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Philippou A, Birhanu B, Biello A, Keefer L, Gorbenko K. A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1851-1858. [PMID: 35191977 DOI: 10.1093/ibd/izac022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In patients with inflammatory bowel disease (IBD), failure to adhere to treatment regimens due to insurance issues can lead to disease complications. Our aim was to examine patients' perceptions of the impact of insurance issues on their health. METHODS Twenty-nine patients with IBD at a large US academic center and an insurance issue participated in a mixed-methods study. Retrospective chart review and an online questionnaire were completed to collect demographic information, IBD characteristics, and validated resilience scores. Semistructured interviews were completed for insurance experiences, which were coded independently by 2 coders for themes. RESULTS Twenty-nine patients completed the interview, and 24 completed the online survey. Sixteen had Crohn's disease, 13 had ulcerative colitis, and 66% were female. The most common insurance issue was lapsed insurance. Many experienced physical consequences, with 58% having flares, 14% undergoing surgery, and 14% developing antibodies. All emotional responses were negative, with the majority feeling stressed (38%). Providers were uninformed of insurance issues in 28% of cases. When asked about perceived resilience, 41% felt incapable of managing the situation, and 45% gave up trying to solve the problem. When asked how to improve going forward, 38% requested an easily accessible advocate to guide them. CONCLUSIONS A large proportion of our cohort chose not to inform their provider, felt incapable of managing on their own, and gave up on resolving their insurance issue. This highlights the need to consider restructuring the insurance system, to identify those at risk for insurance issues, and to make advocates available to avoid devastating consequences.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Beselot Birhanu
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Biello
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ksenia Gorbenko
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mourtakos S, Vasiliou G, Papageorgiou C, Konotangelos K, Philippou A, Bersimis F, Geladas N, Koutsilieris M, Sidossis L, Tsirmpas C, Papageorgiou C. Resilience of the hellenic navy SEALs assessed by heart rate variability during cognitve tasks. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2750] [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: 11/15/2022] Open
Abstract
Abstract
Background
The interaction between high physical performance under extreme conditions and simultaneous control of the cognitive executive functioning has been a subject of research in literature for the past few decades. Stroop test and Heart-rate variability (HRV), have been verified clinical tools for the assessment of cerebral and autonomic/ cardiovascular stress responses respectively.
Purpose
The investigation of HRV adaptive response to stress and cognitive stress resilience under extremely strenuous conditions.
Methods
34 consecutive subjects were enrolled. Of them, 18 were candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (HNS) and 16 were healthy controls (HC). All subjects underwent stroop tasks, along with mental state and personality examination. HRV variables in time and frequency domains recordings were acquired, during each aforementioned cognitive testing procedure.
Results
HNS's performance on both cognitive and emotion stroop tasks were equivalent to controls. During the size comparison of the number stroop and emotion stroop, HC had statistically significantly higher power content at different HRV frequency bands compared to HNS participants (p=0.036 and p=0.06 respectively). Finally, in a between group comparison of the psychometric tools, HNS had significantly higher somatization (p<0.01), anxiety (p=0.037) and neuroticism (p=0.047) than HC. Correlation was conducted for each group separately, between the psychometric tools and the measurements of HRV for both number and emotion stroop. Moderate negative correlations were found between SDNN (Standard deviation of normal-to-normal RR-intervals) during the size comparison of number stroop and three out of nine categories of psychometric questionnaire; somatization (r(23)=−0.452, p<0.05), anxiety (r(23)=−0.457, p<0.05) and hostility (r(23)=−0.445, p<0.05)
Conclusion
The above findings suggest that HNS display flexibility in their autonomic regulation during cognitive and emotional tasks. This characteristic is closely related to problem solving or adaptability skills. Additionally, HRV can be a promising clinical index regarding the assessment of psychophysiological resilience especially in the neurovisceral integration (NVI) model.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica
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Affiliation(s)
- S Mourtakos
- Eginition Hospital of Athens, Athens, Greece
| | - G Vasiliou
- Eginition Hospital of Athens, Athens, Greece
| | - C Papageorgiou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - A Philippou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - F Bersimis
- Agricultural University of Athens, Department of Supply Chain Management, Athens, Greece
| | - N Geladas
- National & Kapodistrian University of Athens, Athens, Greece
| | - M Koutsilieris
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Mourtakos S, Vassiliou G, Kontoangelos K, Philippou A, Bersimis F, Geladas N, Koutsilieris M, Sidossis L, Papageorgiou CH, Papageorgiou C. Endocannabinoids and heart rate variability alterations after exposure to prolonged intensive physical exercise of the Hellenic Navy SEALs. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2751] [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
Recent research indicates that endocanabinoids (eCB) and heart rate variability (HRV) are associated with stress-induced experiences. However, these underlying mechanisms have not been elucidated.
