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Weinstein J. Refining the lens of DNA microscopy. Nat Comput Sci 2024; 4:94-95. [PMID: 38365998 DOI: 10.1038/s43588-024-00601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
- Joshua Weinstein
- Department of Medicine Section of Genetic Medicine, Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA.
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Sarteau AC, Muthukkumar R, Smith C, Busby-Whitehead J, Lich KH, Pratley RE, Thambuluru S, Weinstein J, Weinstock RS, Young LA, Kahkoska AR. Supporting the 'lived expertise' of older adults with type 1 diabetes: An applied focus group analysis to characterize barriers, facilitators, and strategies for self-management in a growing and understudied population. Diabet Med 2024; 41:e15156. [PMID: 37278610 PMCID: PMC11002954 DOI: 10.1111/dme.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/27/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION There is a growing number of older adults (≥65 years) who live with type 1 diabetes. We qualitatively explored experiences and perspectives regarding type 1 diabetes self-management and treatment decisions among older adults, focusing on adopting care advances such as continuous glucose monitoring (CGM). METHODS Among a clinic-based sample of older adults ≥65 years with type 1 diabetes, we conducted a series of literature and expert informed focus groups with structured discussion activities. Groups were transcribed followed by inductive coding, theme identification, and inference verification. Medical records and surveys added clinical information. RESULTS Twenty nine older adults (age 73.4 ± 4.5 years; 86% CGM users) and four caregivers (age 73.3 ± 2.9 years) participated. Participants were 58% female and 82% non-Hispanic White. Analysis revealed themes related to attitudes, behaviours, and experiences, as well as interpersonal and contextual factors that shape self-management and outcomes. These factors and their interactions drive variability in diabetes outcomes and optimal treatment strategies between individuals as well as within individuals over time (i.e. with ageing). Participants proposed strategies to address these factors: regular, holistic needs assessments to match people with effective self-care approaches and adapt them over the lifespan; longitudinal support (e.g., education, tactical help, sharing and validating experiences); tailored education and skills training; and leveraging of caregivers, family, and peers as resources. CONCLUSIONS Our study of what influences self-management decisions and technology adoption among older adults with type 1 diabetes underscores the importance of ongoing assessments to address dynamic age-specific needs, as well as individualized multi-faceted support that integrates peers and caregivers.
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Affiliation(s)
| | - Rashmi Muthukkumar
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
- UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | | | - Sirisha Thambuluru
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - Joshua Weinstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | | | - Laura A. Young
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
- UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
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Zabida A, Zahavi G, Bartoszko J, Otálora-Esteban M, Weinstein J, Frogel J, Miller L, Sivan E, Orkin D, Dolgoker I, Berkenstadt H. Improving blood product management in placenta accreta patients with severe bleeding: institutional experience. Int J Obstet Anesth 2023; 56:103904. [PMID: 37364347 DOI: 10.1016/j.ijoa.2023.103904] [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: 02/06/2022] [Revised: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. METHODS A retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. RESULTS A total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. CONCLUSION Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.
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Affiliation(s)
- A Zabida
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.
