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Lewis DV, Voyvodic J, Shinnar S, Chan S, Bello JA, Moshé SL, Nordli DR, Frank LM, Pellock JM, Hesdorffer DC, Xu Y, Shinnar RC, Seinfeld S, Epstein LG, Masur D, Gallentine W, Weiss E, Deng X, Sun S. Hippocampal sclerosis and temporal lobe epilepsy following febrile status epilepticus: The FEBSTAT study. Epilepsia 2024. [PMID: 38606600 DOI: 10.1111/epi.17979] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This study was undertaken to determine whether hippocampal T2 hyperintensity predicts sequelae of febrile status epilepticus, including hippocampal atrophy, sclerosis, and mesial temporal lobe epilepsy. METHODS Acute magnetic resonance imaging (MRI) was obtained within a mean of 4.4 (SD = 5.5, median = 2.0) days after febrile status on >200 infants with follow-up MRI at approximately 1, 5, and 10 years. Hippocampal size, morphology, and T2 signal intensity were scored visually by neuroradiologists blinded to clinical details. Hippocampal volumetry provided quantitative measurement. Upon the occurrence of two or more unprovoked seizures, subjects were reassessed for epilepsy. Hippocampal volumes were normalized using total brain volumes. RESULTS Fourteen of 22 subjects with acute hippocampal T2 hyperintensity returned for follow-up MRI, and 10 developed definite hippocampal sclerosis, which persisted through the 10-year follow-up. Hippocampi appearing normal initially remained normal on visual inspection. However, in subjects with normal-appearing hippocampi, volumetrics indicated that male, but not female, hippocampi were smaller than controls, but increasing hippocampal asymmetry was not seen following febrile status. Forty-four subjects developed epilepsy; six developed mesial temporal lobe epilepsy and, of the six, two had definite, two had equivocal, and two had no hippocampal sclerosis. Only one subject developed mesial temporal epilepsy without initial hyperintensity, and that subject had hippocampal malrotation. Ten-year cumulative incidence of all types of epilepsy, including mesial temporal epilepsy, was highest in subjects with initial T2 hyperintensity and lowest in those with normal signal and no other brain abnormalities. SIGNIFICANCE Hippocampal T2 hyperintensity following febrile status epilepticus predicted hippocampal sclerosis and significant likelihood of mesial temporal lobe epilepsy. Normal hippocampal appearance in the acute postictal MRI was followed by maintained normal appearance, symmetric growth, and lower risk of epilepsy. Volumetric measurement detected mildly decreased hippocampal volume in males with febrile status.
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Affiliation(s)
- Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, USA
| | - James Voyvodic
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shlomo Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen Chan
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, New York, USA
| | - Jacqueline A Bello
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, and Montefiore Medical Center, Bronx, New York, USA
| | - Douglas R Nordli
- Department of Pediatrics, Section of Child Neurology, University of Chicago, Chicago, Illinois, USA
| | - L Matthew Frank
- Department of Neurology, Children's Hospital of the King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John M Pellock
- Department of Neurology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dale C Hesdorffer
- Department of Epidemiology, G. H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Yuan Xu
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, USA
| | - Ruth C Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Syndi Seinfeld
- Pediatric Epilepsy Program, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Leon G Epstein
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - David Masur
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - William Gallentine
- Stanford University Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Erica Weiss
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaoyan Deng
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shumei Sun
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, USA
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Kemoun G, Weiss E, El Houari L, Bonny V, Goury A, Caliez O, Picard B, Rudler M, Rhaiem R, Rebours V, Mayaux J, Bachet JB, Belin L, Demoule A, Decavèle M. Clinical features and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission: A retrospective multicenter study. Dig Liver Dis 2024; 56:514-521. [PMID: 37718226 DOI: 10.1016/j.dld.2023.08.049] [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: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.
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Affiliation(s)
- G Kemoun
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
| | - E Weiss
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Département d'anesthésie-réanimation, Clichy, France; Université de Paris, UMRS1149, Centre de recherche sur l'inflammation, Liver Intensive Care Group of Europe (LICAGE), France
| | - L El Houari
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - V Bonny
- AP-HP Sorbonne Université, site Saint-Antoine, Service de Médecine Intensive - Réanimation, Paris, France
| | - A Goury
- Unité de médecine intensive et réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, France
| | - O Caliez
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - B Picard
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - M Rudler
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - R Rhaiem
- Service de chirurgie hépatobiliaire, pancréatique et oncologique digestive, Hôpital Robert Debré, CHU de Reims, France
| | - V Rebours
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Service de Pancréatologie, Clichy, France; Université de Paris, INSERM, UMR 1149, pancreatic rare diseases (PaRaDis), centre de référence de maladies rares, Clichy, France
| | - J Mayaux
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - J B Bachet
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - L Belin
- Sorbonne-Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - A Demoule
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Decavèle
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Oleas D, Weiss E, McGinley J, Bronshteyn D, Stimmel M, Facchini R. H - 65 Clinical Evidence for an Age-Dependent Relationship between Kawasaki Disease and Cognition in a Latinx/e Girl. Arch Clin Neuropsychol 2023; 38:1549. [PMID: 37807557 DOI: 10.1093/arclin/acad067.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries (e.g., Japan, U.S.). Rare in the U.S., the systemic, acute inflammation condition with typical symptoms of a fever, cervical lymphadenopathy, conjunctivitis, extremity changes, and exanthema, can cause long term post-inflammatory neurological and emotional changes. Cognitive deficits (e.g., ADHD) can emerge post-KD but the literature is equivocal and to-date there are no U.S. studies. We report the case of an 11-year-old Latinx/e girl to expand knowledge of KD-related cognitive changes. METHOD Comprehensive neuropsychological assessment of an 11-year-old with KD diagnosed in early childhood and hemiplegic migraines, academic difficulties and emotional intolerance. RESULTS Overall ability was within the low average range with significant negative impact of slow processing speed. Academic assessment demonstrated moderate impairment in reading, and mild math impairment. Memory, expressive/receptive language, visuospatial, and psychomotor abilities were within expectation. Variable complex attention, impulsivity, inattention, and poor self-monitoring were evident. Mild anxiety was reported. Resulting diagnoses of ADHD, and Reading Disorder were offered. CONCLUSIONS KD may produce inflammation in the brain and neurological changes which may lead to later cognitive impairment. This 11-year-old Latinx/e girl's cognitive profile supports recent literature suggesting KD-related cognitive difficulties likely develop between 5-10 yrs after KD diagnosis and reinforces the need for longitudinal research. Furthermore, it expands the literature regarding the neuropsychological effects of KD on cognitive functioning in Latinx/e children in the U.S as to date most research has focused on children of Asian-descent.
