1
|
Ghersin I, Weisshof R, Koifman E, Bar-Yoseph H, Ben Hur D, Maza I, Hasnis E, Nasser R, Ovadia B, Dror Zur D, Waterman M, Gorelik Y. Comparative evaluation of a language model and human specialists in the application of European guidelines for the management of inflammatory bowel diseases and malignancies. Endoscopy 2024. [PMID: 38499197 DOI: 10.1055/a-2289-5732] [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: 03/20/2024]
Abstract
BACKGROUND Society guidelines on colorectal dysplasia screening, surveillance, and endoscopic management in inflammatory bowel disease (IBD) are complex, and physician adherence to them is suboptimal. We aimed to evaluate the use of ChatGPT, a large language model, in generating accurate guideline-based recommendations for colorectal dysplasia screening, surveillance, and endoscopic management in IBD in line with European Crohn's and Colitis Organization (ECCO) guidelines. METHODS 30 clinical scenarios in the form of free text were prepared and presented to three separate sessions of ChatGPT and to eight gastroenterologists (four IBD specialists and four non-IBD gastroenterologists). Two additional IBD specialists subsequently assessed all responses provided by ChatGPT and the eight gastroenterologists, judging their accuracy according to ECCO guidelines. RESULTS ChatGPT had a mean correct response rate of 87.8%. Among the eight gastroenterologists, the mean correct response rates were 85.8% for IBD experts and 89.2% for non-IBD experts. No statistically significant differences in accuracy were observed between ChatGPT and all gastroenterologists (P=0.95), or between ChatGPT and the IBD experts and non-IBD expert gastroenterologists, respectively (P=0.82). CONCLUSIONS This study highlights the potential of language models in enhancing guideline adherence regarding colorectal dysplasia in IBD. Further investigation of additional resources and prospective evaluation in real-world settings are warranted.
Collapse
Affiliation(s)
- Itai Ghersin
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Roni Weisshof
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Eduard Koifman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Dana Ben Hur
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Itay Maza
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Erez Hasnis
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Roni Nasser
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dikla Dror Zur
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
| | - Matti Waterman
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yuri Gorelik
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
2
|
Koifman E, Armoni M, Gorelik Y, Harbi A, Streltsin Y, Duek SD, Brun R, Mazor Y. Long term persistence and risk factors for anorectal symptoms following low anterior resection for rectal cancer. BMC Gastroenterol 2024; 24:31. [PMID: 38216868 PMCID: PMC10787434 DOI: 10.1186/s12876-023-03112-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Rectal cancer is commonly treated by chemoradiation therapy, followed by the low anterior resection anal sphincter-preserving surgery, with a temporary protecting ileostomy. After reversal of the stoma a condition known as low anterior resection syndrome (LARS) can occur characterized by a combination of symptoms such as urgent bowel movements, lack of control over bowel movements, and difficulty fully emptying the bowels. These symptoms have a significant negative impact on the quality of life for individuals who have survived the cancer. Currently, there is limited available data regarding the presence, risk factors, and effects of treatment for these symptoms during long-term follow-up. AIMS To evaluate long term outcomes of low anterior resection surgery and its correlation to baseline anorectal manometry (ARM) parameters and physiotherapy with anorectal biofeedback (BF) treatment. METHODS One hundred fifteen patients (74 males, age 63 ± 11) who underwent low anterior resection surgery for rectal cancer were included in the study. Following surgery, patients were managed by surgical and oncologic team, with more symptomatic LARS patients referred for further evaluation and treatment by gastroenterologists. At follow up, patients were contacted and offered participation in a long term follow up by answering symptom severity and quality of life (QOL) questionnaires. RESULTS 80 (70%) patients agreed to participate in the long term follow up study (median 4 years from stoma reversal, range 1-8). Mean time from surgery to stoma closure was 6 ± 4 months. At long term follow up, mean LARS score was 30 (SD 11), with 55 (69%) patients classified as major LARS (score > 30). Presence of major LARS was associated with longer time from surgery to stoma reversal (6.8 vs. 4.8 months; p = 0.03) and with adjuvant chemotherapy (38% vs. 8%; p = 0.01). Patients initially referred for ARM and BF were more likely to suffer from major LARS at long term follow up (64% vs. 16%, p < 0.001). In the subgroup of patients who underwent perioperative ARM (n = 36), higher maximal squeeze pressure, higher maximal incremental squeeze pressure and higher rectal pressure on push were all associated with better long-term outcomes of QOL parameters (p < 0.05 for all). 