| | - G Zahavi
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Bartoszko
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
| | - M Otálora-Esteban
- Department of Anesthesiology, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Weinstein
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Frogel
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - L Miller
- Blood Bank, Sheba Medical Centre, Tel-Hashomer, Israel
| | - E Sivan
- Josef Buchman Gynecology and Maternity Centre, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - D Orkin
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - I Dolgoker
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - H Berkenstadt
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
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Tahir M, Ali A, Nasser I, Weinstein J, Ahmed M, Sarwar A. Abstract No. 129 Histopathological Analysis after Transarterial Radioembolization with Yttrium-90 Resin Microspheres. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.180] [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: 02/27/2023] Open
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Malik M, Ou C, Curry M, Novack V, Weinstein J, Ahmed M, Sarwar A. Abstract No. 232 Evaluating HCC Patient Experiences to Identify Factors Associated with Underutilization of HCC Treatment in the US: A SEER-CAHPS Analysis. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.293] [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: 02/27/2023] Open
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Malik M, Vo N, Tahir M, Parker A, Weinstein J, Ahmed M, Sarwar A. Abstract No. 558 To Determine the Relationship of Tumor Absorbed Dose with Microsphere Distribution/mL Using PET/CT Derived Tumor to Normal Ratio (T:N) in HCC Patients Treated with 90Y Radiation Segmentectomy. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Parikh D, Choksi E, Winokur R, Tan A, Ford R, Weinstein J. Abstract No. 186 Assessment of Change in Treatment Modalities Utilized for Chronic Venous Disease and Elimination of Axial Vein Reflux. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.243] [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: 02/27/2023] Open
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Vo N, Malik M, Tahir M, Parker A, Weinstein J, Ahmed M, Sarwar A. Abstract No. 128 Achieving Prescribed Tumor Absorbed Dose in Radiation Segmentectomy with Resin Microspheres for HCC: Quantitative PET/CT Analysis. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.179] [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: 02/26/2023] Open
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Tahir M, DeBacker SS, Berkowitz S, Weinstein J, Ahmed M, Sarwar A. Abstract No. 55 Evaluating Percutaneous Transhepatic Biliary Drainage (PTBD) Factors Associated with Better Outcomes in the Treatment of Post-Surgical Benign Biliary Strictures. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.099] [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: 02/27/2023] Open
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Rumball I, Chen K, Mikhitarian M, Moirano J, Gandras E, Greben C, Weinstein J. Abstract No. 506 Factors Influencing Clinical Success of Renal Artery Embolization for Bleeding after Percutaneous Nephrolithotomy. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.364] [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: 02/27/2023] Open
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Kahkoska AR, Smith C, Thambuluru S, Weinstein J, Batsis JA, Pratley R, Weinstock RS, Young LA, Hassmiller Lich K. "Nothing is linear": Characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes. Diabetes Res Clin Pract 2023; 196:110204. [PMID: 36509180 PMCID: PMC9974816 DOI: 10.1016/j.diabres.2022.110204] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
AIMS Continuous glucose monitoring (CGM) can reduce hypoglycemia in older adults with type 1 diabetes (T1D). We aimed to characterize factors that influence effective use in this age group. METHODS Older adults with type T1D (age ≥ 65) and their caregivers participated in one of a series of parallel group model building workshops, a participatory approach to system dynamics involving drawing and scripted group activities. Data were synthesized in a qualitative model of the hypothesized system of factors producing distinct patterns of CGM use in older adults. The model was validated through virtual follow-up interviews. RESULTS Data were collected from 33 participants (four patient-caregiver dyads, mean age 73.8 ± 4.4 years [range 66-85 years]; 16 % non-CGM users, 79 % pump users). The system model delineates drivers of CGM uptake, drivers of ongoing CGM use, and feedback loops that either reinforce or counteract future CGM use. Participants emphasized the importance of different sets of feedback loops at different points in the duration of CGM use. CONCLUSIONS The holistic system model underscores that factors and feedback loops driving effective CGM use in older adults are both individualized and dynamic (e.g., changing over time), suggesting opportunities for staged and tailored age-specific education and support.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
| | - Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sirisha Thambuluru
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Joshua Weinstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - John A Batsis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
| | - Richard Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA.
