 and CB2, are therapeutic targets in the treatment of anxiety, obesity, movement disorders, glaucoma, and pain. We have developed an on-line screening method for CB1 and CB2 ligands, where cellular membrane fragments of a chronic myelogenous leukemia cell line, KU-812, were immobilized onto the surface of an open tubular (OT) capillary to create a CB1/CB2-OT column. The binding activities of the immobilized CB1/CB2 receptors were established using frontal affinity chromatographic techniques. This is the first report that confirms the presence of functional CB1 and CB2 receptors on KU-812 cells. The data from this study confirm that the CB1/CB2-OT column can be used to determine the binding affinities (K(i) values) for a single compound and to screen individual compounds or a mixture of multiple compounds. The CB1/CB2-OT column was also used to screen a botanical matrix, Zanthoxylum clava-herculis, where preliminary results suggest the presence of a high-affinity phytocannabinoid.
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MESH Headings
- Cannabinoids/chemistry
- Cell Line, Tumor
- Chromatography, Affinity/methods
- Humans
- Immobilized Proteins/chemistry
- Plant Roots/chemistry
- Protein Binding
- Receptor, Cannabinoid, CB1/agonists
- Receptor, Cannabinoid, CB1/chemistry
- Receptor, Cannabinoid, CB2/agonists
- Receptor, Cannabinoid, CB2/chemistry
- Zanthoxylum/chemistry
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Affiliation(s)
- R Moaddel
- Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
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Weinberger M, Yaron S, Agmon V, Yishai R, Rosenberg A, Peretz C. Curtailed short-term and long-term survival following infection with non-typhoid Salmonella in Israel. Clin Microbiol Infect 2011; 17:278-84. [DOI: 10.1111/j.1469-0691.2010.03184.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Armon A, Gutner S, Rosenberg A, Scolnicov H. Algorithmic network monitoring for a modern water utility: a case study in Jerusalem. Water Sci Technol 2011; 63:233-239. [PMID: 21252425 DOI: 10.2166/wst.2011.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report on the design, deployment, and use of TaKaDu, a real-time algorithmic Water Infrastructure Monitoring solution, with a strong focus on water loss reduction and control. TaKaDu is provided as a commercial service to several customers worldwide. It has been in use at HaGihon, the Jerusalem utility, since mid 2009. Water utilities collect considerable real-time data from their networks, e.g. by means of a SCADA system and sensors measuring flow, pressure, and other data. We discuss how an algorithmic statistical solution analyses this wealth of raw data, flexibly using many types of input and picking out and reporting significant events and failures in the network. Of particular interest to most water utilities is the early detection capability for invisible leaks, also a means for preventing large visible bursts. The system also detects sensor and SCADA failures, various water quality issues, DMA boundary breaches, unrecorded or unintended network changes (like a valve or pump state change), and other events, including types unforeseen during system design. We discuss results from use at HaGihon, showing clear operational value.
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Affiliation(s)
- A Armon
- TaKaDu Ltd., 4 Derech HaHoresh, Yehud 56470, Israel.
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Rosenberg A, Husson TR, Issa NP. The representation of transparent motion in the non-Fourier responses of LGN Y-cells. J Vis 2010. [DOI: 10.1167/9.8.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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D'Antona A, Rosenberg A, Shevell S. The Neural Locus Underlying Perception of the Craik-O'Brien-Cornsweet Effect. J Vis 2010. [DOI: 10.1167/10.7.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ip EC, Kirby RE, Craig E, Mackie F, Kennedy S, Rosenberg A, Kainer G, Frawley J, Haghighi K. ORTHOTOPIC KIDNEY TRANSPLANTATION: SAFETY OF RENAL BIOPSY. Transplantation 2010. [DOI: 10.1097/00007890-201007272-02093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosenberg A, Husson TR, Mallik AK, Issa NP. Frequency-doubling in the early visual system underlies sensitivity to second-order stimuli. J Vis 2010. [DOI: 10.1167/8.6.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Muradin MSM, Rosenberg A, van der Bilt A, Stoelinga PJW, Koole R. The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies. J Craniomaxillofac Surg 2009; 37:334-40. [PMID: 19477655 DOI: 10.1016/j.jcms.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 02/02/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022] Open
Abstract
UNLABELLED Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the nasal width, but would also improve the dynamics of some of the mimic muscles. To test the validity of this hypothesis, a prospective study was set up including 22 patients, using standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively. Sets containing three pictures were made: soft tissue in repose, maximum closed mouth smile and maximum smile. The landmarks, alare, crista philtri and cheilion were analysed. The preliminary results show that ACVY-closure does significantly improve the horizontal movement of cheilion with both maximum closed mouth smile and maximum smile, as well as the vertical movement of crista philtri with maximum closed mouth smile. CONCLUSION The Le Fort I osteotomy with ACVY improves the orofacial dynamics.