21(54%) of patients referred to ARM were treated with BF, but long term outcomes for these patients were not different from those who did not perform BF. CONCLUSIONS A significant number of patients continue to experience severe symptoms and a decline in their quality of life even 4 years after undergoing low anterior resection surgery. Prolonged time until stoma reversal and adjuvant chemotherapy emerged as the primary risk factors for a negative prognosis. It is important to note that referring patients for anorectal physiology testing alone tended to predict poorer long-term outcomes, indicating the presence of selection bias. However, certain measurable manometric parameters could potentially aid in identifying patients who are at a higher risk of experiencing unfavorable functional outcomes. There is a critical need to enhance current treatment options for this patient group.
Collapse
Affiliation(s)
- E Koifman
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel.
| | - M Armoni
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - Y Gorelik
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - A Harbi
- Rambam Health Care Campus, Department of General Surgery, Haifa, Israel
| | - Y Streltsin
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - S D Duek
- Rambam Health Care Campus, Department of General Surgery, Haifa, Israel
| | - R Brun
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - Y Mazor
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
3
|
Tsaban G, Barret O, Peles I, Abramowitz Y, Shmueli H, Cafri C, Zahger D, Koifman E. Prognostic factors of patients with myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1452] [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
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE). Unlike obstructive coronary artery disease (OCAD), data regarding the prognosis of MINOCA are scarce.
Methods
We conducted a retrospective study among consecutive patients with MINOCA in a large tertiary medical center in Israel between the years 2005–2018. We assessed parameters associated with MAE, defined as all-cause mortality or recurrent MI. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded.
Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. The mean age was 61±13, and 710 (46%) were females. At a median follow-up of 7 years, the MAE rate was 17%, as 153 (9.9%) died, and 117 (7.5%) had recurrent MI. ST-elevation MI at presentation and older age were associated with increased 30-day MAE. In multivariate models, independent factors associated with MAE were female gender (HR=0.58; 95% CI 0.43–0.76), age (HR=1.04; 95% CI 1.03–1.05), left ventricular ejection fraction (LVEF) <40% (HR=2.68; 95% CI 1.74–4.12), increased serum-creatinine (HR=1.11; 95% CI 1.02–1.21), higher hemoglobin (HR=0.81; 95% CI 0.76–0.88), and documented sinus rhythm (HR=0.58; 95% CI 0.38–0.86).
Conclusion
MINOCA carries an increased risk for long-term MAE. Among MINOCA patients older age, LVEF <40%, and increased serum-creatinine are associated with increased MAE risk, while female gender, higher hemoglobin, and sinus rhythm are associated with lower MAE risk.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Tsaban
- Soroka University Medical Center , Beer Sheva , Israel
| | - O Barret
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - I Peles
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Abramowitz
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Shmueli
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - C Cafri
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - D Zahger
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - E Koifman
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| |
Collapse
|
4
|
Tsaban G, Barret O, Peles I, Abramowitz Y, Shmueli H, Cafri C, Zahger D, Koifman E. The prognostic impact of coronary anatomy in myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1451] [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
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE) that may occur presence of normal or nonobstructive coronary artery anatomy (NCAA and NOCAA, respectively). The prognostic impact presence of NOCAA on long-term outcomes of MINOCA patients remains unclear.