| | | | - Laura A Young
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Huang G, Strikarsky S, Weinstein J, Ellahi M, Gonzalez A, Idkowiak-Baldys J, Glynn J. 415 Using a cosmetic blend to produce a contraction response in human keratinocytes and deliver tightening of skin around the eye. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.424] [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: 11/26/2022]
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Sikaria D, Weinstein J, Ahmed M, Bulman J. Abstract No. 616 Utilization and impact of implementing a commercial inferior vena cava filter retrieval database on filter retrievals. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.598] [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] Open
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Kini S, Duluk D, Weinstein J. Modeling the impact of digital readiness in recruiting and sustaining underrepresented groups: Data from the All of Us research program. Front Digit Health 2022; 4:1082098. [PMID: 37124163 PMCID: PMC10133694 DOI: 10.3389/fdgth.2022.1082098] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 05/02/2023] Open
Abstract
The All of Us Research Program (All of Us or Program) is an ongoing longitudinal data collection operated by the National Institutes of Health (NIH). The Program aims to improve healthcare for all through the development of a biomedical research resource reflective of the diversity of the United States that includes Underrepresented in Biomedical Research (UBR) groups. Federally Qualified Health Centers (FQHCs) are a key recruitment stream of UBR participants, which are community based and provide primary care and preventive services in medically underserved areas. Over 90% of FQHC patients enrolled in All of Us to date are UBR. The COVID-19 pandemic caused a pause in All of Us activities. Re-starting the activities was a challenge, especially due to the digital divide faced by FQHC participants, and that most Program activities are primarily completed via web-based portal from a computer or a mobile device. This paper investigates the extent to which digital readiness impacted recruitment and sustainment of a pre-pandemic sample of 2,791 FQHC participants to the Program. Digital readiness was defined by access to home-based or other internet-accessing devices, and participants' comfort level using such devices. Results from multivariable logistic regression models showed that lower age, more education, female gender identity, and higher income were associated with higher digital readiness (p ≤ 0.01). Race, rurality, and sexual orientation status were not significant factors associated with digital readiness. Older participants had higher odds of completing Program activities, even though less digitally ready than their younger peers, as they often completed the activities during their in-person clinical visits. A subsequent weighted model demonstrated that FQHC participants who were digitally ready had 27% higher odds of completing Program activities than those not digitally ready. The data highlight the need for improved connectivity and sustainment between longitudinal data collection, research programs, and UBR participants, particularly among those facing the digital divide. Quantifying digital challenges provide operational insights for longitudinal data collection (All of Us, or others), and broadly, other aspects of digital medicine such as telehealth or patient portals by recognizing digital readiness of participants and patients, and the level of support required for success.
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Affiliation(s)
- Soumya Kini
- Principal Health Systems Engineer atThe MITRE Corporation, Mclean, VA, United States
- Correspondence: Soumya Kini
| | - Dave Duluk
- Lead Data Scientist atThe MITRE Corporation, Mclean, VA, United States
| | - Joshua Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Bukhari A, Knowles W, Schwartz J, Lindberg T, Hough H, Reagan J, Wagaman L, Young K, Harward J, Feeney K, Weinstein J. Systematic Review of Evidence-Based Strategies to Enhance Weight Management Programming. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.067] [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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Ali A, Weinstein J, Nasser I, Morrow M, Faintuch S, Ahmed M, Sarwar A. Abstract No. 439 Histological outcomes in resected tumor specimens after Yttrium-90 transarterial radioembolization using resin microspheres. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.248] [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: 10/21/2022] Open
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Lewis T, Berkowitz S, Weinstein J. Abstract No. 565 Smartphone and web-based interventional radiology case logging system to facilitate recording of procedures performed by interventional radiology residents. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.375] [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: 10/21/2022] Open
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Chen K, Bagha Z, Rumball I, Gandras E, Greben C, Weinstein J. Abstract No. 100 Analysis of findings on upper endoscopy versus patient outcomes in empiric embolization of the gastroduodenal artery for nonvariceal upper gastrointestinal bleeding related to duodenal ulcers. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.106] [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] Open
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Subrize M, Ali A, Weinstein J, Faintuch S, Ahmed M, Sarwar A. Abstract No. 70 Post-surgical outcomes for patients with intrahepatic cholangiocarcinoma treated with neoadjuvant resin Yttrium-90 radioembolization using MIRD dosimetry. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.492] [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] Open
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Ali A, Ahmed M, Daily L, Lewis T, Weinstein J, Ou J, Novack V, Faintuch S, Sarwar A. Abstract No. 440 Multimodality therapy improves survival in hepatocellular carcinoma patients with cirrhosis: a propensity score matching analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.249] [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: 10/21/2022] Open