Purpose
The aim of the present study is to investigate if exposure to acute and chronic stress promotes measurable changes concurrently to the peripheral eCB ligands and the HRV.
Methods
13 candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (H.N.S.) participated in the study. All subjects underwent mental state examination, while HRV variables in time and frequency domains recordings were acquired. Furthermore, at baseline and 30 days after prolonged and intensive physical exercise hair were collected in order to measure eCB ligands, such as anandamide (AEA), 2-arachidonoylglycerol (2-AG), and the N-acyl ethanolamine (NAE) molecules: palmitoylethanolamide (PEA) and oleoylethanolamide (OEA).
Results
Comparing basal hair concentrations of eCB ligands before and after intensive physical exercise, we found that AEA, PEA and OEA were notably increased (p<0.01, p<0.05 and p<0.01 respectively) whereas no differences were observed regarding the ligand 2-AG. Regarding time domain features of HRV, a strong positive correlation was found between mean HR, AEA and PEA [r(13)=0.934, p<0.05, (r(13)=0.902, p<0.05]. Regarding frequency domain, a strong negative correlation was found between low frequency (LF) HRV and PEA (r(13)=−0.853, p<0.01). No statistically significant associations were noted between high frequency HRV and EC ligands.
Conclusions
These findings suggest that endocannabinoid-HRV interrelations might share a short-term, and long-term adaptability of the changes in self-regulation associated with stress. Further studies are required to determine the validity of peripheral eCB signaling and HRV as a biomarker for different aspects of stress response.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica
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Affiliation(s)
- S Mourtakos
- Eginition Hospital of Athens, Athens, Greece
| | - G Vassiliou
- Eginition Hospital of Athens, Athens, Greece
| | | | - A Philippou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - F Bersimis
- Agricultural University of Athens, Department of Supply Chain Management, Athens, Greece
| | - N Geladas
- National & Kapodistrian University of Athens, Athens, Greece
| | - M Koutsilieris
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - C Papageorgiou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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Philippou A, Sehgal P, Ungaro RC, Wang K, Bagiella E, Dubinsky MC, Keefer L. High Levels of Psychological Resilience Are Associated With Decreased Anxiety in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 28:888-894. [PMID: 34448855 PMCID: PMC9165553 DOI: 10.1093/ibd/izab200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety and depression are comorbid disorders with IBD and are associated with poor outcomes. Resilience is an innate but modifiable trait that may improve the symptoms of psychological disorders. Increasing resilience may decrease the severity of these comorbid disorders, which may improve IBD outcomes. The aim of this study was to describe the association between resilience, anxiety, and depression in IBD patients. METHODS We performed a cross-sectional study of IBD patients. Patients completed a questionnaire consisting of the Connor-Davidson Resilience Scale (CD-RISC), a measure of resilience, the Generalized Anxiety Disorder 7 (GAD-7), and the Patient Health Questionnaire-9. Primary outcome was severity of anxiety and depression in patients with high resilience. Multivariable linear regression analysis evaluated the association between severity of anxiety and depression and level of resilience. RESULTS A sample of 288 patients was analyzed. Bivariable linear regression analysis showed a negative association between resilience and anxiety (Pearson rho = -0.47; P < .0001) and between resilience and depression (Pearson rho = -0.53; P < .0001). Multivariable linear regression indicated that high resilience is independently associated with lower anxiety and that for every 1-unit increase in CD-RISC, the GAD-7 score decreased by 0.04 units (P = .0003). Unlike anxiety, the association between resilience and depression did not remain statistically significant on multivariable analysis. CONCLUSIONS High resilience is independently associated with lower anxiety in IBD patients, and we report a quantifiable decrease in anxiety score severity for every point of increase in resilience score. These findings suggest that IBD patients with higher resilience may have better coping mechanisms that buffer against the development of anxiety.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Priya Sehgal
- Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelly Wang
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia Bagiella
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marla C Dubinsky
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Address correspondence to: Laurie Keefer, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street, Box 1134, New York, NY, USA. ()
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Pantou A, Giannelou P, Grigoriadis S, Maziotis E, Tzonis P, Koutsouni A, Pappa C, Philippou A, Koutsilieris M, Pantos K, Simopoulou M, Sfakianoudis K. P–676 Mild stimulation followed by embryo accumulation via vitrification appears to be beneficial for managing poor ovarian response: A retrospective cohort study including 610 patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.675] [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
Study question
Could embryo accumulation employing mild stimulation cycles prove beneficial for managing patients presenting with poor ovarian response (POR)?