Methods
This is a retrospective study among consecutive MINOCA patients in a large referral medical center in Israel between the years 2005–2018. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded. Patients were classified according to their coronary angiography diagnosis into NCAA and NOCAA. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). We performed survival analyses using multivariable Cox regression, controlling for potential cofounders.
Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. Among MINOCA patients, 651 (42%) had NCAA, and 893 (58%) had NOCAA. The mean age was 61.2±12.6 years, and 710 (46.0%) were females. The NOCAA group had more females and were older with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal failure (p<0.05 for all). At a median follow-up of 7 years, MAE occurred in 203 (22.7%) patients and 67 (10.3%) patients in the NOCAA and NCAA groups, respectively (p<0.01). In fully-adjusted multivariable model, NOCAA remained a significant risk factor for long-term MAE [adjusted-hazard-ratio (aHR) 1.67, 95% confidence-interval (95% CI) 1.25–2.23; p<0.001; figure]. Other factors associated with MAE were older age (aHR 1.05, 95% CI 1.03–1.06; p<0.001), left ventricular ejection fraction (LVEF) <40% (aHR 3.04, 95% CI 2.03–4.57; p<0.001)
Conclusion
Among MINOCA patients, NOCAA was associated with a worse long-term prognosis than NCAA. Other risk factors for long-term MAE were older age and LVEF <40%, while female sex and sinus rhythm at presentation were associated with lower MAE risk.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Tsaban
- Soroka University Medical Center , Beer Sheva , Israel
| | - O Barret
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - I Peles
- Soroka University Medical Center, Clinical Research Center , Beer Sheva , Israel
| | - Y Abramowitz
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - H Shmueli
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - C Cafri
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - D Zahger
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| | - E Koifman
- Soroka University Medical Center, Heart Institute , Beer Sheva , Israel
| |
Collapse
|
5
|
Barrett O, Edry Nadiv O, Peles I, Abramowitz Y, Cafri C, Rosenstein G, Merkin M, Zahger D, Koifman E. Long-term outcome of patients with myocardial infraction with nonobstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a condition of growing interest and research. We aimed to evaluate the long-term prognosis of MINOCA patients and identify possible risk factors associated with long term mortality in this patient's population.
Methods
We performed a retrospective observational cohort study including all patients aged ≥18 years hospitalized to a large tertiary center between 2005–2018 with a primary diagnosis of acute myocardial infarction (AMI) and non-obstructive lesions with less than <50% stenosis in all coronary arteries. The aim of the study was to assess the long-term mortality and to evaluate factors associated with increased mortality in this population.
Results
MINOCA was diagnosed in 1544 patients during the study period. Mean age of patients was 61±12.3 and 46% were female. Common comorbidities were dyslipidemia (32.6%) and hypertension (21.2%) and 17% had prior PCI. More than third of the patients were treated with statins (37.2%), micropirin (32.7%) and angiotensin converting enzyme (ACE)-inhibitors (30.4%). While short-term prognosis was favorable with only 1.2% mortality at 30-days, 1-year mortality was 3.9% and 19.9% mortality at mean follow-up time of 8.5 years. While many factors were associated with unfavorable long-term outcome in the univariate analysis, only advanced age (HR =1.05, 95% confidence interval (CI) 1.02–1.07; p<0.001) and congestive heart failure (HR=3.53, 95% CI 1.74–7.18; P<0.001) were independently associated with increased mortality risk in the adjusted model.