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Ali A, Ahmed M, Evenson A, Weinstein J, Raven K, Eckhoff D, Nasser I, Morrow M, Faintuch S, Sarwar A. Abstract No. 75 Neoadjuvant Yttrium-90 transarterial radioembolization using MIRD dosimetry with resin microspheres. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ali A, Sarwar A, Hussain M, Padmanabhan L, Luo M, Weinstein J, Patwardhan V, Curry M, Ahmed M. 4:03 PM Abstract No. 59 Risk factors and outcomes for patients developing heart failure after transjugular intrahepatic portosystemic shunt. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sarwar A, Weinstein J, Ali A, Curry M, Khwaja K, Bullock A, Faintuch S, Ahmed M. 3:18 PM Abstract No. 239 Feasibility of radiation segmentectomy with resin microspheres prescribed using medical internal radiation dosimetry model. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.283] [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: 10/25/2022] Open
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Weinstein J, El-Gabalawy F, Sarwar A, Brook O, Faintuch S, Hsu M, DeBacker SS, Berkowitz S, Palmer M, Ahmed M. Abstract No. 465 Threshold analysis for determining number of movements in the kinematic analysis of hand motion in interventional radiology. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.526] [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: 10/25/2022] Open
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Maheshwari N, Sarwar A, Weinstein J, Ahmed M, Ali A. Abstract No. 650 Percutaneous debridement of partial hepatic necrosis due to hepatic artery thrombosis after liver transplantation. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.711] [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] Open
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Weinstein J, El-Gabalawy F, Sarwar A, Brook O, Faintuch S, Palmer M, DeBacker SS, Hsu M, Berkowitz S, Ahmed M. Abstract No. 451 Analysis of kinematic differences in hand motion between the dominant and nondominant hand of interventional radiology trainees performing simulated radial artery access. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.512] [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] Open
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Ljuboja D, Perez E, Subrize M, Weinstein J, Faintuch S, Ahmed M, Sarwar A. Abstract No. 521 Performing time-driven activity based costing for interventional oncology procedures: variability in time measurements. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.602] [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] Open
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Luo M, Sarwar A, Lewis T, Weinstein J, Faintuch S, Ahmed M. Abstract No. 532 Outcomes for hepatocellular carcinoma with portal vein invasion treated with resin yttrium-90 radioembolization using MIRD model dosimetry. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.613] [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] Open
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Lewis T, Sarwar A, Weinstein J, Ahmed M. Abstract No. 622 Utility of over-dilation of 10 mm TIPS stent with 12-mm balloon angioplasty. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.667] [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: 10/17/2022] Open
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Berkowitz S, Collares F, Weinstein J, Nathanson L, Ahmed M. Abstract No. 609 Imaging beyond PACS: documenting clinical photographs in the electronic medical record with a mobile application. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Li Z, Weinstein J, Rozenberg A, Hansberry D, Levin D. Abstract No. 679 How subspecialized are academic interventional radiologists? J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.724] [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] Open
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Weinstein J, Rozenberg A, Li Z, Hansberry D, Eschelman D, Levin D. Abstract No. 678 Analysis of clinical workload of private practice interventional radiologists. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.723] [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] Open
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Koppula R, Weinstein J, Krishnasamy V, Akman A, Sarin S, Chun A, Venbrux A. Temporary embolization of the cystic artery in right hepatic lobe Y-90 radioembolization. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jiang N, He J, Weinstein J, Penland L, Saaki S, He X, Dekker C, Wilson P, Greenberg H, Davis M, Fisher D, Quake S. High Throughput Sequencing of the Human Antibody Repertoire in Response to Influenza Vaccination (58.14). The Journal of Immunology 2012. [DOI: 10.4049/jimmunol.188.supp.58.14] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Despite the many advances in personal genome analysis, the immunoglobulin repertoire of the genome, while central to human health, is in practice extraordinarily challenging to measure and analyze. There are several reasons for this, including the facts that each B cell contains a distinct antibody sequence encoded in its genome, that the antibody repertoire is not constant but changes over time, and the high similarity between antibody sequences. We have addressed this challenge by using high-throughput long read sequencing to perform immunogenetic characterization of expressed human antibody repertoires. Informatic analysis of large numbers of antibody heavy chain sequences from individual subjects allowed us to perform global characterizations of isotype distributions, clonal lineage structure of the repertoire and age-related mutational activity. With influenza vaccination as a specific stimulus, we used lineage analysis to measure the clonal structure and mutational distribution of individuals’ repertoires; analysis of this data showed that elderly subjects have a decreased number of lineages but an increased pre-vaccination mutation load in their repertoire and that some of these subjects have an oligoclonal character to their repertoire in which the diversity of the lineages is greatly reduced relative to younger subjects. These analyses may ultimately be useful as metrics to measure vaccine response and to further understand impaired immune function in aging.