Summary answer
Embryo accumulation may be an efficient POR management strategy, enabling a higher number and quality cohort of embryos, ultimately improving success results.
What is known already
It is widely accepted that POR constitutes a challenging condition. The limited oocyte yield associated with POR detrimentally impacts in vitro fertilization (IVF) success rates. Moreover, the documented heterogeneity among POR patients compromises our efforts to successfully address POR, despite the advances noted regarding stimulation protocols employed today. Considering the aforementioned, embryo accumulation following consecutive stimulation cycles has emerged as an alternative management strategy towards increasing the number of available embryos prior to embryo transfer (ET), mimicking normoresponding conditions. However, only few studies have been so far conducted and the need for further data is underlined.
Study design, size, duration
A single-center retrospective study was conducted in the Centre of Human Reproduction, Genesis-Athens Clinic from January 2015-December 2019. Only patients presenting with POR according to Bologna criteria were included. In total, 610 POR patients were considered eligible and were divided in three groups namely, mild stimulation-fresh ET (150 IUs of gonadotropins) (MILDF), mild stimulation employing embryo accumulation (MILDA), and natural cycle employing embryo accumulation (NATA). Respective comparisons on embryology and pregnancy data are provided.
Participants/materials, setting, methods
Resulting embryos from the MILDF, MILDA, and NATA groups were cultured up to the cleavage stage and categorized into three groups according to quality, namely top (grade 1), good (grade 2–3) and poor (grade 4–5) (Veeck, 1999). Top and good quality embryos were considered eligible for ET/vitrification. The banking scenario entailed accumulation of at least three embryos, including at least one top quality embryo. Embryo transfers included up to two cleavage stage embryos.
Main results and the role of chance
Comparing MILDF and MILDA groups, a higher number of available oocytes and embryos was observed in MILDA (2.36±1.15 vs 6.58±1.11; 1.72±1.02 vs 3.51±0.61, P-value<0.001). However, a mean number of 3.90±1.56 oocyte retrievals were required to conclude MILDA compared to MILDF which was concluded following a single oocyte retrieval (P-value<0.001). Cancellation-rate was significantly lower in the MILDA compared to MILDF group (0% vs 18.93%, P-value <0.001). A higher proportion of top quality embryos were transferred in the MILDA group (66.58% vs 43.67%, P-value<0.001). The MILDA group presented with higher positive-HCG (27.89% vs 23.30%, P-value=0.302), clinical-pregnancy (22.11% vs 17.96%, P-value=0.316) and live-birth rates (16.84% vs 14.08%, P-value=0.487). However, these differences were not significant. Comparing MILDA and NATA groups, the MILDA presented with a lower number of required oocyte retrievals and a higher number of oocytes per oocyte retrieval compared with NATA (3.90±1.56 vs 7.15±1.80; 1.95±0.74 vs 0.89±0.20, P-value<0.001). Moreover, the MILDA presented with a higher mean number of resulting embryos (5.20±0.78 vs 4.82±0.88, P-value<0.001). No difference was observed regarding the proportion of the resulting top quality embryos. The MILDA group presented with slightly higher clinical-pregnancy (22.11% vs 20.09%, P-value=0.628) and live-birth (16.84% vs 14.02%, P-value=0.490) rates, however these differences were not significant.
Limitations, reasons for caution
The retrospective nature of the study constitutes a major limitation. Considering that numerous confounders are inevitable when retrospective data is analyzed, authors employed strict eligibility criteria in an effort to reduce bias. Statistical analysis revealed a well-controlled population, considering that general patients’ characteristics did not differ between the three groups.
Wider implications of the findings: Embryo accumulation may constitute an efficient management strategy for POR, as more embryos of better quality are available for ET compared to fresh-IVF-ET. Mild stimulation should be preferred for embryo accumulation instead of natural cycles, as less oocyte retrievals are required. Future studies should be conducted to verify these conclusions.