Conclusions
MINOCA is not an infrequent condition that carries a good short-term outcome, but long-term outcome may be comparable to patients with obstructive coronary disease. Further research should be performed to elucidate the various mechanisms of MINOCA.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- O Barrett
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - O Edry Nadiv
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - I Peles
- Soroka University Medical Center, Clinical research center, Beer Sheva, Israel
| | - Y Abramowitz
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - C Cafri
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - G Rosenstein
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - M Merkin
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - D Zahger
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - E Koifman
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| |
Collapse
|
6
|
Barrett O, Hadad L, Abramowitz Y, Cafri C, Rosenstein G, Merkin M, Zahger D, Koifman E. Comparison of coronary bifurcation lesions stenting techniques- a network meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2551] [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
Coronary bifurcations lesions (CBL) are account for 15–20% of all percutaneous coronary interventions (PCI) and constitute a major challenge for interventionists in terms of procedural success rate and long-term cardiac events. Based on data from multiple randomized trials and registries, current guidelines advocate the use of provisional side branch (SB) stenting strategy for the majority of CBL's. However, for true or complex CBL's (long side branches lesions, difficult side branches access or high risk of side branches compromise), which account for up to 25% of CBL's, this strategy may by unsafe and ineffective due to a potential risk of intraprocedural or long-term occlusion of a significant side branch and a two-stenting technique may be needed in order to achieve optimal results. Up to date, the optimal two- stenting technic for CBL remains in debate. Accordingly, our aim was to compare different stenting techniques in coronary bifurcation lesions.
Methods
We performed a MEDLINE search for randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL's with reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare culotte, T and protrusion (TAP), crush and provisional techniques
Results
A total of 13 RCT and 12 observational studies were identified including 6806 patients, among whom 1,201 were treated with cullotte, 2,731 with crush, 797 with TAP and 2077 with provisional stenting. The Bayesian hierarchical random-effects model demonstrated a significant reduction in target lesion revascularization (TLR) rate with crush techniques compared with provisional technique (OR 0.64 95% CI 0.42–0.97) along with a trend for reduction in major adverse cardiovascular (MACE) events (OR 0.75, 95% CI 0.55–1.02). TAP and culotte techniques did not show similar results. Equality of other endpoints, including mortality, myocardial infarction and re-stenosis was found between all CBL's techniques (Figure 1).
Discussion
Our findings suggest improved outcomes with crush technique compared to other double stenting techniques in terms of TLR with a trend towards MACE reduction. Further research is required to determine the optimal stenting technique for coronary bifurcations lesions along with the utility of imaging and physiology in this complex subset.
Figure 1. Comparison of double stentin techniques
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- O Barrett
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - L Hadad
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - Y Abramowitz
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - C Cafri
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - G Rosenstein
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - M Merkin
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - D Zahger
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| | - E Koifman
- Soroka Medical Center and Ben-Gurion University of the Negev., Division of cardiology, Beer Sheva, Israel
| |
Collapse
|
7
|