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Affiliation(s)
- Ning Jiang
- 1Bioengineering, Stanford University, Stanford, CA
- 2Biomedical Engineering, University of Texas at Austin, Austin, TX
| | - Jiankui He
- 1Bioengineering, Stanford University, Stanford, CA
| | | | | | - Sanae Saaki
- 4Department of Medicine, Stanford University Sch. of Med., Stanford, CA
| | - Xiaosong He
- 4Department of Medicine, Stanford University Sch. of Med., Stanford, CA
| | - Cornelia Dekker
- 5Department of Pediatrics, Stanford University Sch. of Med., Stanford, CA
| | - Patrick Wilson
- 7Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Harry Greenberg
- 4Department of Medicine, Stanford University Sch. of Med., Stanford, CA
| | - Mark Davis
- 3Department of Immunology and Microbiology, Stanford University Sch. of Med., Stanford, CA
| | - Daniel Fisher
- 8Department of Applied Physics, Stanford University, Stanford, CA
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Yordy JS, Shen L, Diao L, Wang J, Coombes K, Giri U, Xie Y, Minna JD, Girard L, Weinstein J, Heymach J, Ang KK, Story MD, Meyn R. Use of a gene expression signature related to epithelial-to-mesenchymal transition (EMT) to predict for overall survival (OS) in cohorts of lung and head and neck cancer (HNSCC) patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7010] [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: 11/20/2022] Open
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Byers L, Wang J, Diao L, Yordy J, Girard L, Story M, Coombes K, Weinstein J, Minna J, Heymach J. 37 An epithelial to mesenchymal transition (EMT) gene expression signature identifies Axl as an EMT marker in non-small cell lung cancer (NSCLC) and head and neck cancer (HNC) lines and predicts response to erlotinib. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71742-0] [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: 10/18/2022] Open
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Wang J, Lin S, Yordy J, Byers L, Diao L, Weinstein J, Coombes K, Minna J, Heymach J. 609 Integrative analysis of DNA methylation and gene expression identifies a DNA methylation signature associated with erlotinib resistance in EGFR wild type non-small cell lung cancer cells. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72316-8] [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] Open
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Libon DJ, McMillan C, Gunawardena D, Powers C, Massimo L, Khan A, Morgan B, Farag C, Richmond L, Weinstein J, Moore P, Coslett HB, Chatterjee A, Aguirre G, Grossman M. Neurocognitive contributions to verbal fluency deficits in frontotemporal lobar degeneration. Neurology 2009; 73:535-42. [PMID: 19687454 DOI: 10.1212/wnl.0b013e3181b2a4f5] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To test the hypothesis that different neurocognitive networks underlie verbal fluency deficits in frontotemporal lobar degeneration (FTLD). METHODS Letter ("FAS") and semantic ("animal") fluency tests were administered to patients with a behavioral/dysexecutive disorder (bvFTLD; n = 71), semantic dementia (SemD; n = 21), and progressive nonfluent aphasia (PNFA; n = 26). Tests measuring working memory, naming/lexical retrieval, and semantic knowledge were also obtained. MRI voxel-based morphometry (VBM) studies were obtained on a subset of these patients (bvFTLD, n = 51; PNFA, n = 11; SemD, n = 10). RESULTS Patients with SemD were disproportionately impaired on the semantic fluency measure. Reduced output on this test was correlated with impaired performance on naming/lexical retrieval tests. VBM analyses related reduced letter and semantic fluency to anterior and inferior left temporal lobe atrophy. Patients with bvFTLD were equally impaired on both fluency tests. Poor performance on both fluency tests was correlated with low scores on working memory and naming/lexical retrieval measures. In this group, MRI-VBM analyses related letter fluency to bilateral frontal atrophy and semantic fluency to left frontal/temporal atrophy. Patients with PNFA were also equally impaired on fluency tests. Reduced semantic fluency output was correlated with reduced performance on naming/lexical retrieval tests. MRI-VBM analyses related semantic fluency to the right frontal lobe and letter fluency to left temporal atrophy. CONCLUSIONS Distinct neurocognitive networks underlie impaired performance on letter and semantic fluency tests in frontotemporal lobar degeneration subgroups.
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Affiliation(s)
- D J Libon
- Department of Neurology, Drexel University, Philadelphia, PA 19102, USA.