Trial registration number
Not applicable
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Affiliation(s)
- A Pantou
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - P Giannelou
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - S Grigoriadis
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - E Maziotis
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - P Tzonis
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - A Koutsouni
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - C Pappa
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - A Philippou
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - M Koutsilieris
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - K Pantos
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - M Simopoulou
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - K Sfakianoudis
- Centre of Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
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Sfakianoudis K, Galatis D, Maziotis E, Pantou A, Giannelou P, Grigoriadis S, Tzonis P, Griva T, Zikopoulos A, Philippou A, Koutsilieris M, Pantos K, Simopoulou M. P–674 Development of a predictive model indicating the population of poor responders benefiting from luteal phase oocyte retrieval. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.673] [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
Study question
Can successful implementation of luteal phase oocyte retrieval (LuPOR) following conventional follicular phase oocyte retrieval (FoPOR) be predicted for poor ovarian response (POR) patients?
Summary answer
Antral follicle count (AFC), number of small follicles recorded in FoPOR, and estradiol (E2) levels on FoPOR and LuPOR trigger days, predict successful LuPOR application.
What is known already
A second follicular wave in the same menstrual cycle was first observed in domestic animals such as horses and cattle and thenceforth in women. The second follicular wave has been introduced as an encouraging means towards optimizing the context of in vitro fertilization (IVF) success rates for infertile women and especially for POR patients. Double ovarian stimulation coupled with two oocyte retrievals in the same menstrual cycle has been proposed, and encouraging results have been reported. However, the high heterogeneity characterizing POR patients dictates that studies should focus on factors indicating efficient LuPOR application.
Study design, size, duration
This retrospective observational study included 1688 women diagnosed with POR, undergoing natural IVF cycles between 2012–2020 including two oocyte retrievals in the same menstrual cycle. Patients’ age, body mass index (BMI), number of previous POR incidences, basal hormonal levels, AFC, E2 evaluated on both trigger days and number of small follicles (8–13 mm) were evaluated on their predictive power regarding retrieval of at least one MII oocyte following LuPOR, being regarded as successful LuPOR implementation.
Participants/materials, setting, methods
A diagnosis of POR according to Bologna criteria served as the inclusion criterion for this single center study. All other infertility etiologies were excluded. Patient dataset was stratified according to age in quantiles. A random 20% of each quantile was employed to validate the model. The remaining 80% was employed to develop this model. The predictive value was determined employing the Area Under the Curve (AUC) of the Receiver Operating Characteristics, employing Youden’s index.
Main results and the role of chance
Patients’ age, BMI, number of previous failed IVF attempts, basal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and progesterone failed to be predictive of a successful LuPOR as the AUC was below 0.6. AFC with a threshold value of 4.47, was found to be predictive of an effective LuPOR with an AUC of 0.86, sensitivity 0.8, specificity 0.75, and accuracy 0.79. E2 levels evaluated on the FoPOR trigger day, with a threshold value of 232.66 pg/ml, were similarly predictive of an effective LuPOR presenting with an AUC 0.86, specificity 0.75, sensitivity 0.86 and accuracy 0.82. Similarly, E2 evaluated on the LuPOR trigger day, with a threshold value of 200.89 pg/ml, presented with an AUC 0.89, specificity 0.85, sensitivity 0.95 and accuracy 0.92. The number of small follicles during FoPOR also appeared to be predictive of the presence of at least one MII oocyte during LuPOR, with a threshold value of 2.94. The AUC was 0.82, specificity 0.75, sensitivity 0.76 and accuracy 0.75. When combining the above characteristics into a single predictive model the AUC was 0.88, specificity 0.73, sensitivity 0.94 and accuracy 0.89. The positive and negative predictive value of the model were 93.5% and 46.8%, respectively.
Limitations, reasons for caution
Employment of natural cycles may present as a limitation when examining the value of this study, as the cut-off values reported herein may be altered when stimulation is employed. Since internal validation may be confounded by the fact that this was a single center study, external validation is required.
Wider implications of the findings: The clinical end-point of this study reporting back to the practitioner, is the development of a predictive model identifying the optimal POR population for whom LuPOR practice is valuable. The high positive predictive value of this model may assist clinicians in identifying poor responders who will benefit from this approach.