Beigel R, Mazin I, Koifman E, Shechter M, Pres H, Shlomo N, Rosenberg N, Asher E, Matetzky S. Aspirin withdrawal in patients treated with ticagrelor presenting with non-ST elevation myocardial infarction. J Thromb Haemost 2018; 16:663-669. [PMID: 29443445 DOI: 10.1111/jth.13977] [Citation(s) in RCA: 5] [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: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Essentials Strong P2Y12 blockade may cause platelet inhibition that is only minimally enhanced by aspirin. We evaluated aspirin withdrawal on platelet reactivity in ticagrelor treated patients. Aspirin withdrawal resulted in increased platelet reactivity to arachidonic acid. Aspirin withdrawal caused little difference in adenosine diphosphate-induced platelet aggregation. SUMMARY Background Recent studies have shown that the thromboxane A2 -dependent pathway is dependent on the ADP-P2Y12 pathway, and that strong P2Y12 receptor blockade alone causes inhibition of platelet aggregation that is minimally enhanced by aspirin. Data from the PLATO trial suggested that, among ticagrelor-treated patients, high-dose versus low-dose (< 100 mg day-1 ) aspirin is associated with an increased risk fof ischemic events. Objectives To evaluate the impact of aspirin withdrawal on platelet reactivity in acute coronary syndrome (ACS) patients treated with a potent P2Y12 blocker. Patients/Methods This was a current prospective, randomized, placebo-controlled, double-blind, cross-over study. The study population comprised 22 consecutive ACS patients who underwent percutaneous coronary intervention and were treated with aspirin (100 mg day-1 ) and ticagrelor. Thirty days post-ACS, open-label aspirin was stopped, and patients were randomized to either blinded aspirin or placebo for 2 weeks, with each patient crossing over to the other arm for an additional 2 weeks. Platelet reactivity to arachidonic acid and ADP determined with light-transmission aggregometry (LTA) and VerifyNow was evaluated at baseline, and 2 weeks and 4 weeks later. Results Aspirin withdrawal resulted in an increase in arachidonic-acid induced platelet reactivity as determined with both LTA (77.0% ± 11.3% versus 20.8% ± 4.4%) and VerifyNow (607.7 ± 10.6 aspirin reaction units [ARU] versus 408.5 ± 14.4 ARU). Platelet response to ADP, as determined with both LTA and VerifyNow, did not differ with either aspirin or placebo (32.9% ± 2.6% versus 35.8% ± 3.6%, and 33.5 ± 6.4 P2Y12 reaction units (PRU) versus 29.6 ± 5.7 PRU, respectively). Conclusions Aspirin withdrawal early post-ACS results in increased platelet reactivity in response to arachidonic acid, despite concomitant treatment with the potent P2Y12 blocker ticagrelor.
Collapse
Affiliation(s)
- R Beigel
- Cardiovascular Division, Intensive Cardiac Care Unit, Sheba Medical Center, Tel Aviv, Israel
| | - I Mazin
- Cardiovascular Division, Intensive Cardiac Care Unit, Sheba Medical Center, Tel Aviv, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - E Koifman
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - M Shechter
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - H Pres
- Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel
| | - N Shlomo
- Cardiovascular Division, Intensive Cardiac Care Unit, Sheba Medical Center, Tel Aviv, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Rosenberg
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - E Asher
- Cardiovascular Division, Intensive Cardiac Care Unit, Sheba Medical Center, Tel Aviv, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - S Matetzky
- Cardiovascular Division, Intensive Cardiac Care Unit, Sheba Medical Center, Tel Aviv, Israel
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Alraies M, Buchanan K, Steinvil A, Rogers T, Koifman E, Gai A, Torguson R, Ben-Dor I, Satler L, Garcia-Garcia H, Waksman R. P5122High bleeding risk influences the type of stent used in patients presetting with acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5122] [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
|
9
|
Buchanan K, Alraies M, Rogers T, Steinvil A, Kajita A, Koifman E, Xu L, Torguson R, Lipinski M, Garcia-Garcia H, Ben-Dor I, Pichard A, Satler L, Waksman R, Asch F. P4227Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis patients following transcatheter aortic valve replacement. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4227] [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: 11/12/2022] Open
|
10
|
Koifman E, Asch F, Didier R, Jerusalem Z, Torguson R, Kiramijyan S, Ben-Dor I, Wang Z, Goldstein S, Xu L, Pichard A, Satler L, Waksman R. P750Impact of diastolic dysfunction severity on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p750] [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
|
11
|
Nakhleh M, Amal H, Jeries R, Broza YY, Aboud M, Gharra A, Ivgi H, Khatib S, Badarneh S, Har-Shai L, Glass-Marmor L, Lejbkowicz I, Miller A, Badarny S, Winer R, Finberg J, Cohen-Kaminsky S, Perros F, Montani D, Girerd B, Garcia G, Simonneau G, Nakhoul F, Baram S, Salim R, Hakim M, Gruber M, Ronen O, Marshak T, Doweck I, Nativ O, Bahouth Z, Shi DY, Zhang W, Hua QL, Pan YY, Tao L, Liu H, Karban A, Koifman E, Rainis T, Skapars R, Sivins A, Ancans G, Liepniece-Karele I, Kikuste I, Lasina I, Tolmanis I, Johnson D, Millstone SZ, Fulton J, Wells JW, Wilf LH, Humbert M, Leja M, Peled N, Haick H. Diagnosis and Classification of 17 Diseases from 1404 Subjects via Pattern Analysis of Exhaled Molecules. ACS Nano 2017; 11:112-125. [PMID: 28000444 PMCID: PMC5269643 DOI: 10.1021/acsnano.6b04930] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/02/2016] [Indexed: 05/17/2023]