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Weinstein J, Burton J, Katz B. 69: Patient Outcomes and Resource Utilization for Emergency Department Patients With Suspected Pulmonary Embolism and Initial Chest Computed Tomography Angiography Studies Deemed Suboptimal for Interpretation. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.090] [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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Abstract
Whether the US Constitution guarantees a right to conduct scientific research is a question that has never been squarely addressed by the United States Supreme Court. Similarly, the extent to which the First Amendment protects the right to communicate the results of scientific research is an issue about which there is scant judicial authority. This article suggests that a crucial guidepost for exploring both these uncharted areas of constitutional law should be whether restrictions on scientific research or communication truly implicate fundamental individual rights or instead primarily concern issues of general social welfare-issues that in a democracy are properly decided by the representative branches of government or their delegates, not by the judiciary.
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Affiliation(s)
- J Weinstein
- Sandra Day O'Connor College of Law, Arizona State University, Tempe, AZ 85287, USA.
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Agrawal NJ, Weinstein J, Radhakrishnan R. Landscape of finite-temperature equilibrium behaviour of curvature-inducing proteins on a bilayer membrane explored using a linearized elastic free energy model. Mol Phys 2008; 106:1913-1923. [PMID: 21243078 PMCID: PMC3020790 DOI: 10.1080/00268970802365990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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] [Indexed: 12/14/2022]
Abstract
Using a recently developed multiscale simulation methodology, we describe the equilibrium behaviour of bilayer membranes under the influence of curvature-inducing proteins using a linearized elastic free energy model. In particular, we describe how the cooperativity associated with a multitude of protein-membrane interactions and protein diffusion on a membrane-mediated energy landscape elicits emergent behaviour in the membrane phase. Based on our model simulations, we predict that, depending on the density of membrane-bound proteins and the degree to which a single protein molecule can induce intrinsic mean curvature in the membrane, a range of membrane phase behaviour can be observed including two different modes of vesicle-bud nucleation and repressed membrane undulations. A state diagram as a function of experimentally tunable parameters to classify the underlying states is proposed.
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Affiliation(s)
- Neeraj J. Agrawal
- Department of Chemical and Biomolecular Engineering, Philadelphia, PA 19104, USA
| | - Joshua Weinstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ravi Radhakrishnan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Liu Y, Purvis J, Shih A, Weinstein J, Agrawal N, Radhakrishnan R. A multiscale computational approach to dissect early events in the Erb family receptor mediated activation, differential signaling, and relevance to oncogenic transformations. Ann Biomed Eng 2007; 35:1012-25. [PMID: 17273938 PMCID: PMC3021414 DOI: 10.1007/s10439-006-9251-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 12/12/2006] [Indexed: 11/24/2022]
Abstract
We describe a hierarchical multiscale computational approach based on molecular dynamics simulations, free energy-based molecular docking simulations, deterministic network-based kinetic modeling, and hybrid discrete/continuum stochastic dynamics protocols to study the dimer-mediated receptor activation characteristics of the Erb family receptors, specifically the epidermal growth factor receptor (EGFR). Through these modeling approaches, we are able to extend the prior modeling of EGF-mediated signal transduction by considering specific EGFR tyrosine kinase (EGFRTK) docking interactions mediated by differential binding and phosphorylation of different C-terminal peptide tyrosines on the RTK tail. By modeling signal flows through branching pathways of the EGFRTK resolved on a molecular basis, we are able to transcribe the effects of molecular alterations in the receptor (e.g., mutant forms of the receptor) to differing kinetic behavior and downstream signaling response. Our molecular dynamics simulations show that the drug sensitizing mutation (L834R) of EGFR stabilizes the active conformation to make the system constitutively active. Docking simulations show preferential characteristics (for wildtype vs. mutant receptors) in inhibitor binding as well as preferential enhancement of phosphorylation of particular substrate tyrosines over others. We find that in comparison to the wildtype system, the L834R mutant RTK preferentially binds the inhibitor erlotinib, as well as preferentially phosphorylates the substrate tyrosine Y1068 but not Y1173. We predict that these molecular level changes result in preferential activation of the Akt signaling pathway in comparison to the Erk signaling pathway for cells with normal EGFR expression. For cells with EGFR over expression, the mutant over activates both Erk and Akt pathways, in comparison to wildtype. These results are consistent with qualitative experimental measurements reported in the literature. We discuss these consequences in light of how the network topology and signaling characteristics of altered (mutant) cell lines are shaped differently in relationship to native cell lines.