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Affiliation(s)
- M S M Muradin
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
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Chagpar AB, Blumencranz P, Whitworth PW, Deck KB, Rosenberg A, Simmons RM, Reintgen DS, Beitsch P, Saha S, Julian TB. Use of intraoperative breast cancer sentinel lymph node (SLN) assay to predict of ≥4 positive (+) lymph nodes (LN). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
530 Background: Predicting which patients will have ≥4 +LN and may need radiation therapy affects immediate breast reconstruction. We hypothesized that model s to predict the likelihood of ≥4+LN may be improved by incorporation of quantitative real time RT-PCR analysis of SLN. Methods: 728 patients were enrolled in 2 prospective studies of the GeneSearch BLN Assay (Veridex LLC) for SLN metastases. 205 (28.2%) were found to have +SLN by hematoxylin-eosin staining. Of these, 115 pts (15.8%) had tumors ≤5 cm in size with >4 total LN removed, forming the cohort of interest for this study. Quantitative cycle times (CT) for mammaglobin (MG) and CK19 were correlated with finding ≥4+LN on final pathology. Results: Median tumor size was 2.0 cm (range; 0.2–5.0 cm). Median number of SLN removed was 3 (range; 1–11). 18 patients (15.7%) had ≥4 +LN on final pathology. Median CT for MG was 29.1 (interquartile range (IQR): 24.7–39.0) in patients with <4 +LN vs. 21.4 (IQR: 18.5–26.8) in those with ≥4 +LN, p<0.001. Median CT for CK19 was 23.7 (IQR: 20.9–28.2) in patients with <4 +LN vs. 19.6 (IQR: 17.8–20.7) in those with ≥4 +LN, p<0.001. Tumor size ≥2cm, proportion of SLN+ >50%, MG CT <25.8 and CK19 <20.8 were correlated with ≥4 +LN on final pathology. On multivariate analysis, tumor size, MG CT and CK19 CT were significant (see table). A simplified CPR was created with 1 point given if tumor size was ≥2cm, 1 point if MG CT <25.8 and 2 points if CK19 CT<20.8. Of the 24 patients (20.9%) with 0 points, only 1 (4.2%) had ≥4 +LN; of the 12 patients (10.4%) with 3 points, 8 (66.7%) had ≥4 +LN on final pathology, p<0.001. Area under the receiver-operator curve was 86.2% (95% CI: 76.1%-96.2%). Conclusions: Intraoperative quantitative RT-PCR of SLN improves prediction of ≥4 +LN; further validation of this model will have clinical utility regarding the use of immediate, delayed, or delayed-immediate reconstruction approaches. [Table: see text] [Table: see text]
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Affiliation(s)
- A. B. Chagpar
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - P. Blumencranz
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - P. W. Whitworth
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - K. B. Deck
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - A. Rosenberg
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - R. M. Simmons
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - D. S. Reintgen
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - P. Beitsch
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - S. Saha
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
| | - T. B. Julian
- University of Louisville, Louisville, KY; Morton Plant Mease Healthcare, Clearwater, FL; Nashville Breast Center, Nashville, TN; South Orange County Surgical Medical Group, Laguna Hills, CA; Jefferson University Hospital, Philadelphia, PA; Weill-Cornell Breast Center, New York, NY; Lakeland Regional Medical Center, Lakeland, FL; Dallas Surgical Group, Dallas, TX; McLaren Regional Medical Center, Flint, MI; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA
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