Trial registration number
Not applicable
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Affiliation(s)
- K Sfakianoudis
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - D Galatis
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - E Maziotis
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - A Pantou
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - P Giannelou
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - S Grigoriadis
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - P Tzonis
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - T Griva
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - A Zikopoulos
- Royal Cornwall Hospital, Obstetrics and Gynaecology, Truro- Treliske, United Kingdom
| | - A Philippou
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - M Koutsilieris
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
| | - K Pantos
- Centre for Human Reproduction- Genesis Athens Clinic, Assisted Conception Unit, Chalandri- Athens, Greece
| | - M Simopoulou
- Medical School- National and Kapodistrian University of Athens, Physiology, Athens, Greece
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Philippou A, Rizvi A, Steinlauf A. Dramatic Deep and Durable Remission of Acute Fulminant Ulcerative Colitis Achieved with Cyclosporine in a Patient Who Failed the Induction Intravenous Phase of Cyclosporine. Case Rep Gastroenterol 2021; 15:147-153. [PMID: 33708063 PMCID: PMC7923724 DOI: 10.1159/000512426] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/16/2020] [Indexed: 12/02/2022] Open
Abstract
Medical rescue therapy for patients with severe steroid-refractory ulcerative colitis (UC) consists of intravenous (IV) cyclosporine or infliximab and remains limited. Cyclosporine is used by fewer medical facilities due to comfort and need for close drug level monitoring, despite evidence that it can have dramatic benefits. In many tertiary centers it is accepted that after 3–7 days of treatment with IV cyclosporine without response, a patient will not respond to the therapy, and other modalities, namely surgery, should be considered. We present the case of a 36-year-old man with acute severe UC refractory to steroids and multiple biologics, who “failed” IV cyclosporine for 2 weeks, much longer than the usually accepted induction phase, and achieved remission with continuation of oral cyclosporine. This case demonstrates the possibility that continued therapy with cyclosporine for a longer duration than the currently accepted timeline can lead to remission and avoidance of colectomy in properly selected and monitored patients.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Anam Rizvi
- Department of Internal Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Adam Steinlauf
- Department of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
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Bogdanis G, Stavrinou P, Fatouros I, Philippou A, Chatzinikolaou A, Draganidis D, Ermidis G, Maridaki M. Short-term high-intensity interval exercise training attenuates oxidative stress responses and improves antioxidant status in healthy humans. Food Chem Toxicol 2013; 61:171-7. [DOI: 10.1016/j.fct.2013.05.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/10/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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Tzanis G, Philippou A, Dimopoulos S, Karatzanos E, Sousonis V, Kapelios C, Rontogianni D, Terrovitis J, Koutsilieris M, Nanas S. Anabolic effects of interval exercise training on skeletal muscle of patients with chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5787] [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: 11/14/2022] Open
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Ntanasis-Stathopoulos J, Tzanninis JG, Philippou A, Koutsilieris M. Epigenetic regulation on gene expression induced by physical exercise. J Musculoskelet Neuronal Interact 2013; 13:133-146. [PMID: 23728100] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
It is well established that physical exercise modulates the function of many physiological systems, such as the musculoskeletal, the cardiovascular and the nervous system, by inducing various adaptations to the increased mechanical load and/or metabolic stress of exercise. Many of these changes occur through epigenetic alterations to DNA, such as histone modifications, DNA methylations, expression of microRNAs and changes of the chromatin structure. All these epigenetic alterations may have clinical relevance, thus playing an important role in the prevention and confrontation of neurophysiological disorders, metabolic syndrome, cardiovascular diseases and cancer. Herein we review the known epigenetic modifications induced by physical exercise in various physiological systems and pathologies, and discuss their potential clinical implications.