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Affiliation(s)
- Yingting Liu
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA
| | - Jeremy Purvis
- Genomics and Computational Biology Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Shih
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA
| | - Joshua Weinstein
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Neeraj Agrawal
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravi Radhakrishnan
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biochemistry and Biophysics, University of Pennsylvania, Philadelphia, PA, USA
- Genomics and Computational Biology Program, University of Pennsylvania, Philadelphia, PA, USA
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Zage PE, Weinstein J, Mets MB, Lasky JB, Goldman S. Outcomes of a two-drug chemotherapy regimen for retinoblastoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9064 Background: Retinoblastoma is the most common intraocular tumor of childhood in the U.S. and has an overall survival rate of over 90%. The optimal treatment regimen for intraocular retinoblastoma has not yet been established. Current treatment regimens for retinoblastoma involve combinations of chemotherapy with focal therapy. We report here the results of an institutional retinoblastoma treatment trial to determine the vision- and globe-salvage rates and associated toxicity of a regimen combining carboplatin and etoposide with focal therapy. Methods: 29 patients diagnosed with either bilateral retinoblastoma or unilateral retinoblastoma in infants under 12 months of age were treated prospectively with carboplatin and etoposide plus focal therapy between 1992 and 2004 at Children’s Memorial Hospital in Chicago. External beam radiation therapy (EBRT) and enucleation were utilized as needed. Results: The regression rate after 6 cycles of chemotherapy was 85.4%. 7 eyes received EBRT and 22 eyes were enucleated. The overall vision salvage rate without EBRT was 50%, with a vision salvage rate of eyes with Reese-Ellsworth (R-E) groups I-IV tumors of 82.6%. The vision salvage rate of eyes with R-E group V tumors was 20%. The vision salvage rate for eyes with Murphree groups A and B was 77.3%, but only 26.9% for groups C and D. The 10-year estimated EBRT/enucleation-free survival rate was 47%. There were no treatment related mortalities and minimal long-term side effects, with one case of secondary malignancy. Conclusions: The combination of carboplatin and etoposide with focal therapy is a well-tolerated regimen that avoids EBRT and has acceptable vision salvage rates for R-E groups I-IV and Murphree groups A and B retinoblastoma. Patients with R-E group V and Murphree groups C and D retinoblastoma do less well with chemotherapy and require more intensive or novel approaches to therapy. No significant financial relationships to disclose.
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Affiliation(s)
- P. E. Zage
- Children’s Memorial Hospital, Chicago, IL
| | | | - M. B. Mets
- Children’s Memorial Hospital, Chicago, IL
| | | | - S. Goldman
- Children’s Memorial Hospital, Chicago, IL
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Polenakovik H, Polenakovik S, Weinstein J, Pelstring RJ, Mackowiak PA. New-Onset Purpura in a Patient with Recently Diagnosed Temporal Arteritis. Clin Infect Dis 2003. [DOI: 10.1086/375900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Weinstein J. Do we need a theory of demographic transition? Humboldt J Soc Relat 2002; 7:71-86. [PMID: 12312515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Wettermark G, Weinstein J, Sousa J, Dogliotti L. Kinetics of cis-trans Isomerization of para-Substituted N-Benzylideneanilines. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100889a023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [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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Bedimo R, Weinstein J. Photo quiz. Disseminated blastomycosis. Clin Infect Dis 2001; 33:1706, 1770-1. [PMID: 11724028 DOI: 10.1086/338215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Roy L, Coullin P, Vitrat N, Hellio R, Debili N, Weinstein J, Bernheim A, Vainchenker W. Asymmetrical segregation of chromosomes with a normal metaphase/anaphase checkpoint in polyploid megakaryocytes. Blood 2001; 97:2238-47. [PMID: 11290584 DOI: 10.1182/blood.v97.8.2238] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During differentiation, megakaryocytes increase ploidy through a process called endomitosis, whose mechanisms remain unknown. As it corresponds to abortive mitosis at anaphase and is associated with a multipolar spindle, investigation of chromosome segregation may help to better understand this cell-cycle abnormality. To examine this variation, a new method was developed to combine primed in situ labeling to label centromeres of one chromosome category and immunostaining of tubulin. Human megakaryocytes were obtained from normal bone marrow culture. By confocal microscopy, this study demonstrates an asymmetrical distribution of chromosomes (1 or 7) either between the spindle poles at anaphase stage of endomitosis and between the different lobes of interphase megakaryocyte nuclei. The metaphase/anaphase checkpoint appears normal on the evidence that under nocodazole treatment megakaryocytes progressively accumulate in pseudo-metaphase, without spontaneous escape from this blockage. Immunostaining of p55CDC/hCDC20 with similar kinetochore localization and dynamics as during normal mitosis confirms this result. HCdh1 was also expressed in megakaryocytes, and its main target, cyclin B1, was normally degraded at anaphase, suggesting that the hCdh1-anaphase-promoting complex checkpoint was also functional. This study found the explanation for these unexpected results of an asymmetrical segregation coupled to normal checkpoints by careful analysis of multipolar endomitotic spindles: whereas each aster is connected to more than one other aster, one chromosome may segregate symmetrically between 2 spindle poles and still show asymmetrical segregation when the entire complex spindle is considered.