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Uy NG, Weiss E, McGinley J, Stimmel M, Bronshteyn D, Masur D, Facchini R. B - 24 Neuropsychological Profile of a Child with ASD, ADHD, and Psychotic Features. Arch Clin Neuropsychol 2023; 38:1388. [PMID: 37807381 DOI: 10.1093/arclin/acad067.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and psychotic traits, although highly comorbid, have rarely been studied in children. Existing research indicates that impulsivity, comprehension difficulties, and inflexibility are overlapping symptoms within the ASD and ADHD populations. Adult research shows high comorbidity estimates between ASD and psychosis. Here we describe the neuropsychological profile of a 14-year-old boy with diagnoses of ASD and ADHD with psychotic features. We highlight the value of comprehensive and flexible neuropsychological assessment while integrating detailed testing, behavioral observations, and collateral report. METHODS Medical history of this child included late-term and breech birth with his first Apgar score at expected level and his second score falling below expected level. Delayed acquisition of developmental milestones, learning difficulties, speech difficulties, anxiety, and hyperactivity, were reported. Auditory hallucinations triggered by stress were observed during evaluation. Comprehensive neuropsychological evaluation requires nonstandard exploration of cognitive domains and time-limited testing sessions to acquire robust estimates of functioning. RESULTS Overall cognitive abilities were in the borderline range with highly variable academic performances (extremely low to average). All performances were grossly below age level and were significantly impacted by auditory hallucinations but were consistent with the diagnoses of ASD and ADHD. CONCLUSION This case of a boy with ASD, ADHD, and auditory hallucinations demonstrates the diagnostic overlap among these conditions and the necessity for flexible neuropsychological testing, detailed behavioral observations and caregiver report in the assessment of overlapping clinical features. Multiple sources of data are required to identify patterns in symptomatology to inform differential diagnosis and comorbidities.
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Taylor RJ, Omidi A, Rosu M, Maggioncalda E, Weiss E. Effects of Respiratory and Cardiac Motion on Dose to the Left Anterior Descending Artery in Patients Undergoing Radiation Therapy for Locally Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e64-e65. [PMID: 37785906 DOI: 10.1016/j.ijrobp.2023.06.788] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation dose to the left anterior descending artery (LAD) appears to be an independent predictor of major cardiac events and all-cause mortality following radiation therapy (RT) for lung cancer. In this study, we characterize the dosimetric effects of respiratory (RM) and cardiac (CM) motion on LAD. MATERIALS/METHODS Ten patients with stage IIIA-IVA lung cancer received cine MRIs (25 phases) at expiration which were used to evaluate the CM, and 4D CT scans for the evaluation of RM. Following registration of the expiration images of 4D CTs with MRIs, RT dose was transferred from planning CT datasets to all phases of 4D CTs and cine MRIs. LAD was manually contoured on all scans. The contours from each 4D phase represent LADs over multiple cardiac cycles, thus they are referred to as cLAD from here on. Displacements and dose variations of cLAD between exhale/inhale on 4D CTs and of LAD between systolic and diastolic phases on cine MRIs were analyzed, and paired t-tests were performed to assess the significance of the differences observed. RESULTS The following metrics are reported averaged over all patients. Clinical treatment planning CT metrics and doses: Mean dose, max dose, V5 Gy and V15 Gy were 15.0 (±11.3) Gy, 31.1 (±22.1) Gy, 53 (±33)%, 35 (±30)%. The cLAD metrics and dose variations due to respiratory motion (between exhale and inhale): RM amplitude was 0.3±0.2cm (RL 0.3 ± 0.1 cm, AP 0.2 ± 0.2 cm, SI 0.3 ± 0.2 cm). The variations in mean dose, max dose, V5 and V15 were 4.0 (±4.0) Gy, 1.6 (±1.5) Gy, 4.4 (±3.4)%, 4.0 (±3.4)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with expiration in 8, 9, 5 and 5 patients, respectively. LAD metrics and dose variations due to cardiac motion (between systole and diastole): CM amplitude was 0.2 ± 0.1 cm (RL 0.2 ± 0.1 cm, AP 0.2 ± 0.1 cm, SI 0.3 ± 0.1 cm). The variations in mean dose, max dose, V5 and V15 were 1.7 (±1.4) Gy, 1.2 (±0.9) Gy, 5.2 (± 6.7)%, 4.6 (± 4.0)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with diastole in 7, 7, 8 and 8 patients respectively. Statistical significance: The differences in displacement and dose between respiration and cardiac motion were not statistically significant. CONCLUSION Respiratory and cardiac-induced physiological variations of the LAD position have dosimetric consequences comparable in magnitude. Expiration and diastole lead to increased LAD doses. This underscores the importance of considering both the respiratory and the cardiac motion when motion management techniques are considered. 4D CTs inherently include the cardiac motion. However, if breath-hold is used for respiratory motion mitigation, CM might not be captured appropriately due to short tube rotation times. In this case, understanding CM characteristics is important for more accurate assessment of LAD dose.