Abstract
We report on an artificially intelligent nanoarray based on molecularly modified gold nanoparticles and a random network of single-walled carbon nanotubes for noninvasive diagnosis and classification of a number of diseases from exhaled breath. The performance of this artificially intelligent nanoarray was clinically assessed on breath samples collected from 1404 subjects having one of 17 different disease conditions included in the study or having no evidence of any disease (healthy controls). Blind experiments showed that 86% accuracy could be achieved with the artificially intelligent nanoarray, allowing both detection and discrimination between the different disease conditions examined. Analysis of the artificially intelligent nanoarray also showed that each disease has its own unique breathprint, and that the presence of one disease would not screen out others. Cluster analysis showed a reasonable classification power of diseases from the same categories. The effect of confounding clinical and environmental factors on the performance of the nanoarray did not significantly alter the obtained results. The diagnosis and classification power of the nanoarray was also validated by an independent analytical technique, i.e., gas chromatography linked with mass spectrometry. This analysis found that 13 exhaled chemical species, called volatile organic compounds, are associated with certain diseases, and the composition of this assembly of volatile organic compounds differs from one disease to another. Overall, these findings could contribute to one of the most important criteria for successful health intervention in the modern era, viz. easy-to-use, inexpensive (affordable), and miniaturized tools that could also be used for personalized screening, diagnosis, and follow-up of a number of diseases, which can clearly be extended by further development.
Collapse
Affiliation(s)
- Morad
K. Nakhleh
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Haitham Amal
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Raneen Jeries
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Yoav Y. Broza
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Manal Aboud
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Alaa Gharra
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Hodaya Ivgi
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Salam Khatib
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Shifaa Badarneh
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| | - Lior Har-Shai
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center and Rappaport Family Faculty
of Medicine, Technion−Israel Institute
of Technology, Haifa 31096, Israel
| | - Lea Glass-Marmor
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center and Rappaport Family Faculty
of Medicine, Technion−Israel Institute
of Technology, Haifa 31096, Israel
| | - Izabella Lejbkowicz
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center and Rappaport Family Faculty
of Medicine, Technion−Israel Institute
of Technology, Haifa 31096, Israel
| | - Ariel Miller
- Division of Neuroimmunology and Multiple
Sclerosis Center, Carmel Medical Center and Rappaport Family Faculty
of Medicine, Technion−Israel Institute
of Technology, Haifa 31096, Israel
| | - Samih Badarny
- Movement
Disorders Clinic, Department of Neurology, Carmel Medical Center,
and Rappaport Family Faculty of Medicine, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - Raz Winer
- Movement
Disorders Clinic, Department of Neurology, Carmel Medical Center,
and Rappaport Family Faculty of Medicine, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - John Finberg
- Department of Molecular Pharmacology, Rappaport
Family Faculty of Medicine, Technion−Israel
Institute of Technology, Haifa 31096, Israel
| | - Sylvia Cohen-Kaminsky
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Frédéric Perros
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - David Montani
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Barbara Girerd
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Gilles Garcia
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Gérald Simonneau
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Farid Nakhoul
- Department of
Nephrology and Hypertension Baruch Padeh
Medical Center, Poriya 15208, Israel
| | - Shira Baram
- Department of Obstetrics
and Gynecology, Emek Medical Center, Afula 18101, and Rappaport Family
Faculty of Medicine, Technion−Israel
Institute of Technology, Haifa 31096, Israel
| | - Raed Salim
- Department of Obstetrics
and Gynecology, Emek Medical Center, Afula 18101, and Rappaport Family
Faculty of Medicine, Technion−Israel
Institute of Technology, Haifa 31096, Israel
| | - Marwan Hakim
- Department