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Affiliation(s)
- L Roy
- Institut National de la Santé et de la Recherche Médicale (INSERM) U362, France
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Abstract
BACKGROUND Coronary stenosis of the left anterior descending artery (LAD) is respected by cardiologists because of its negative influence on morbidity and mortality. An important anatomical consideration is the length of the LAD. OBJECTIVE To investigate the relationship between length of LAD and coronary dominance. DESIGN Retrospective comparison of 100 consecutive angiograms with left coronary dominance with 100 consecutive angiograms with right coronary dominance. The relationship between the length of the LAD and coronary dominance was analyzed. METHODS We retrospectively compared 100 consecutive angiograms with left coronary dominance (the posterior descending artery being supplied by the circumflex artery) with 100 consecutive angiograms with right coronary dominance (the posterior descending artery being supplied by the right coronary artery). LADs were categorized into three types: type A, LAD terminating before the cardiac apex; type B, LAD reaching the apex but not supplying the inferoapical segment of the left ventricle; and type C, LAD wrapping around the apex and supplying the inferoapical segment. LAD typing was also analyzed in relation to gender. RESULTS It was found that the LAD wrapped around the apex in 87% of cases of left coronary dominance but only in 47% of patients with right coronary dominance, and that the long LADs were more frequently seen in women than in men, irrespective of coronary dominance. CONCLUSIONS We found that the LAD in left coronary dominance is usually long and wraps around the apex, and believe that angiographic interventions in such cases have important clinical significance.
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Affiliation(s)
- R Ilia
- Cardiology Department, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Abstract
OBJECTIVE Celiac sprue is being diagnosed with increasing frequency by screening individuals with epidemiologically associated autoimmune syndromes. We sought to test our hypothesis that hepatitis C also may predispose to celiac sprue because it can trigger autoimmune reactions. METHODS Two hundred fifty-nine consecutively evaluated patients with chronic hepatitis C infection, 59 with autoimmune liver disease, 137 with other hepatic diseases, 356 with various GI syndromes, and 221 normal volunteers underwent serologic screening for celiac sprue. Patients with antigliadin, antiendomysial, and antitissue transglutaminase antibodies in serum underwent duodenoscopy and biopsy. RESULTS There was a statistically significantly higher prevalence of antigliadin antibody in all groups of patients with liver disease compared with GI controls and normal controls. However, only patients with hepatitis C (n = 3; 1.2%) or autoimmune liver disease (n = 2; 3.4%) had antiendomysial/antitissue transglutaminase antibody in serum. One of 221 normal volunteers (0.4%) was antigliadin, antiendomysial, and antitissue transglutaminase positive; this individual also was found to have hepatitis C (previously undiagnosed). Each of these six individuals had mild intestinal symptoms, duodenal histopathology consistent with celiac sprue, and the celiac-associated HLA-DQ2 allele. Five of the six followed a prescribed gluten-free diet and experienced symptomatic improvement. CONCLUSION Celiac sprue is epidemiologically associated with chronic hepatitis C infection and with autoimmune liver disease. Because hepatitis C is much more frequently encountered than autoimmune liver disease, hepatitis C appears to be the most common hepatic disease associated with the development of celiac sprue.
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Affiliation(s)
- K D Fine
- The Intestinal Health Institute, Dallas, Texas 75357, USA
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