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Affiliation(s)
- R J Taylor
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - A Omidi
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - M Rosu
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | | | - E Weiss
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
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Jayakody O, Breslin M, Ayers E, Verghese J, Barzilai N, Weiss E, Milman S, Blumen HM. Age-related changes in gait domains: Results from the LonGenity study. Gait Posture 2023; 100:8-13. [PMID: 36463714 PMCID: PMC9974801 DOI: 10.1016/j.gaitpost.2022.11.009] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/30/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Impairment in gait domains such as pace, rhythm, and variability are associated with falls, cognitive decline, and dementia. However, the longitudinal changes in these gait domains are poorly understood. The aim of this study was to examine age-related changes in gait domains overall and in those with cognitive impairment and mobility disability. METHODS Participants were from the LonGenity study (n = 797; M Age=75.1 SD 6.5 years; 58.2% female) and were followed up to 12 years (Median=3.3; IQR: 1.1; 6.3). Gait speed and absolute values of step length, step time, cadence and, variability (standard deviation) of step length and step time during usual pace walking were assessed. Principal components analysis was used to obtain weighted combinations of three gait domains: pace (velocity, step length), variability (step length variability, step time variability) and rhythm (step time). Linear mixed effect models were used to examine age-related changes in gait domains overall, and in those with cognitive impairment and mobility disability at baseline. RESULTS Pace declined, and rhythm increased (worsened) in an accelerating non-linear fashion. Variability gradually increased with age. Those with cognitive impairment had faster rates of change in pace and rhythm. Those with mobility disability had faster increases in rhythm. CONCLUSIONS Age-related changes in gait domains are not uniform. Individuals with cognitive and mobility impairments are particularly vulnerable to accelerated change in pace and or rhythm.
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Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
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Ha B, Morrill MY, Salim AM, Stram D, Weiss E. Differences in Surgical Complications for Stage 1 Phalloplasty With Concurrent Versus Asynchronous Hysterectomy in Transmasculine Patients. Perm J 2022; 26:49-55. [PMID: 36245082 PMCID: PMC9761287 DOI: 10.7812/tpp/22.054] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background The authors sought to compare the perioperative morbidity of Stage 1 phalloplasty with asynchronous vs concurrent hysterectomy among transmasculine patients. Methods This retrospective study included transmasculine patients undergoing Stage 1 phalloplasty with either asynchronous or concurrent hysterectomy at Kaiser Permanente Northern California from January 1, 2017, to September 9, 2019. The primary outcome was differences in surgical site infection rates. Secondary outcomes included perioperative and other postoperative complications. Comparisons of demographics and outcomes were made by F-tests and Fisher's exact tests. A p value of < 0.05 was considered statistically significant. Results Of 66 transmasculine patients undergoing Stage 1 phalloplasty, 32 (48%) had an asynchronous hysterectomy and 34 (52%) had a concurrent hysterectomy. Overall, surgical site infection rates were low, and there were no significant differences between groups. Patients who had undergone asynchronous hysterectomy had more neourethral complications with Stage 1 phalloplasty than those undergoing concurrent procedures (28% vs 3%, p < 0.05). There were no significant differences in estimated blood loss, length of stay, urinary tract infection, overactive bladder or narcotic use between groups. Conclusion Overall, there were no differences between groups in most postoperative complication rates. Although more neourethral complications were found in those undergoing asynchronous hysterectomy prior to Stage I phalloplasty, this may be partially explained by increasing surgeon experience over time given this difference did not remain statistically significant after the first year of the study period. Gynecologists seeking to provide comprehensive and inclusive care to transmasculine patients should take these findings into consideration when counseling patients planning genital gender affirmation surgery.
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Affiliation(s)
- Barbara Ha
- 1Obstetrics & Gynecology, Kaiser Permanente, San Francisco, CA, USA,Barbara Ha, MD, MSPH
| | - Michelle Y Morrill
- 2Female Pelvic Medicine & Reconstructive Surgery, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Ali M Salim
- 3Plastic Surgery, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Douglas Stram
- 4Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Erica Weiss
- 5Obstetrics & Gynecology, Kaiser Permanente Northern California, San Francisco, CA, USA
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Jayakody SO, Ayers E, Verghese J, Weiss E, Barzilai N, Milman S, Blumen HM. Proxy measures of cognitive reserve and trajectories of gait and cognitive decline in older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.061242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Joe Verghese
- Albert Einstein College of Medicine Bronx NY USA
| | - Erica Weiss
- Albert Einstein College of Medicine Bronx NY USA
| | - Nir Barzilai
- Albert Einstein College of Medicine Bronx NY USA
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Blumen HM, Jayakody SO, Ayers E, Barzilai N, Milman S, Weiss E, Verghese J. Cognitive reserve moderates the relationship between hippocampal volume and cognitive decline – but not gait decline. Alzheimers Dement 2022. [DOI: 10.1002/alz.066055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Nir Barzilai
- Albert Einstein College of Medicine Bronx NY USA
| | | | - Erica Weiss
- Albert Einstein College of Medicine Bronx NY USA
| | - Joe Verghese
- Albert Einstein College of Medicine Bronx NY USA
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Wang S, Mahon R, Weiss E, Jan N, Taylor R, McDonagh P, Quinn B, Yuan L. Automated Lung Cancer Segmentation Using a Dual-Modality Deep Learning Network with PET and CT Images. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Palmeri MJ, Bronshteyn D, Facchini R, Masur D, McGinley J, Weiss E. A-163 Neuropsychological Profile of Early Onset ADEM and AMSAN. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac060.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective: We present the neuropsychological profile of a 9-year-old girl with a history of waxing and waning ataxia, initially diagnosed at 18 months of age, with Acute Disseminated Encephalomyelitis (ADEM), later thought to be axonal motor sensory neuropathy (AMSAN). ADEM is a rapid onset neuroinflammatory disease typically seen in children ages 3-10 following infection, which results in demyelinating lesions. AMSAN is a rare variant of Guillain-Barre´ syndrome causing muscle/sensation difficulty. Common long-term cognitive correlates of ADEM include attention, processing speed and internalizing problems in the context of average overall cognition.
Method: Comprehensive neuropsychological evaluation referral by neurology to assist with continued workup given atypical history and unclear academic difficulties. Initial symptom workup revealed signal changes in spinal cord and demyelinating lesions in the left frontal lobe and upper cervical spine. She was treated with intravenous immunoglobulins (IVIG), but symptoms returned several months later and then again. Subsequent improvements with therapy for ataxia, speech and feeding difficulties.
Results: Overall cognitive functioning in the low average range with notable and extensive attentional limitations requiring continual prompting. Evaluation also revealed below grade and age level performance in all academic areas, significant oromotor and gross motor coordination difficulties, and mild self-esteem issues in this child who presented much younger than her chronological age.