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Affiliation(s)
- J Ntanasis-Stathopoulos
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Philippou A, Maridaki M, Bogdanis G, Halapas A, Koutsilieris M. Changes in the mechanical properties of human quadriceps muscle after eccentric exercise. In Vivo 2009; 23:859-865. [PMID: 19779124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Muscular adaptation which occurs following eccentric exercise-induced muscle damage has been associated with changes in the mechanical properties of muscle manifested as a shift in the length-tension relationship towards longer muscle lengths. However, it is not clear whether this shift is a long term adaptation to eccentric exercise. The purpose of this study was to investigate functional adaptations to skeletal muscle damage in humans, tracking such responses several days into muscle recovery. Ten healthy young men performed an eccentric exercise protocol involving the quadriceps muscle and functional measurements were performed before and on days 1, 2, 5, 8, 12 and 16 post-exercise. Blood samples were also withdrawn before and at 6 h, and 2 days, 5 days and 16 days post-exercise. The exercise protocol resulted in muscle damage, indicated by changes in clinical markers including increased serum creatine kinase activity and muscle soreness compared to pre-exercise levels (p<0.05-0.001). An acute, but not sustained shift in the quadriceps isokinetic and isometric angle-torque curves towards longer muscle lengths was observed post-exercise (p<0.05). It was speculated that the functional adaptations following eccentric exercise might be affected by the short resting and functional length of the quadriceps muscle, relative to its optimum. More studies are needed to confirm the hypothesis that a sustained shift in the muscle's length-tension relationship, as an adaptation after lengthening contraction-induced damage, is muscle specific.
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Affiliation(s)
- A Philippou
- Department of Experimental Physiology, Medical School, National and Kapdistrian University of Athens, Goudi, Athens
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Philippou A, Papageorgiou E, Bogdanis G, Halapas A, Sourla A, Maridaki M, Pissimissis N, Koutsilieris M. Expression of IGF-1 isoforms after exercise-induced muscle damage in humans: characterization of the MGF E peptide actions in vitro. In Vivo 2009; 23:567-575. [PMID: 19567392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Different insulin-like growth factor-1 (IGF-1) isoforms, namely IGF-1Ea, IGF-1Eb and IGF-1Ec (MGF), have been proposed to have various functions in muscle repair and growth. To gain insight into the potentially differential actions of IGF-1 isoforms in the regulation of muscle regeneration, we assessed the time course of their expressions at both mRNA and protein levels after exercise-induced muscle damage in humans. In addition, we characterized mature IGF-1 and synthetic MGF E peptide signalling in C2C12 myoblast-like cells in vitro. Ten healthy male volunteers were subjected to exercise-induced muscle damage and biopsy samples were taken from the exercised muscles before and 6 h, 2, 5 and 16 days post exercise. Muscle damage was documented by specific functional and biochemical responses post exercise. PCR-based analyses of muscle biopsy samples revealed a rapid and transient up-regulation of MGF mRNA expression which was followed by a prolonged increase of IGF-1Ea and IGF-1Eb mRNA expression (p<0.05). Patterns similar to those for mRNA expression were detected for MGF and IGF-1Ea expression at the protein level. The action of synthetic MGF E peptide differed from that of mature IGF-1 since its proliferative effect on C2C12 myoblast-like cells was not blocked by an anti-IGF-1 receptor neutralizing antibody and it did not phosphorylate Akt. Therefore, we conclude that the differential expression profile of IGF-1 isoforms in vivo and the possible IGF-1R - independent MGF E peptide signalling in skeletal muscle-like cells in vitro support the notion that tissue-specific mRNA expression of MGF isoform produces mature IGF-1 and MGF E peptides which possibly act as distinct mitogens in skeletal muscle regeneration.
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Affiliation(s)
- A Philippou
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, 75 Micras Asias, Goudi-Athens, 115 27, Greece
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Halapas A, Papalois A, Stauropoulou A, Philippou A, Pissimissis N, Chatzigeorgiou A, Kamper E, Koutsilieris M. In vivo models for heart failure research. In Vivo 2008; 22:767-780. [PMID: 19181005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The medical treatment of heart failure (HF) is associated with 50% survival at 5 years, thus being one of the major causes of mortality in Western countries. An understanding of the pathophysiology of HF is essential for the development of novel efficient therapies. Consequently, the use of animal models is indispensable. In addition, the development of new in vivo models of HF is critical for the evaluation of treatments such as gene therapy, mechanical devices and new surgical approaches. However, every animal model has advantages and limitations and none of them is suitable to study all aspects of HF. Besides the technical determinants of a model, species, strain and gender affect the pathophysiology of a given heart pathogenesis and, therefore, have to be considered in each animal model. The most common in vivo models used in cardiology research and in particular in HF remodeling are presented.