of Obstetrics and Gynecology, Nazareth Hospital EMMS, Nazareth, and
Faculty of Medicine in the Galilee, Bar
Ilan University, Ramat
Gan, Israel
| | - Maayan Gruber
- The Department of Otolaryngology Head and
Neck Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Ohad Ronen
- The Department of Otolaryngology Head and
Neck Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Tal Marshak
- The Department of Otolaryngology Head and
Neck Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Ilana Doweck
- The Department of Otolaryngology Head and
Neck Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Ofer Nativ
- Department of Urology, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Zaher Bahouth
- Department of Urology, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Da-you Shi
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Wei Zhang
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Qing-ling Hua
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Yue-yin Pan
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Li Tao
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Hu Liu
- Department
of Oncology, The First Affiliated Hospital
of Anhui Medical University, Hefei 230032, China
| | - Amir Karban
- Internal Medicine C and Gastroenterology Departments,
Rambam Medical Center, Rappaport Family Faculty of Medicine, Technion−Israel Institute of Technology, Haifa 3525408, Israel
| | - Eduard Koifman
- Internal Medicine C and Gastroenterology Departments,
Rambam Medical Center, Rappaport Family Faculty of Medicine, Technion−Israel Institute of Technology, Haifa 3525408, Israel
| | - Tova Rainis
- Department of Gastroenterology, Bnai Zion
Hospital and Rappaport Family Faculty of Medicine, Technion−Israel Institute of Technology, Haifa 31096, Israel
| | - Roberts Skapars
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
| | - Armands Sivins
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
| | - Guntis Ancans
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
| | - Inta Liepniece-Karele
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
| | - Ilze Kikuste
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
- Digestive Diseases
Centre, GASTRO, 6 Linezeraiela, LV1006 Riga, Latvia
| | - Ieva Lasina
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
| | - Ivars Tolmanis
- Digestive Diseases
Centre, GASTRO, 6 Linezeraiela, LV1006 Riga, Latvia
| | - Douglas Johnson
- Department of Radiation
Oncology, Baptist Cancer Institute (BCI), 1235 San Marco Boulevard, Suite100, Jacksonville, Florida 32207, United States
| | - Stuart Z. Millstone
- Pulmonary
and Critical Care Associates, Orange Park, Florida 32073, United States
| | - Jennifer Fulton
- Pulmonary Diseases, Baptist Medical Center, Jacksonville, Florida 32217, United States
| | - John W. Wells
- Pulmonary
and Critical Care Associates, Orange Park, Florida 32073, United States
| | - Larry H. Wilf
- Oncologic Imaging Division, Florida Radiation Oncology Group, Jacksonville, Florida 32217, United States
| | - Marc Humbert
- Univ. Paris-Sud, Faculté
de Médecine, Université Paris-Saclay, AP-HP, Centre National de Référence
de l′Hypertension Pulmonaire Sévère, Département
Hospitalo-Universitaire (DHU) Thorax Innovation, Service de Pneumologie,
Hôpital de Bicêtre, UMRS _999, INSERM and Univ. Paris−Sud,
Laboratoire d’Excellence (LabEx) en Recherche sur le Médicament
et l′Innovation Thérapeutique (LERMIT), Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson 92350, France
| | - Marcis Leja
- Faculty of Medicine, University of Latvia, Digestive Diseases, Riga East University Hospital, 19 Rainisboulv, LV1586 Riga, Latvia
- Digestive Diseases
Centre, GASTRO, 6 Linezeraiela, LV1006 Riga, Latvia
| | - Nir Peled
- Thoracic
Cancer Unit, Davidoff Cancer Center, RMC, Kaplan Street, Petach Tiqwa 49100, Israel
| | - Hossam Haick
- Department of Chemical
Engineering and Russell Berrie Nanotechnology Institute, Technion−Israel Institute of Technology, Haifa 3200003, Israel
| |
Collapse
|
12
|
Karban A, Nakhleh MK, Cancilla JC, Vishinkin R, Rainis T, Koifman E, Jeries R, Ivgi H, Torrecilla JS, Haick H. Programmed Nanoparticles for Tailoring the Detection of Inflammatory Bowel Diseases and Irritable Bowel Syndrome Disease via Breathprint. Adv Healthc Mater 2016; 5:2339-44. [PMID: 27390291 DOI: 10.1002/adhm.201600588] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 06/01/2016] [Revised: 06/14/2016] [Indexed: 12/17/2022]
Abstract
Chemical sensors based on programmable molecularly modified gold nanoparticles are tailored for the detection and discrimination between the breathprint of irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD). The sensors are examined in both lab- and real-world clinical conditions. The results reveal a discriminative power accuracy of 81% between IBD and IBS and 75% between Crohn's and Colitis states.