Conclusions: This case demonstrates the importance of neuropsychological evaluation in pediatric paraneoplastic motor/sensory motor syndromes. While underlying cause of demyelination and ataxia in this case remains unclear, cognitive findings revealed significant areas that require intervention which could have been identified and supported earlier in her development.
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Abbassi F, Gero D, Muller X, Bueno A, Figiel W, Robin F, Laroche S, Picard B, Shankar S, Ivanics T, van Reeven M, van Leeuwen OB, Braun HJ, Monbaliu D, Breton A, Vachharajani N, Bonaccorsi Riani E, Nowak G, McMillan RR, Abu-Gazala S, Nair A, Bruballa R, Paterno F, Weppler Sears D, Pinna AD, Guarrera JV, de Santibañes E, de Santibañes M, Hernandez-Aleja R, Olthoff K, Ghobrial RM, Ericzon BG, Ciccarelli O, Chapman WC, Mabrut JY, Pirenne J, Müllhaupt B, Ascher NL, Porte RJ, de Meier VE, Polak WG, Sapisochin G, Attia M, Weiss E, Adam RA, Cherqui D, Boudjema K, Zienewicz K, Jassem W, Puhan M, Dutkowski P, Clavien PA. Novel benchmark values for redo liver transplantation – does the outcome justify the effort? Br J Surg 2022. [DOI: 10.1093/bjs/znac178.001] [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: 11/12/2022]
Abstract
Abstract
Objective
In the era of organ shortage, redo liver transplantation (reLT) is frequently discussed in terms of expected poor outcome, high cost and therefore wasteful resources. However, there is a lack of benchmark data to reliably assess outcomes after reLT. The aim of this study was to define the ideal reLT case, and to establish clinically relevant benchmark values for best achievable outcome in reLT.
Methods
We collected data on reLT between January 2010 and December 2018 from 22 high volume transplant centers on three continents. Benchmark cases were defined as recipients with model of end-stage liver disease score <=25, absence of portal vein thrombosis, no mechanical ventilation before surgery, receiving a graft from a donor after brain death. In addition, early reLT including those for primary non-function (PNF) were excluded. Clinically relevant endpoints covering intra- and postoperative course were selected and complications were graded by severity using the Clavien-Dindo classification and the comprehensive complication index (CCI). The benchmark cutoff for each outcome was derived from the 75th percentile of the median values of all benchmark centers, indicating the “best achievable” result. To assess the utility of the newly established benchmark values, we analyzed patients who received reLT for PNF (non-benchmark patients).
Results
Out of 1110 reLT 413 (37.2%) qualified as benchmark cases. Benchmark values included: Length of intensive care unit and hospital stay: <=6 and <=24 days, respectively; Clavien-Dindo grade >=3a complications and the CCI at 1 year: <=76% and <=72.2, respectively; in-hospital and 1-year mortality rates: <=14.0% and <=14.3%, respectively. The cutoffs for transplant-specific complications such as biliary complications at 1 year, outflow problems at 1 year and hepatic artery thrombosis at discharge were <=27.3%, <=2.5% and <=4.8%, respectively. Patients receiving a reLT for PNF showed mean outcome values all outside the reLT benchmark values. In-hospital mortality rate was 34.4% and the mean CCI at discharge 68.8.
Conclusion
ReLT remains associated with high morbidity and mortality. The availability of benchmark values for outcome parameters of reLT may serve for comparison in any future analyses of individuals, patient groups, or centers, but also in the evaluation of new therapeutic strategies and principles.
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Affiliation(s)
- F Abbassi
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - D Gero
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - X Muller
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - A Bueno
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - W Figiel
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - F Robin
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - S Laroche
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - B Picard
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - S Shankar
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - T Ivanics
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M van Reeven
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - O B van Leeuwen
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - H J Braun
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - D Monbaliu
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - A Breton
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - N Vachharajani
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - E Bonaccorsi Riani
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - G Nowak
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - R R McMillan
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - S Abu-Gazala
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - A Nair
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - R Bruballa
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - F Paterno
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - D Weppler Sears
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - A D Pinna
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - J V Guarrera
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - E de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - M de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - R Hernandez-Aleja
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - K Olthoff
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - R M Ghobrial
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - B-G Ericzon
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - O Ciccarelli
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - W C Chapman
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - J-Y Mabrut
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - J Pirenne
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - B Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich , Zurich, Switzerland
| | - N L Ascher
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - R J Porte
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - V E de Meier
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - W G Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - G Sapisochin
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M Attia
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - E Weiss
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - R A Adam
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - D Cherqui
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - K Boudjema
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - K Zienewicz
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - W Jassem
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - M Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University Hospital Zurich , Zurich, Switzerland
| | - P Dutkowski
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - P-A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
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13
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Jayakody O, Breslin M, Ayers E, Verghese J, Barzilai N, Milman S, Weiss E, Blumen HM. Relative Trajectories of Gait and Cognitive Decline in Aging. J Gerontol A Biol Sci Med Sci 2022; 77:1230-1238. [PMID: 34791239 PMCID: PMC9159658 DOI: 10.1093/gerona/glab346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gait and cognition decline with advancing age, and presage the onset of dementia. Yet, the relative trajectories of gait and cognitive decline in aging are poorly understood-particularly among those with the motoric cognitive risk (MCR) syndrome. This study compared changes in simple and complex gait performance and cognition, as a function of age and MCR. METHODS We examined gait and cognitive functions of 1 095 LonGenity study participants (mean age = 75.4 ± 6.7 years) with up to 12 years of annual follow-up. Participants were of Ashkenazi Jewish descent, free of dementia, ambulatory, and had a 12.2% MCR prevalence at baseline. Gait speed was measured at usual pace walking (single-task walking, STW-speed) and walking while talking (WWT-speed). Eleven neuropsychological test scores were examined separately, and as a global cognition composite. Linear mixed-effects models adjusted for baseline sex, education, parental longevity, cognitive impairment, and global health were used to estimate changes in gait and cognition, as a function of age and MCR. RESULTS STW-speed, WWT-speed, and cognitive tests performance declined in a nonlinear (accelerating) fashion with age. STW-speed declined faster than WWT-speed and cognitive test scores. People with MCR showed faster rates of decline on figure copy and phonemic fluency. CONCLUSIONS Gait declines at a faster rate than cognition in aging. People with MCR are susceptible to faster decline in visuospatial, executive, and language functions. This study adds important knowledge of trajectories of gait and cognitive decline in aging, and identifies MCR as a risk factor for accelerated cognitive decline.