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Affiliation(s)
- A Halapas
- Department of Experimental Physiology, Medical School, University of Athens, Athens, Greece
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Philippou A, Maridaki M, Koutsilieris M. The role of urokinase-type plasminogen activator (uPA) and transforming growth factor beta 1 (TGFbeta1) in muscle regeneration. In Vivo 2008; 22:735-750. [PMID: 19181000] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Skeletal muscle regeneration is a highly synchronized process involving the activation of various cellular and molecular events, coordinating inflammation and regeneration processes which are crucial for the beneficial outcome of tissue remodeling. Fibrosis, a failure of tissue remodeling, is initiated with muscle regeneration; however, it is the result of an excessive inflammatory response, representing an imbalance between enhanced production and deposition and impaired degradation of extracellular matrix (ECM) components of the muscle. Therefore, factors influencing the relative degree of muscle fiber regeneration as compared to the amount of scar formation have a critical role in functional muscle remodeling. Herein we have focused on the role of urokinase-type plasminogen activator (uPA) and transforming growth factor beta 1 (TGF/1) in ECM degradation and reconstitution in muscles.
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Affiliation(s)
- A Philippou
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Philippou A, Stavropoulou A, Sourla A, Pissimissis N, Halapas A, Maridaki M, Koutsilieris M. Characterization of a rabbit antihuman mechano growth factor (MGF) polyclonal antibody against the last 24 amino acids of the E domain. In Vivo 2008; 22:27-35. [PMID: 18396778] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The human insulin-like growth factor-1 (IGF-1) gene gives rise to multiple, heterogeneous mRNA transcripts by alternative splicing, thus producing different IGF-1 isoforms. The mechano growth factor (MGF) is an IGF-1 isoform that was found to be markedly up-regulated in exercised or damaged muscle. The specific E domain of the MGF splice variant may act as an independent growth factor. The aim of the present study was to characterize a rabbit antihuman MGF polyclonal antibody. New-Zealand rabbits were immunized by injections of a purified synthetic peptide corresponding to the last 24 amino acids of the human C-terminal of the MGF E domain. Western blotting and immunohistochemical techniques were used to characterize the specificity of the polyclonal anti-MGF antiserum. The anti-MGF antiserum was found to recognize the MGF E-peptide and not the common part of the IGF-1 isoforms, i.e. the mature IGF-1 peptide. Furthermore, it specifically bound to the MGF protein in human skeletal and in rat cardiac muscle, apparently due to the considerable homology between the human and rat MGF E-peptide sequences. Immunostaining analysis showed that this polyclonal anti-MGF antibody was able to detect MGF in human muscle and in rat cardiomyocytes and vessels' smooth muscle cells. We conclude that this rabbit polyclonal anti-human/rat MGF antibody could become a valuable tool in the study of IGF-1 isoforms in human and rat tissues.
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Affiliation(s)
- A Philippou
- Department of Experimental Physiology, Medical School, Faculty of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
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Philippou A, Halapas A, Maridaki M, Koutsilieris M. Type I insulin-like growth factor receptor signaling in skeletal muscle regeneration and hypertrophy. J Musculoskelet Neuronal Interact 2007; 7:208-218. [PMID: 17947802] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Skeletal muscle is able not only to increase its mass as an adaptation to mechanical loading generated by and imposed upon muscle but also to regenerate after damage, via its intrinsic regulation of gene transcription. Both cellular processes, muscle regeneration and hypertrophy, are mediated by the activation, proliferation and differentiation of muscle satellite cells and appear to be modulated by the mitotic and myogenic activity of locally produced insulin-like growth factor 1 (IGF-1), which functions in an autocrine/paracrine mode. Differentiation of satellite cells into myoblasts involves the regulation of skeletal muscle-specific proteins belonging to the family of myogenic regulatory factors (MRFs). The endocrine, autocrine and paracrine functions of IGF-1 are mediated through binding to the type I IGF receptor (IGF-1.R), which is a ligand-activated receptor tyrosine kinase. The binding of IGF-1 to IGF-1.R induces its autophosphorylation, which recruits specific cytoplasmic molecules containing the Insulin Receptor Substrate Proteins (IRS). The recruitment of IRS proteins by IGF-1/IGF-1.R binding is a critical level at which the proliferative and differentiative actions of IGF-1 diverge. Specific signaling pathways downstream of IGF-1, potentially involved in the mitogenic and myogenic responses and mediating skeletal muscle protein synthesis and hypertrophy following exercise-induced muscle overloading and damage, are discussed. A potential alternative activation of different signaling pathway(s) via a different receptor remains to be demonstrated.