Collapse
Affiliation(s)
- Amir Karban
- Internal Medicine C and Gastroenterology Departments at Rambam Medical Center, Rappaport School of Medicine at Technion-Israel Institute of Technology, Haifa, 3109610, Israel
| | - Morad K Nakhleh
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - John C Cancilla
- Department of Chemical Engineering, Complutense University of Madrid, Madrid, 28040, Spain
| | - Rotem Vishinkin
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Tova Rainis
- Department of Gastroenterology at Bnai Zion Hospital, Rappaport School of Medicine at Technion-Israel Institute of Technology, Haifa, 31048, Israel
| | - Eduard Koifman
- Internal Medicine C and Gastroenterology Departments at Rambam Medical Center, Rappaport School of Medicine at Technion-Israel Institute of Technology, Haifa, 3109610, Israel
| | - Raneen Jeries
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Hodaya Ivgi
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Jose S Torrecilla
- Department of Chemical Engineering, Complutense University of Madrid, Madrid, 28040, Spain
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, 3200003, Israel.
| |
Collapse
|
13
|
Koifman E, Kopel E, Medvedovsky D, Maor E, Hamdan A, Goldenberg I, Klempfner R. Differential effect of left ventricular ejection fraction on long term mortality in patients hospitalized with acute heart failure. Data from the HFSIS 2003 registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1494] [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
|
14
|
Rozen G, Koifman E, Goitein O, Kuperstein R, Konen E, Feinberg M, Hod H, Matetzky S. ACS-like acute myocarditis vs. acute myocardial infarction: continuous clinical challenge. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3870] [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: 11/13/2022] Open
|
15
|
Koifman E, Kopel E, Rozen G, Maor E, Fefer P, Matezky S, Hamdan A, Goldenberg I, Klempfner R. Predictors of mineralocorticoid receptor antagonist utilization in patients with left ventricular dysfunction following acute myocardial infarction: real world data from the acute coronary syndrome IS. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1336] [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: 11/12/2022] Open
|
16
|
Mazor Y, Koifman E, Elkin H, Chowers Y, Krivoy N, Karban A, Efrati E. Risk Factors for Serious Adverse Effects of Thiopurines in Patients with Crohn’s Disease. Curr Drug Saf 2013; 8:181-5. [DOI: 10.2174/15748863113089990033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/02/2013] [Accepted: 07/02/2013] [Indexed: 11/22/2022]
|
17
|
Koifman E, Mashiach T, Papier I, Karban A, Eliakim R, Chermesh I. Proactive screening in Israel identifies alarming prevalence of malnutrition among hospitalized patients—Action is needed. Nutrition 2012; 28:515-9. [DOI: 10.1016/j.nut.2011.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 07/01/2011] [Accepted: 07/29/2011] [Indexed: 11/16/2022]
|