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Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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14
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Ye J, Rizvi F, Welch G, Thomas T, Weiss E, Chandra R, Gutiontov S, Motwani S, Mattes M. Implementation of Standardized Lecture to Improve Radiation Oncology Knowledge in Multidisciplinary Lung Cancer Care Team: Initial Results of a Multi-Institutional Pilot Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Sideman AB, Chalmer R, Ayers E, Gershon R, Verghese J, Wolf M, Ansari A, Arvanitis M, Bui N, Chen P, Chodos A, Corriveau R, Curtis L, Ehrlich AR, Farias SET, Goode C, Hill-Sakurai L, Nowinski CJ, Premkumar M, Rankin KP, Ritchie CS, Tsoy E, Weiss E, Possin KL. Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care. J Alzheimers Dis 2022; 86:655-665. [PMID: 35124639 PMCID: PMC9048609 DOI: 10.3233/jad-215106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Rachel Chalmer
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joe Verghese
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Asif Ansari
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Arvanitis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nhat Bui
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pei Chen
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Roderick Corriveau
- National Institute of Neurological Disorders & Stroke, National Institute of Health, Bethesda, MA, USA
| | - Laura Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy R. Ehrlich
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Collette Goode
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Hill-Sakurai
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Cindy J. Nowinski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mukund Premkumar
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Erica Weiss
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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16
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Jayakody SO, Ayers E, Verghese J, Barzilai N, Milman S, Weiss E, Blumen HM. Trajectories of gait and cognitive decline in aging, and as a function of parental longevity and the motoric cognitive risk syndrome. Alzheimers Dement 2021. [DOI: 10.1002/alz.051872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Joe Verghese
- Albert Einstein College of Medicine Bronx NY USA
- Montefiore Medical Center Bronx NY USA
| | - Nir Barzilai
- Albert Einstein College of Medicine Bronx NY USA
| | | | - Erica Weiss
- Albert Einstein College of Medicine Bronx NY USA
- Montefiore Medical Center Bronx NY USA
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17
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Cooper D, Padilla L, Watson A, Neiderer K, Smith B, Weiss E. Determining Radiation Doses of Critical Normal Tissues for Stereotactic Body Radiotherapy (SBRT) of Central Lung Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Cooper D, Guy C, Weiss E. P29.01 Deformable vs. Rigid Registration in Evaluating Composite Doses to Central Organs at Risk in Thoracic Reirradiation. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Stimmel M, Ayers E, Verghese J, Weiss E. A-160 Validating the Picture-Based Memory Impairment Screen as a Memory Screener in a Diverse Primary Care Setting. Arch Clin Neuropsychol 2021. [DOI: 10.1093/arclin/acab062.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Quick cognitive screeners which can be used for ethnically and educationally diverse patients are particularly useful within the primary care setting. The Picture-Based Memory Impairment Screen (PMIS) is a brief screening tool which has been validated in such a population. Here we compare the PMIS against a gold-standard memory task (Hopkins Verbal Learning Test-Revised [HVLT-R]) and evaluate its utility as a stand-alone memory screener.
Method
In this cross-sectional study, adults over 65 with cognitive concerns were recruited at their primary care visit to complete the PMIS as part of a larger randomized controlled trial aimed at improving detection of cognitive impairment. A subset of those participants also agreed to complete neuropsychological testing in English or Spanish (including the HVLT-R). Correlations were performed.
Results
108 participants (Mean age = 73; 73% female; 39% Black/AA; 58% Hispanic; 52% evaluated in Spanish; Mean years education = 10.8) completed the PMIS and HVLT-R. The PMIS was correlated with the HVLT-R Immediate Raw Score (rs = 0.229, p = 0.17) and even more strongly correlated with the HVLT-R Delayed Raw Score (rs = 0.347, p < 0.001).
Conclusions
Early results of this ongoing trial suggest that the PMIS is a useful memory screener which can be used to quickly identify individuals in a diverse primary care setting who are likely to have memory weakness.
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20
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Gulley E, Verghese J, Blumen HM, Ayers E, Wang C, Portenoy RK, Zwerling JL, Weiss E, Knotkova H. Neurostimulation for cognitive enhancement in Alzheimer's disease (the NICE-AD study): a randomized clinical trial. Neurodegener Dis Manag 2021; 11:277-288. [PMID: 34240627 DOI: 10.2217/nmt-2020-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
New therapies for symptoms in Alzheimer's disease (AD) are urgently needed. Prior studies suggest that transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory method, may be a safe and potentially effective treatment, but conclusions have been limited by small-sample sizes and brief stimulation protocols. This double-blind randomized trial involving 100 older adults with mild-to-moderate AD examines effects of 6 months of at-home active tDCS or sham delivered over the dorsolateral prefrontal cortex. The primary outcome is global cognitive performance. Secondary outcomes include executive-control/spatial selective attention, functional neuroplasticity, depressive symptoms, quality of life and the durability of effects 3 months after the stimulation period. The results will provide evidence on the efficacy of multimonth at-home tDCS in the AD treatment. =Clinical trial identifier NCT04404153 (Clinicaltrials.gov).