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Affiliation(s)
- A Philippou
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Goudi-Athens, Greece
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Philippou A, Bogdanis G, Maridaki M. Isotonic muscle function is selectively reduced after muscle damage induced by isometric exercise at a long muscle length. ISOKINET EXERC SCI 2007. [DOI: 10.3233/ies-2007-0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Philippou
- Department of Sports Medicine and Biology of Physical Activity, Faculty of Physical Education and Sports Science, University of Athens, Athens, Greece
| | - G.C. Bogdanis
- Department of Sports Medicine and Biology of Physical Activity, Faculty of Physical Education and Sports Science, University of Athens, Athens, Greece
| | - M. Maridaki
- Department of Sports Medicine and Biology of Physical Activity, Faculty of Physical Education and Sports Science, University of Athens, Athens, Greece
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Anderson MW, Terasaki O, Ohsuna T, Malley PJO, Philippou A, Mackay SP, Ferreira A, Rocha J, Lidin S. Microporous titanosilicate ETS-10: A structural survey. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/01418639508243589] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. W. Anderson
- a Department of Chemistry , UMIST , PO Box 88, Manchester , M60, 1QD , UK
| | - O. Terasaki
- b Department of Physics , Tohoku University , Aramaki Aoba, Sendai , 980 , Japan
| | - T. Ohsuna
- c College of Science and Engineering, Iwaki Meisei University , 5-5-1 Iino Chuoudai, Iwaki, Fukuchima , 970 , Japan
| | - P. J. O. Malley
- a Department of Chemistry , UMIST , PO Box 88, Manchester , M60, 1QD , UK
| | - A. Philippou
- a Department of Chemistry , UMIST , PO Box 88, Manchester , M60, 1QD , UK
| | - S. P. Mackay
- a Department of Chemistry , UMIST , PO Box 88, Manchester , M60, 1QD , UK
| | - A. Ferreira
- d Department of Chemistry , University of Aveiro , 3800 , Aveiro , Portugal
| | - J. Rocha
- d Department of Chemistry , University of Aveiro , 3800 , Aveiro , Portugal
| | - S. Lidin
- e Inorganic Chemistry 2, Chemical Centre, Lund University , Lund , Sweden
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Anderson M, Rocha J, Lin Z, Philippou A, Orion I, Ferreira A. Isomorphous substitution in the microporous titanosilicate ETS-10. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0927-6513(95)00098-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anderson MW, Philippou A, Lin Z, Ferreira A, Rocha J. Ein mikroporöses Titanaluminiumsilicat ETAS-10, in dem die Al- und Ti-Atome einander ausweichen. Angew Chem Int Ed Engl 1995. [DOI: 10.1002/ange.19951070924] [Citation(s) in RCA: 4] [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: 11/11/2022]
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Prast H, Fischer H, Philippou A. Characterization of muscarinic acetylcholine heteroreceptors modulating in vivo release of histamine in the rat hypothalamus. Inflamm Res 1995; 44 Suppl 1:S58-9. [PMID: 8521002 DOI: 10.1007/bf01674395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- H Prast
- Department of Pharmacology and Toxicology, University of Innsbruck, Austria
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Anderson M, Terasaki O, Ohsuna T, Philippou A, MacKay S, Ferreira A, Rocha J, Lidin S. Structure of the microporous titanosilicate ETS-10. Zeolite Science 1994: Recent Progress and Discussions - Supplementary Materials to the 10th International Zeolite Conference, Garmish-Partenkirchen, Germany, July 17-22, 1994 1995. [DOI: 10.1016/s0167-2991(06)81181-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Anderson MW, Terasaki O, Ohsuna T, Philippou A, MacKay SP, Ferreira A, Rocha J, Lidin S. Structure of the microporous titanosilicate ETS-10. Nature 1994. [DOI: 10.1038/367347a0] [Citation(s) in RCA: 444] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gemenis T, Philippou A, Gouliamos A, Kalovidouris A, Papavasiliou C, Panani A, Chalevelakis G, Papacharalambus X, Raptis S. Atypical location of extramedullary hematopoietic masses in thalassemia. Radiologe 1989; 29:295-6. [PMID: 2740493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case of beta-thalassemia with multiple foci of extramedullary hematopoiesis (EH) is reported. EH masses were demonstrated in the presacral and the costovertebral space. EH foci were also encountered in the spleen.
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Affiliation(s)
- T Gemenis
- Department of Radiology, University of Athens, Medical School, Greece
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