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Affiliation(s)
- Emma Gulley
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Helena M Blumen
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Cuiling Wang
- Department of Epidemiology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Russell K Portenoy
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,Department of Family & Social Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA.,MJHS Hospice & Palliative Care, New York, NY 10006, USA
| | - Jessica L Zwerling
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Helena Knotkova
- Department of Family & Social Medicine, Albert Einstein College of Medicine, The Bronx, NY 10461, USA.,MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA
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21
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Hobeika C, Cauchy F, Weiss E, Chopinet S, Sepulveda A, Dondero F, Khoy-Ear L, Grigoresco B, Dokmak S, Durand F, Le Roy B, Paugam-Burtz C, Soubrane O. Practical model to identify liver transplant recipients at low risk of postoperative haemorrhage, bile leakage and ascites. BJS Open 2021; 5:6073666. [PMID: 33609380 PMCID: PMC7893463 DOI: 10.1093/bjsopen/zraa031] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to identify a subgroup of recipients at low risk of haemorrhage, bile leakage and ascites following liver transplantation (LT). Methods Factors associated with significant postoperative ascites (more than 10 ml/kg on postoperative day 5), bile leakage and haemorrhage after LT were identified using three separate multivariable analyses in patients who had LT in 2010–2019. A model predicting the absence of all three outcomes was created and validated internally using bootstrap procedure. Results Overall, 944 recipients underwent LT. Rates of ascites, bile leakage and haemorrhage were 34.9, 7.7 and 6.0 per cent respectively. The 90-day mortality rate was 7.0 per cent. Partial liver graft (relative risk (RR) 1.31; P = 0.021), intraoperative ascites (more than 10 ml/kg suctioned after laparotomy) (RR 2.05; P = 0.001), malnutrition (RR 1.27; P = 0.006), portal vein thrombosis (RR 1.56; P = 0.024) and intraoperative blood loss greater than 1000 ml (RR 1.39; P = 0.003) were independently associated with postoperative ascites and/or bile leak and/or haemorrhage, and were introduced in the model. The model was well calibrated and predicted the absence of all three outcomes with an area under the curve of 0.76 (P = 0.001). Of the 944 patients, 218 (23.1 per cent) fulfilled the five criteria of the model, and 9.6 per cent experienced postoperative ascites (RR 0.22; P = 0.001), 1.8 per cent haemorrhage (RR 0.21; P = 0.033), 4.1 per cent bile leak (RR 0.54; P = 0.048), 40.4 per cent severe complications (RR 0.70; P = 0.001) and 1.4 per cent 90-day mortality (RR 0.13; P = 0.004). Conclusion A practical model has been provided to identify patients at low risk of ascites, bile leakage and haemorrhage after LT; these patients could potentially qualify for inclusion in non-abdominal drainage protocols.
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Affiliation(s)
- C Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - E Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Chopinet
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Sepulveda
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Dondero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - L Khoy-Ear
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Grigoresco
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Dokmak
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Durand
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Le Roy
- Department of Digestive and Oncological Surgery, Centre Hospitalier Universitaire Nord Saint-Etienne, Saint-Priest en Jarez, France
| | - C Paugam-Burtz
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
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Ricco A, Allen A, Mukhopadhyay N, Kalman N, Weiss E. The Association Between Laboratory Pretreatment Immune Parameters and Radiographic Lung Changes in Early Stage Lung Cancer Patients Undergoing Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jan N, Mukhopadhyay N, Weiss E. Target Volume Definition for Radiotherapy of Staple Line Recurrences of Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cooper D, Ricco A, Rezai Gharai L, Guy C, Weiss E. Risk of Radiation Pneumonitis in Locally Advanced Lung Cancer Patients: Role of Interstitial Lung Disease Subtypes and Severity of Pulmonary Emphysema. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ricco A, Rezai Gharai L, Kalman N, Weiss E. Interstitial Lung Disease Subtypes and Severity of Pulmonary Emphysema: Relation to Radiographic Lung Changes and Radiation Pneumonitis after Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ricco A, Kim A, Canada J, Grizzard J, Dana F, Rezai Gharai L, Abbate A, Weiss E. Extracellular Volume Fraction of Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mahon R, Jan N, Hugo G, Muscu S, Weiss E. Accuracy of Deformable Image Registration for Reirradiation of Lung Cancer Following Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hinterberger C, Weiss E, Whelan M, Sen A. Food and Beverage Marketing to Children on YouTube: An Advertisement Content Analysis and Nutritional Comparison. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vodovar D, Ricard JD, Zafrani L, Weiss E, Desrentes E, Roux D. [Assessment of a newly-implemented blended teaching of intensive care and emergency medicine at Paris-Diderot University]. Rev Med Interne 2020; 41:368-374. [PMID: 32008801 DOI: 10.1016/j.revmed.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/28/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Blended-learning methods could be a response to student nonattendance. Non-compulsory teaching combining e-learning/interactive face-to-face sessions has been implemented at Paris-Diderot Medical School for the teaching of intensive care and emergency medicine during the 2018/2019 university period. The aim of the study was to assess this newly-implemented blended teaching. METHODS Questionnaire submitted to the 388 DFASM3 medical students present at the faculty exam of intensive care/emergency medicine. Attendance at a teaching modality was defined by the follow-up of more than half of this teaching modality. Correlations between attendance at e-learning and/or interactive face-to-face sessions, and grade were performed. RESULTS A total of 358/388 (92%) students participated in this survey. A quarter of the students (88/321 - 25%) reported they usually attended at traditional lectures. Regarding blended-learning, 210/317 (67%) students reported having attended at e-learning courses and 84/321 (27%) attended at interactive face-to-face sessions. The distribution of students according to their attendance at e-learning and/or interactive face-to-face sessions was significantly different (P<0.01). There was a significant correlation (P<0.001) between attendance at e-learning and grade obtained at the faculty exam. Nevertheless, this correlation was also found for these students in another course taught traditionally. Overall, 309/315 (98%) students were satisfied with the blended teaching, 297/318 (93%) wanted its extent to the whole medical school's curriculum. CONCLUSION The use of combined learning methods reached more students than traditional teachings and allowed the University to focus on its role of knowledge transfer.
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Affiliation(s)
- D Vodovar
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; FeTox, centre antipoison et de toxicovigilance de Paris, hôpital Fernand-Widal, AP-HP, 200, rue du Faubourg Saint-Denis, 75010 Paris, France.
| | - J D Ricard
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Louis Mourier, AP-HP, 92700 Colombes, France
| | - L Zafrani
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - E Weiss
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Département d'anesthésie-réanimation, hôpital Beaujon, AP-HP, 92110 Clichy, France
| | - E Desrentes
- UFR de médecine Paris-Diderot, service MédiTICE, université de Paris, 75010 Paris, France
| | - D Roux
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Louis Mourier, AP-HP, 92700 Colombes, France
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Mahon RN, Ghita M, Hugo GD, Weiss E. ComBat harmonization for radiomic features in independent phantom and lung cancer patient computed tomography datasets. ACTA ACUST UNITED AC 2020; 65:015010. [DOI: 10.1088/1361-6560/ab6177] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Weiss E, Facchini R, Zwerling J. Cognitive Test Differences Between our Bronx English and Spanish Speaking Patients: Lessons Learned Through the Expansion of Neuropsychological Services. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To demonstrate the differences between the English-speaking and Spanish-speaking patients evaluated at a Memory Disorders Clinic.
Participants and Method
Through a foundation grant to reduce barriers to appropriate neurological care, we established a bilingual/bicultural neuropsychology post-doctoral fellowship. In the initial 2 years, 405 new patients were seen at our multidisciplinary memory disorders clinics for neuropsychological and neurological evaluations. These patients were 63% female (n = 256), and had a mean age of 73.09 (SD = 10.63, range 52-98). Fifty-eight percent of our population identified as Hispanic/Latino (primarily Puerto Rican and Dominican) and 42% were evaluated in Spanish.
Results
Patients evaluated in Spanish had less education (p < .001) and were younger (p = .03) than those evaluated in English (including our Hispanic/Latino English speaking patients). Individuals evaluated in Spanish performed worse on a mental status exam (Blessed) than those evaluated in English (p = .001) even after controlling for age and education (p = .048). However, those evaluated in Spanish were more likely to do better on memory tasks than those evaluated in English, compared to their respective normative peers. Higher levels of anxiety and depression were evident in Hispanics/Latinos compared to non-Hispanics with highest levels in Hispanics evaluated in English.
Conclusions
Through a grant to expand services to the previously underserved Spanish-only speaking population of the Bronx, we were able to validate the need for appropriate language and cultural resources in our robust medical community. We demonstrated that our Spanish speaking population is diverse and requires different resources from their English-speaking counterparts. Our data supports the establishment of additional studies (including improved cultural and language specific normative data) and further education of providers working with our diverse populations.
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Cooper D, Conrad S, Padilla L, Weiss E. Comparing Maximum Dose to Central Airways in Mid-Ventilation Versus Average Intensity Projection-Based 4DCT Planning for Lung Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ricco A, Slade A, Canada J, Grizzard J, Dana F, Gharai LR, Neiderer K, Vera A, Abbate A, Weiss E. T1 Mapping and Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Slade A, Weiss E. Diabetes Self-Management among Cancer Survivors: Differences by Diagnosis and Treatment. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schneider S, Weiss E. AGR - 1 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz037.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre, peri and post- ELD trial, assessment in a complex case of possible NPH is presented.
Method
33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up.
Results
Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial.
Conclusions
Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.
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Shagalow S, Facchini R, Masur D, Weiss E, Schneider S, Jacobs S, Yozawitz E, McGinley J. A-58 Rare Case of Klinefelter Syndrome with 13/14 Balanced Translocation and Absence Epilepsy: Impact of Combined Genotypes on Cognitive Neuropsychological Phenotype. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Klinefelter syndrome (KS) and Robertsonian translocation of 13/14 [rob t(13;14)] are the most common sex-chromosome disorder and chromosome rearrangement, respectively (Engels et al., 2008; Skakkebæk, Wallentin, & Gravholt, 2015). Both are associated with increased risk of cognitive/intellectual disability (ID). A case of KS and de novo (i.e., unbalanced) rob t(13;14) was previously reported (Gül & Şayli, 1994). A case of KS with balanced rob t(13;14) and well-controlled generalized absence epilepsy will be presented with consideration for pediatric neuropsychological practice.
Method
Neuropsychological evaluation of a 12-year-old, right-handed boy diagnosed with comorbid KS, rob t(13;14), and generalized absence epilepsy. Particular attention was given to language given his KS diagnosis. The patient is in a 12:1:1 self-contained classroom with speech-language therapy and social skills groups in place. The patient’s mother is confirmed to have rob t(13;14), whereas paternal contribution is unknown.
Results
Adolescent with a history of language difficulties, especially comprehension. Recent school-based WISC-V FSIQ was in the extremely low range (SS = 53), with weaker verbal comprehension and working memory. Academic achievement was globally very low. Expressive and receptive language, visual perception and motor coordination were extremely low to low average. Verbal list learning and visual attention were near average to average.
Conclusions
This case contributes to the very limited body of pediatric neuropsychological data on the combined genotype of KS with rob t(13;14) and absence epilepsy. Both the KS and rob t(13;14) cognitive phenotypes have been characterized as highly variable, with the comorbidity a likely increased risk for ID.
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Schneider S, Weiss E, Facchini R, Shagalow S, Jacobs S, McGinley J, Masur D. B-32 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre-, peri and post- ELD trial, assessment in a complex case of possible NPH is presented.
Method
33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up.
Results
Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial.
Conclusions
Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.
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Jacobs S, Facchini R, Weiss E, McGinley J, Masur D. A-34 An Atypical Case of Primary Progressive Aphasia: Implications for Differentiating the Semantic Variant. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Primary progressive aphasia is a neurodegenerative condition consisting of three primary variants. The semantic variant (svPPA) is typically associated with anomia and word-finding issues paired with fluent speech, although other symptoms can arise over time including non-verbal deficits and behavioral changes. A complex case of svPPA with evidence of robust impairment across multiple domains in the presence of notable psychosocial and medical factors is presented.
Method
Sixty-year-old woman with complaints of worsening memory and language changes in the context of marked behavioral disinhibition, deterioration of daily functioning, and indication of delusions was seen for outpatient neuropsychological evaluation. Medical history includes severe depression, anxiety, hypertension, and rheumatic heart disease. CT scan was significant for frontal and temporal atrophy and chronic right cerebellar infarct.
Results
Neuropsychological evaluation revealed uniformly extremely low scores. Presentation was notable for inappropriate behaviors, and expressive and receptive language difficulties. Significant confusion and functional impairment were evident. Her time awareness varied and she at some moments spoke about events from 20-30 years ago as if they were recent. Global language impairment was evident on formal testing and clearly moderated all other performances, including tasks of memory which were impaired. Notable weakness in visual-spatial processing and executive function were also present.
Conclusions
Complex medical and psychosocial history, and atypical decline patterns complicated the diagnosis of a patient with profound progressive expressive language impairment. SvPPA is offered as the diagnosis.
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Gonzalez D, Facchini R, Marquez C, Masur D, McGinley J, Weiss E, Zwerling J. A-83 The Applicability of the Word Accentuation Test (WAT) in a Diverse Spanish Speaking Population: A Pilot Study. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
A valid estimate of premorbid ability (PA) is important when attempting to identify cognitive decline. Measures of PA in English have been widely validated, but there is a lack of PA instruments for Spanish speakers. The findings of a pilot study assessing the feasibility of using the Word Accentuation Test (WAT) as a PA measure in a diverse, traditionally underserved, Spanish speaking population are described.
Method
The WAT was administered as part of comprehensive neuropsychological evaluations and neurobehavioral status exams (NBSE) completed with Spanish speaking patients at Montefiore Medical Center (MMC) in a 6-month period. Sixty-one patients completed the WAT- 12 as part of comprehensive testing (mean age 60 (SD 11.05) range 43-80, 67% female) and 49 during NBSEs within the context of multidisciplinary memory disorders clinics (mean age 74.35 (SD 8.60) range 51-93, 80% female). T-tests and correlations with WAT performances were completed.
Results
Overall, our population correctly read an average of 19.67 (SD 7.61) words. There was no statistical difference by gender or age, but years of education predicted WAT performance (p = .004). For those individuals who had comprehensive cognitive evaluations, WAT scores were correlated with performance on the vocabulary subtest of the EIWA-III (p = .003). All patients without severe dementia were able to complete the task.
Conclusions
Analysis of pilot data from our diverse Spanish population demonstrated that the WAT is an PA appropriate task that appears to have good correlation with years of education and vocabulary performance. Additional research is necessary to validate the measure in this cohort and other cohorts.
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Ayers E, Ansari A, Boulifard D, Chalmer R, Amy E, Malik R, Wang C, Weiss E, Zwerling J, Verghese J. P4-022: 5-COG TO IMPROVE DETECTION OF COGNITIVE IMPAIRMENT AND DEMENTIA IN PRIMARY CARE: A RANDOMIZED CLINICAL TRIAL PROTOCOL. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Rachel Chalmer
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
| | - Ehrlich Amy
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
| | - Rubina Malik
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
| | - Cuiling Wang
- Albert Einstein College of Medicine; Bronx NY USA
| | - Erica Weiss
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
| | | | - Joe Verghese
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
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Dawson K, Mange B, Torney PA, Gonzalez V, Sae-Hau M, Weiss E, Price M, Mansfield C, Comenencia-Ortíz E, Masaquel A, Ravelo A. PATIENT-REPORTED EXPERIENCE AND PREFERENCES WITH TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) AND FOLLICULAR LYMPHOMA (FL). Hematol Oncol 2019. [DOI: 10.1002/hon.225_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- K. Dawson
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
| | - B. Mange
- Health Preference Assessment; RTI Health Solutions, Research Triangle Park; NC United States
| | - P. A. Torney
- Education and Support Services; Lymphoma Research Foundation; New York NY United States
| | - V. Gonzalez
- Support Services; Lymphoma Research Foundation; New York NY United States
| | - M. Sae-Hau
- Patient Access; The Leukemia & Lymphoma Society; Rye Brook NY United States
| | - E. Weiss
- Patient Access; The Leukemia & Lymphoma Society; Rye Brook NY United States
| | - M. Price
- Surveys and Observational Studies; RTI Health Solutions, Research Triangle Park; NC United States
| | - C. Mansfield
- Health Preference Assessment; RTI Health Solutions, Research Triangle Park; NC United States
| | - E. Comenencia-Ortíz
- Alliance & Advocacy Relations, Genentech, Inc.; South San Francisco CA United States
| | - A. Masaquel
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
| | - A. Ravelo
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
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Van Zandt M, Weiss E, Almyasheva A, Lipior S, Maisel S, Naegele JR. Adeno-associated viral overexpression of neuroligin 2 in the mouse hippocampus enhances GABAergic synapses and impairs hippocampal-dependent behaviors. Behav Brain Res 2018; 362:7-20. [PMID: 30605713 DOI: 10.1016/j.bbr.2018.12.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/14/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The cell adhesion molecule neuroligin2 (NLGN2) regulates GABAergic synapse development, but its role in neural circuit function in the adult hippocampus is unclear. We investigated GABAergic synapses and hippocampus-dependent behaviors following viral-vector-mediated overexpression of NLGN2. Transducing hippocampal neurons with AAV-NLGN2 increased neuronal expression of NLGN2 and membrane localization of GABAergic postsynaptic proteins gephyrin and GABAARγ2, and presynaptic vesicular GABA transporter protein (VGAT) suggesting trans-synaptic enhancement of GABAergic synapses. In contrast, glutamatergic postsynaptic density protein-95 (PSD-95) and presynaptic vesicular glutamate transporter (VGLUT) protein were unaltered. Moreover, AAV-NLGN2 significantly increased parvalbumin immunoreactive (PV+) synaptic boutons co-localized with postsynaptic gephyrin+ puncta. Furthermore, these changes were demonstrated to lead to cognitive impairments as shown in a battery of hippocampal-dependent mnemonic tasks and social behaviors.
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Affiliation(s)
- M Van Zandt
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - E Weiss
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - A Almyasheva
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - S Lipior
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - S Maisel
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - J R Naegele
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States.
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Zhao S, Mahon R, Mukhopadhyay N, Hugo G, Weiss E. Changes in Radiomic Features During Radiation Therapy as Predictors for Outcome in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weiss E, Jan N. Recurrence Pattern after SBRT for Stage I Lung Cancer – Impact on Patient Outcome. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zhao S, Sima A, Mahon R, Tennyson N, Weiss E. Tumor Volume Changes During and after Radiation Therapy as a Predictor for Local Recurrence in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gockel-Blessing E, Weiss E, Ramel M, Wright K. Heart Rate Response to Caffeine Ingestion as a Predictor of Magnitude and Direction of Blood Pressure Changes. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Golbek A, Reafsnyder S, Rancourt D, Kelly P, Rahman R, Weiss E. Peppermint Oil Fails to Improve Exercise Performance. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mandolfo C, Baumgart C, Weiss E, Stephen F. Consuming An Anti-Inflammatory Diet to Alleviate Chronic Pain. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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